Deck 7: Final Considerations in Ventilator Setup

Question 1

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 is 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.

Answer 1

Increase the CPAP to 8 cm H₂O.

Question 2

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 and 55 mm Hg
B) 50 and 60 mm Hg
C) 60 and 100 mm Hg
D) 100 and 120 mm Hg

Answer 2

60 and 100 mm Hg

Question 3

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

Answer 3

Low pressure = 20 cm H₂O,high pressure = 36 cm H₂O

Question 4

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 5

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 6

The mechanical ventilator event that is considered potentially life-threatening or a level 2 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 7

Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (F_IO₂)settings?

A) 0.5
B) 0.6
C) 0.8
D) 1

Question 8

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

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

Question 9

A patient's baseline arterial blood gas (ABG)reveals a partial pressure of oxygen (P_aO₂)of 78 mm Hg while receiving 35% supplemental oxygen.What should the ventilator fractional inspired oxygen (F_IO₂)be set at to obtain a target P_aO₂ of 95mm Hg?

A) 34%
B) 43%
C) 55%
D) 67%

Question 10

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

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

Question 11

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 12

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (P_aO₂)of 45 mm Hg.The patient is being intubated and the ventilator set up.What is the appropriate fractional inspired oxygen (F_IO₂)to achieve a P_aO₂ of 60 mm Hg?

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

Question 13

Identify the patient that 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 (P_plateau)= 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 P_plateau = 25 cm H₂O

Question 14

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

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

Question 15

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

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

Question 16

What is the range for setting flow triggering?

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

Question 17

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

Question 18

What fractional inspired oxygen (F_IO₂)setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (P_aO₂)of 53 mm Hg while receiving 50% oxygen and the desired P_aO₂ is 90 mm Hg?

A) 64%
B) 74%
C) 85%
D) 95%

Question 19

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 20

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 21

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 (P_aCO₂)72 mm Hg,partial pressure of oxygen (PaO₂)88 mm Hg,oxygen saturation (S_aO₂)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 bpm,tidal volume (V_T)650 mL,fractional inspired oxygen (F_IO₂)50%,positive-end-expiratory pressure (PEEP)6 cm H₂O
B) Noninvasive positive pressure ventilation (NPPV)with bilevel positive airway pressure (Bilevel PAP)rate 8 bpm,inspiratory positive airway pressure (IPAP)10 cm H₂O,expiratory positive airway pressure (EPAP)2 cm H₂O
C) Intubate,pressure-controlled synchronized intermittent mandatory ventilation (PC-SIMV)rate 10 bpm,peak inspiratory pressure (PIP)30 cm H₂O,F_IO₂ 60%,PEEP 3cm H₂O
D) Administer 30% oxygen via air entrainment mask and continuous bronchodilator therapy

Question 22

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,V_T 200 mL,F_IO₂ 100%,positive-end-expiratory pressure (PEEP)5 cm H₂O
B) VC-CMV rate 12,V_T 400 mL,F_IO₂ 40%,PEEP 3 cm H₂O
C) Pressure-controlled synchronized intermittent mandatory ventilation (PC-SIMV)rate 10,peak inspiratory pressure (PIP)30 cm H₂O,F_IO₂ 60%,PEEP 3cm H₂O
D) PC-SIMV rate 12,PIP 35 cm H₂O,F_IO₂ 30%,PEEP 8 cm H₂O

Question 23

The statement that is true concerning the use of permissive hypercapnia in the management of patients with acute respiratory distress syndrome (ARDS)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.

Question 24

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 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)42mm 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 lbs.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 (F_IO₂)30%
C) Intubate,use pressure-controlled continuous mandatory ventilation (PC-CMV),f = 8,peak inspiratory pressure (PIP)28 cm H₂O,T_I 0.75 sec,positive-end-expiratory pressure (PEEP)3 cm H₂O,F_IO₂ 100%
D) Intubate,use volume-controlled continuous mandatory ventilation (VC-CMV),f = 12,tidal volume (V_T)600 mL,PF 40 L/min,PEEP 5 cm H₂O,F_IO₂ 60%

Question 26

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 27

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 28

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

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

Question 29

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 V_TS = 8-10 mL/kg
C) Ventilating acute respiratory distress syndrome (ARDS)patient with plateau pressure P_plateau > 30 cm H₂O
D) Pressure-supported ventilation with tidal volume (V_T)= 4-6 mL/kg

Question 30

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

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

Question 31

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,F_IO₂ 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 (F_IO₂)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,F_IO₂ 30%
D) Volume-controlled synchronized intermittent mandatory ventilation (VC-SIMV),f = 12 breaths/min,tidal volume (V_T)= 725 mL,PS 5 cm H₂O,PEEP 5 cm H₂O,F_IO₂ 24%

Question 32

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)shows: pH 7.25,partial pressure of carbon dioxide (P_aCO₂)55 mm Hg,partial pressure of oxygen (P_aO₂)54 mm Hg,oxygen saturation (S_aO₂)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 (V_T)810 mL,positive-end-expiratory pressure (PEEP)8 cm H₂O,fractional inspired oxygen (F_IO₂)100%
C) Intubate,volume-controlled synchronized intermittent mandatory ventilation (VC-SIMV),f 6,V_T 425 mL,PEEP 10 cm H₂O,F_IO₂ 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,F_IO₂ 60%

Question 33

An 18-year-old,5'6" and 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 bpm,tidal volume (V_T)600 mL,positive-end-expiratory pressure (PEEP)5 cm H₂O,fractional inspired oxygen (F_IO₂)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 V_T the same,increase f to 25 bpm,increase PEEP to 12 cm H₂O.
B) Decrease V_T to 250 mL,increase f to 15 bpm,increase PEEP to 15 cm H₂O.
C) Increase V_T to 550 mL,decrease f to 8 bpm,increase PEEP to 10 cm H₂O.
D) Decrease V_T to 400 mL,decrease f to 8 bpm,decrease PEEP to 3 cm H₂O.

Question 34

A male patient who is 5'10" and weighs 190 lbs 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 bpm,tidal volume (V_T)750 mL,positive-end-expiratory pressure (PEEP)5 cm H₂O,fractional inspired oxygen (F_IO₂)100%
B) Pressure-controlled continuous mandatory ventilation (PC-CMV),f 15 bpm,peak inspiratory pressure (PIP)35 cm H₂O,PEEP 10 cm H₂O,F_IO₂ 100%
C) Volume-controlled synchronized intermittent mandatory ventilation (VC-SIMV),f 6 bpm,V_T 300 mL,pressure support (PS)10 cm H₂O,PEEP 5 cm H₂O,F_IO₂ 50%
D) Pressure-controlled synchronized intermittent mandatory ventilation (PC-SIMV),f 12 bpm,PIP 20 cm H₂O,PS 10 cm H₂O,PEEP 5 cm H₂O,F_IO₂ 40%

Question 35

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