Deck 6: Initial Ventilator Settings

Question 1

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

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

Answer 1

Descending Ramp

Question 2

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

Answer 2

500 mL

Question 3

Calculate the tubing compliance (C_T)when the measured volume is 100 mL and the static pressure is 65 cm H₂O.

A) 0.0015 mL/cm H₂O
B) 0.65 cm H₂O/mL
C) 1.5 mL/cm H₂O
D) 6.5 mL/cm H₂O

Answer 3

1.5 mL/cm H₂O

Question 4

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 5

Calculate the expiratory time (T_E)when the ventilator frequency is set to 25 bpm and the inspiratory time (T_I)is 0.75 second.

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

Question 6

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

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

Question 7

When initially setting up a ventilator the plateau pressure (P_Plateau)is measured at 47 cm H₂O with a set volume of 100 mL.After applying the ventilator to the patient,the average peak pressure reached during volume delivery is 28 cm H₂O.How much volume is lost in the ventilator tubing?

A) 13 mL
B) 60 mL
C) 147 mL
D) 168 mL

Question 8

What is the flow rate necessary to deliver a tidal volume (V_T)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

Question 9

Calculate the inspiratory time (T_I)when a ventilator is set at a tidal volume (V_T)of 500 mL and a constant flow rate of 30 L/min.

A) 0.6 second
B) 1 second
C) 1.5 seconds
D) 1.7 seconds

Question 10

Calculate the tubing compliance (C_T)when the measured volume is 150 mL and the static pressure is 53 cm H₂O.

A) 0.003 mL/cm H₂O
B) 0.35 cm H₂O/mL
C) 2.8 mL/cm H₂O
D) 7.95cm H₂O/mL

Question 11

Calculate the volume lost if the tubing compression factor is 2.5 mL/cm H₂O and the pressure change during ventilation is 32 cm H₂O.

A) 2.5 mL
B) 12.8 mL
C) 64 mL
D) 80 mL

Question 12

Calculate the inspiratory to expiratory (I:E)ratio when the inspiratory time is 0.5 seconds and the respiratory rate is 30 bpm.

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

Question 13

When initially setting up a ventilator,the plateau pressure (P_Plateau)is measured at 68 cm H₂O with a set volume of 200 mL.After applying the ventilator to the patient,the average peak pressure reached during volume delivery is 22 cm H₂O.How much volume is lost in the ventilator tubing?

A) 0.064 mL
B) 7.5 mL
C) 64.7 mL
D) 95.7 mL

Question 14

Calculate the inspiratory to expiratory (I:E)ratio for a ventilator that is set to deliver 850 mL at a frequency of 15 bpm with a flow rate of 45 L/min.

A) 1:1.1
B) 1:2.5
C) 1:3.5
D) 1:4

Question 15

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 16

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

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

Question 17

The flow wave form 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 18

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

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

Question 19

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) V_T = 525 mL,rate = 14 bpm
B) V_T = 750 mL,rate = 12 bpm
C) V_T = 825 mL,rate = 10 bpm
D) V_T = 950 mL,rate = 8 bpm

Question 20

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 wave form should be used?

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

Question 21

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 22

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 23

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) V_T = 220 mL,rate = 25 bpm,PEEP = 10 cm H₂O
B) V_T = 360 mL,rate = 15 bpm,PEEP = 5 cm H₂O
C) V_T = 550 mL,rate = 12 bpm,PEEP = 12 cm H₂O
D) V_T = 750 mL,rate = 10 bpm,PEEP = 8 cm H₂O

Question 24

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 lbs.During volume-controlled continuous mandatory ventilation (VC-CMV)his average peak inspiratory pressure (PIP)was about 26 cm H₂O and the plateau pressure (P_Plateau)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 25

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 bpm,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) V_T = 700 mL,rate = 12 bpm,PEEP = 3 cm H₂O
B) V_T = 900 mL,rate = 10 bpm,PEEP = 5 cm H₂O
C) V_T = 450 mL,rate = 20 bpm,PEEP = 8 cm H₂O
D) V_T = 800 mL,rate = 15 bpm,PEEP = 10 cm H₂O

Question 26

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 27

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

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

Question 28

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) Bileval Positive Airway Pressure (Bilevel PAP)

Question 29

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) V_T = 450 mL,rate = 18 bpm,PEEP = 8 cm H₂O
B) V_T = 600 mL,rate = 10 bpm,PEEP = 5 cm H₂O
C) V_T = 750 mL,rate = 15 bpm,PEEP = 10 cm H₂O
D) V_T = 900 mL,rate = 12 bpm,PEEP = 5 cm H₂O

Question 30

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 bpm,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 which reveals: pH 7.31;partial pressure of carbon dioxide (PaCO₂)57 mm Hg;partial pressure of oxygen (PaO₂)58 mm Hg;arterial oxygen saturation (S_aO₂)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),peal inspiratory pressure (PIP)40 cm H₂O,positive-end-expiratory pressure (PEEP)8 cm water (H₂O),fractional inspired oxygen (F_IO₂)1.0.
D) Use BiPAP with IPAP 10 cm H₂O,EPAP 5cm H₂O,bleed in 4 L/min oxygen.

Question 31

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 32

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 (V_T)and ventilator rate settings that should be recommended for this patient are which of the following?

A) V_T = 315 mL,rate = 20 bpm
B) V_T = 364 mL,rate = 14 bpm
C) V_T = 468 mL,rate = 12 bpm
D) V_T = 563 mL,rate = 10 bpm

Question 33

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 34

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

Question 35

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 36

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 37

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