Deck 28: Weaning and Discontinuance of Mechanical Ventilation

Question 1

While a patient is on an SBT trial the practitioner must watch for rapid decompensation.This is indicated by which of the following?

A) Significant decrease in SpO₂ and increase in heart rate
B) Arterial blood gases less than PaCO₂ of 50 mmHg and PO₂ greater than 60 mmHg
C) MIP of negative 20 cmH2O or less
D) PaO₂/FIO₂ ratio greater than 150-200

Answer 1

Significant decrease in SpO₂ and increase in heart rate

Question 2

Which of the following are factors that affect the respiratory system's ability to do work?
I.Airway resistance
II.Respiratory muscle function
III.Lung compliance

A) I, II and III
B) I and III
C) II only
D) II and III

Answer 2

I, II and III

Question 3

According to the AARC Clinical Practice Guidelines which of the following identifies failure or intolerance in the spontaneous breathing trial?

A) Increasing or worsening of discomfort
B) Thorcoabdominal paradox
C) Use of accessory respiratory muscles
D) All of the above

Answer 3

All of the above

Question 4

According to the AARC Clinical Practice Guidelines on Weaning and Discontinuation on Ventilatory Support,adequate patient oxygenation criteria for weaning is measured by
I.PaO₂ greater than 60 mm Hg
II.FIO₂ set less than 0.4
III.PEEP zero
IV.PO₂/FIO₂ ratio greater than 150-300

A) I, II, III and IV
B) I, II and III
C) I, II and IV
D) II, III and IV

Question 5

What should the respiratory care practitioner do when assessing a patient for potential weaning from mechanical ventilation?

A) Evaluate the insurance coverage for critical care services
B) Identify improvement from cause respiratory failure
C) Assess the presence of chronic lung disease
D) Evaluate the medical care services that are available

Question 6

The respiratory care practitioner must be aware that a patient may be difficult to wean from the ventilator if ___________________

A) they are deprived of sleep due to activity, lights and noise in the ICU.
B) they are psychologically dependent on the machine.
C) they are still on significant levels of sedation.
D) All of the above

Question 7

Which of the following should the practitioner use as a rationale to disqualify a patient from a weaning trial?

A) Heart rate less than 140 beats per minute but still above 80 bpm
B) Mentation clearing
C) Lack of spontaneous respiratory drive
D) PaO₂ / FiO₂ ratio of 220

Question 8

Which of the following is true regarding a protocol?

A) It prevents non-therapists from performing respiratory care.
B) It reduces the need for continual physician input and involvement.
C) It can lengthen the time a patient spends on a ventilator.
D) It gives the respiratory care practitioner a duty that nurses are not allowed to perform.

Question 9

The respiratory therapist notices the mechanically ventilated patient's work of breathing is increased due to the resistance caused by the artificial airway.This problem can be reduced using _______________

A) BiPAP.
B) ATC.
C) PRVC.
D) PEEP.

Question 10

A patient who has been mechanically ventilated for many weeks is alert and attempting to communicate but still needs the artificial airway.According to the AARC CPG,the respiratory therapist should recommend replacing the endotracheal tube with ____________

A) an LMA.
B) a tracheostomy tube.
C) an oral pharyngeal airway.
D) a larger endotracheal tube.

Question 11

According to the AARC Clinical Practice Guidelines on Weaning and Discontinuation on Ventilatory Support other objective criteria for weaning is measured by _____________
I.Patient is arousable and not on sedation
II.Hemoglobin level greater than 8-10 g/dL
III.No fever present
IV.No respiratory acidosis

A) I, II, III and IV
B) I, II and III
C) I, II and IV
D) II, III and IV

Question 12

Assessing for adequate oxygenation for weaning from mechanical ventilation can include which of the following?
I.PEEP less than or equal to 5-8 cm H₂O
II.FIO₂ greater than or equal to 0.6
III.PaO₂/FIO₂ greater than 150-200

A) I, II and III
B) I and II
C) I and III
D) II and III

Question 13

Once the patient successfully tolerates SBT,the respiratory care practitioner should ___________

A) recommend insertion of tracheostomy tube.
B) switch to a smaller endotracheal tube.
C) assess the potential for endotracheal tube extubation.
D) reduce the ventilator setting to minimum levels.

Question 14

If a patient fails an SBT which of the following is the correct action to take?

A) Reintubate the patient and place on mechanical ventilation
B) Reattempt SBT in 8 hours
C) Reattempt SBT every 24 hours
D) Do not use SBT as a weaning method try another method.

Question 15

Prior to weaning or discontinuing ventilatory support the first step a respiratory therapist should take is to ______________

A) identify the hospital critical care census.
B) assess the amount and level of sedation.
C) determine if the patient has ventilator associated pneumonia.
D) determine if the cause of ventilator failure has been resolved.

Question 16

According to the AARC Clinical Practice Guidelines,which of the following identifies success or tolerance in the spontaneous breathing trial?

A) PaO₂ less than 50 mmHg
B) Increase in PaCO₂ of less than 10 mmHg
C) pH less than 7.32
D) Systolic blood pressure greater than 200 mmHg

Question 17

Which of the following should the practitioner complete prior to a spontaneous breathing trial?
I.Note current ventilator settings
II.Note heart rate,rhythm,blood pressure,O₂ sat
III.Place patient in semi or high Fowler 's position
IV.Increase sedation to allow patient to rest

A) I, II, III and IV
B) I, II and III
C) II, III and IV
D) I and II

Question 18

Which of the following is the best predictor of successfully weaning a patient from a ventilator?

A) f/Vt ratio of less than 105
B) PaO₂/FIO₂ ratio greater than 150-200
C) VD/VT ratio less than 0.55-0.60
D) MIP less than -20 to -30 cm H2O

Question 19

Which of the following is true of the method of ventilator weaning called spontaneous breathing trials (SBT)?

A) Mechanical ventilation can be discontinued if patient cannot tolerate as little as 30 minutes off
B) SBT is the same as SIMV mode of ventilation
C) Measurements of cardiac output and SvO₂ are essential
D) Sedation can be given if a patient begins to have difficulty with breathing

Question 20

A patient with an irreversible disease,like high spinal cord injury,should not be considered permanently ventilator dependent until __________________

A) a fenestrated tracheostomy tube is inserted.
B) there are three or more apneas per day.
C) 3 months of weaning attempts have failed.
D) all of the above

Question 21

A closed loop ventilator system ____________________

A) Eliminates the need for nurses and respiratory care practitioners.
B) can be used in the absence of a protocol.
C) continually adjusts the ventilator based on measured patient parameters.
D) is a rebreathing system of ventilator care

Question 22

Besides meeting the criteria of previous assessments done by the respiratory care practitioner to determine readiness for extubation,the patient must also be able to _______________

A) speak and sit up.
B) protect the upper airway and cough effectively.
C) tolerate SIMV of 4 breaths per minute.
D) maintain PaO₂ 70 mmHg or more on FIO₂ 0.4

Question 23

What should the respiratory therapist do if the patient does not pass the SBT?

Question 24

What four general questions should the respiratory care practitioner assess prior to weaning from mechanical ventilation?

Question 25

How do cardiovascular problems result in ventilator dependence?

Question 26

Evidence of decompensation during an SBT include which of the following?
I.Cardiac dysrhythmias
II.Increased anxiety
III.Diaphoresis
IV.Digital clubbing

A) I, II, III and IV
B) I, II and III
C) II, III and IV
D) I and III

Question 27

How do neurological problems result in ventilator dependence?

Question 28

To assess for the presences of an endotracheal tube cuff leak ,the RCP should do which of the following?

A) Listen at the patient's mouth for air escaping with each ventilator breath
B) Place a stethoscope on the patient's neck and listen for air on inspiratory breath
C) Check ventilator delivered Vt and measured exhaled Vt
D) All of the above

Question 29

How do respiratory conditions result in ventilator dependence?

Question 30

Prior to an SBT which of the following should the respiratory care practitioner assess?
I.Plateau Pressure
II.Breath sounds
III.Spontaneous tidal volume
IV.Mode of ventilation

A) I, II, III and IV
B) I, II and III
C) II, III and IV
D) II and III