Deck 12: Methods to Improve Ventilation in Patient-Ventilator Management

Question 1

A 45-year-old female (58-kg IBW)with a past medical history of asthma arrives at the emergency department short of breath,anxious,diaphoretic,and unable to perform a peak expiratory flow measurement.She also has a combined acidosis.Breath sounds reveal the patient is not moving much air.The patient is intubated,stabilized,and transported to the ICU.The ventilator settings are: PC-CMV,f = 12/min,PIP = 30 cm H₂O,F_IO₂ = 0.6,and PEEP = 3 cm H₂O.The patient is sedated and paralyzed;the resulting ABGs are: pH 7.17,PaCO₂ 69.3 mm Hg,PaO₂ 90 mm Hg,and HCO₃^- 21 mEq/L after continuous bronchodilator therapy.The respiratory rate is increased to 20/min,and the next ABG results are: pH 7.26,PaCO₂ 58 mm Hg,PaO₂ 96 mm Hg,and HCO₃^- 22 mEq/L.The respiratory therapist should suggest which of the following at this time?

A) Increase PIP to 38 cm H₂O
B) Decrease PIP to 25 cm H₂O
C) Continue with current therapy
D) Change to VC-CMV,f = 12/ min,V_T = 700 mL

Answer 1

Continue with current therapy

Question 2

At what point during deep suctioning should negative pressure be applied?

A) Five seconds after resistance is met
B) Ten seconds after insertion of the catheter
C) After 1-cm withdrawal from the point of resistance
D) After 2-cm withdrawal from the point of resistance

Answer 2

After 1-cm withdrawal from the point of resistance

Question 3

Metabolic acidosis may be caused by which of the following?

A) Overdose with salicylate
B) Diuretic administration
C) Nasogastric suctioning
D) Lactate administration

Answer 3

Overdose with salicylate

Question 4

A male patient (74-kg IBW)is being ventilated with PC-CMV,f = 12/min,PIP = 20 cm H₂O,T_I = 1.5 seconds;the resulting flow-time scalar is shown below.The patient's measured V_T is 435 mL.ABG results on these settings are: pH 7.32,PaCO₂ 54 mm Hg,HCO₃^- 25 mEq/L.The most appropriate action to take is which of the following?

A) Increase f to 16 /min
B) Increase T_I to 2.5 sec
C) Increase PIP to 27 cm H₂O
D) Decrease flow rate to 40 L/min

Question 5

Metabolic alkalosis can be caused by which of the following?

A) Renal failure
B) Potassium deficiency
C) Carbonic anhydrase inhibitors
D) Ethylene glycol

Question 6

A female patient (59-kg IBW)with no history of pulmonary disease is being invasively ventilated with VC-CMV,f = 12/min,V_T = 470 mL,PEEP = 5 cm H₂O,F_IO₂ = 0.5.ABG results with these settings are: pH 7.31,PaCO₂ 54 mm Hg,PaO₂ 92 mm Hg,SaO₂ 90%,HCO₃^- 24 mEq/L.The most appropriate action for the respiratory therapist to take is which of the following?

A) Increase f to 16/min
B) Increase V_T to 635 mL
C) Decrease V_T to 400 mL
D) Decrease PEEP to 3 cm H₂O

Question 7

A patient with CHF is being mechanically ventilated.The patient's current PaCO₂ = 28 mm Hg,and the ventilator set rate is 16/minute.The desired PaCO₂ for this patient is 40 mm Hg.To what should the set rate be changed?

A) 7/min
B) 11/min
C) 14/min
D) 18/min

Question 8

Permissive hypercapnia would benefit patients with which of the following?

A) Cerebral trauma
B) Intracranial lesion
C) Acute lung injury
D) Cardiovascular instability

Question 9

A patient diagnosed with sepsis who is being mechanically ventilated has a combined minute ventilation of 25 L/min with a PaCO₂ of 38 mm Hg.The reason for these findings is most likely which of the following?
1)Increased
2)Decreased
3)Increased V_D/V_T
4)Decreased V_D/V_T

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

Question 10

During mechanical ventilation of a patient with COPD,the PaCO₂ = 58 mm Hg and the = 5.5 L/min.The desired PaCO₂ for this patient is 45 mm Hg.To what should the be changed?

A) 4.3 L/min
B) 4.8 L/min
C) 6.6 L/min
D) 7.1 L/min

Question 11

If respiratory acidosis persists after alveolar ventilation of a patient has been increased,which of the following could be the cause?

A) Chronic obstructive pulmonary disease
B) Pulmonary embolism
C) Pulmonary edema
D) Low PEEP levels

Question 12

In which of the following situations should iatrogenic hyperventilation be considered?

A) Severe traumatic brain injury
B) Initial treatment for increased intracranial pressure
C) Acute head injuries with increased intracranial pressure
D) Acute neurological deterioration with increased intracranial pressure

Question 13

A patient with an IBW of 68 kg is intubated and being mechanically ventilated with VC-CMV,f = 12/min,and V_T = 470 mL.The patient has a combined respiratory rate of 25/min.The ABG results are: pH 7.56,PaCO₂ 26 mm Hg,and HCO₃^- 22 mEq/L.The most appropriate action is to do which of the following?

A) Decrease the set f to 8/min
B) Decrease the set V_T to 300 mL
C) Sedate and paralyze the patient
D) Change the mode to VC-IMV

Question 14

A male patient (76-kg IBW)with no history of pulmonary disease is brought to the emergency department for treatment of a drug overdose.He is intubated and placed on mechanical ventilation with VC-CMV,f = 12/min,V_T = 450 mL.The resulting arterial blood gas values are: pH 7.32,PaCO₂ 53 mm Hg,and HCO₃^- 25 mEq/L.The most appropriate action to correct the acid-base disturbance is which of the following?

A) Increase V_T to 595 mL
B) Increase V_T to 760 mL
C) Increase frequency to 16/min
D) Decrease frequency to 10/min

Question 15

A 28-year-old female (55-kg IBW)is being mechanically ventilated with VC-CMV,f = 14/min,V_T = 700 mL.The patient has no history of pulmonary disease.The resulting ABG values are: pH 7.55,PaCO₂ 27 mm Hg,HCO₃^- 23 mEq/L.The most appropriate action to take is which of the following?

A) Decrease V_T to 600 mL
B) Decrease V_T to 450 mL
C) Decrease f to 12/min
D) Decrease f to 10/min

Question 16

A male patient (83 kg IBW)is intubated and ventilated with PC-CMV,f = 12/min,set PIP = 28 cm H₂O,resulting in a V_T of 430 mL.The ABG results on this setting are: pH 7.35,PaCO₂ 45 mm Hg,and HCO₃^- 23 mEq/L.Forty-eight hours later on the same settings,the ABG results are: pH 7.54,PaCO₂ 27 mm Hg,and HCO₃^- 21 mEq/L with an exhaled V_T of 800 mL.The most appropriate action at this time is which of the following?

A) Decrease PIP to 25 cm H₂O
B) Decrease PIP to 19 cm H₂O
C) Decrease f to 10/min
D) Decrease f to 8/min

Question 17

A 59-kg IBW female patient is being mechanically ventilated in the CMV mode,f = 12/min,V_T = 400 mL,PEEP = 5 cm H₂O,F_IO₂ = 0.5.The ABG results on these settings show a respiratory acidosis and severe hypoxemia.The respiratory therapist increases the set V_T and increases the PEEP to 12 cm H₂O.The resulting ABGs show improved oxygenation,but the patient still has a respiratory acidosis.The respiratory acidosis may be due to which of the following?

A) Tissue hypoxia
B) Increased dead space
C) Increased cardiac output
D) Continued hypoventilation

Question 18

Treatment for increased intracranial pressure includes all of the following except which technique?

A) Hyperosmolar therapy
B) Neuromuscular blockade
C) Iatrogenic hyperventilation
D) Cerebral spinal fluid drainage

Question 19

A patient with pneumonia and underlying COPD is being mechanically ventilated in the VC-CMV mode with V_T 650 mL.The resulting PaCO₂ is 62 mm Hg.What change should be made to the V_T to obtain a desired PaCO₂ of 50 mm Hg for this patient?

A) 400 mL
B) 800 mL
C) 1000 mL
D) 1200 mL

Question 20

The average tidal volume range in an individual with no pulmonary problems is which of the following?

A) 4 to 5 mL/kg IBW
B) 5 to 8 mL/kg IBW
C) 8 to 10 mL/kg IBW
D) 12 to 15 mL/kg IBW

Question 21

What size suction catheter is appropriate for use in a patient with a 6-mm ET tube?

A) 8 Fr
B) 10 Fr
C) 12 Fr
D) 14 Fr

Question 22

When using a SVN or pMDI with NPPV,where in the NPPV circuit should the device be placed to obtain the greatest aerosol deposition?

A) Before the leak port
B) Anywhere in the circuit
C) Between the NPPV and the humidifier
D) Between the leak port and the face mask

Question 23

Advantages of closed suctioning include which of the following?
1)No need to prehyperoxygenate or posthyperoxygenate
2)No need to prehyperventilate or posthyperventilate
3)Decreased risk of infection for caregiver
4)No loss of PEEP during the procedure

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

Question 24

A patient with extensive infiltrates throughout the right lung should be placed in which of the following positions to improve oxygenation?

A) Left lung down laterally
B) Right lung down laterally
C) Left lung down with right lung 45 degrees from supine
D) Right lung down with left lung 45 degrees from supine

Question 25

A mechanically ventilated patient continues to have rhonchi after deep suctioning.The respiratory therapist should recommend which of the following?

A) Prone position
B) Vest Airway Clearance System
C) Prone position with the foot of the bed elevated 12 inches
D) Supine position with the foot of the bed elevated 18 inches

Question 26

A suction catheter long enough to reach a mainstem bronchus should be what length?

A) 22 cm (8.7 in)
B) 25 cm (9.8 in)
C) 46 cm (18 in)
D) 56 cm (22 in)

Question 27

During a closed suctioning procedure,the patient's heart rate changes from 95 beats/min to 58 beats/min.The respiratory therapist should take what immediate action?

A) Continue the procedure until secretions are removed.
B) Stop the procedure and switch to the open suctioning method.
C) Stop the procedure and use the ventilator to hyperoxygenate the patient with 100% oxygen.
D) Remove the patient from the ventilator and ventilate the person with a resuscitator bag.

Question 28

What size suction catheter is appropriate for use in a patient with a 7-mm ET tube?

A) 8 Fr
B) 10 Fr
C) 12 Fr
D) 14 Fr

Question 29

Which of the following is recommended when administering aerosols to mechanically ventilated patients with a small-volume nebulizer?

A) Make sure the flow-by is turned on during administration.
B) Keep the HME in-line during the aerosol treatment.
C) Use the ventilator nebulizer system when appropriate.
D) Bypass the humidifier during the aerosol treatment.

Question 30

An invasively ventilated patient with ARDS is on PC-CMV,PIP = 30 cm H₂O,PEEP = 12 cm H₂O,F_IO₂ = 1.0.The patient's returned V_T is 320 mL.The ABG results on these settings are: pH 7.3,PaCO₂ 53 mm Hg,PaO₂ 62 mm Hg.The patient is placed in the prone position,and after 1 hour,ABG results show: pH 7.38,PaCO₂ 46mm Hg,PaO₂ 83 mm Hg.The respiratory therapist should do which of the following?

A) Keep the patient in the prone position.
B) Place the patient in the supine position.
C) Keep the patient in the prone position and decrease the F_IO₂.
D) Place the patient in the supine position and decrease PEEP.

Question 31

Bedside bronchoscopy of an invasively ventilated patient is being performed by a physician and respiratory therapist.Fentanyl and midazolam were used for conscious sedation.After the bronchoscopy,the patient is not arousable.Which of the following should be done at this time?

A) Draw a sample for arterial blood gas determinations
B) Increase the patient's respiratory rate
C) Administer naloxone
D) Administer atropine

Question 32

What effect does positive pressure ventilation have on fluid balance?

A) It increases urinary output.
B) It increases renal perfusion.
C) It causes renal malfunction.
D) It increases plasma ADH levels.

Question 33

Which of the following ventilator graphics could be used to assess the response to bronchodilator therapy for a patient receiving mechanical ventilation with VC-CMV?
1)Pressure-time scalar
2)Flow-time scalar
3)Pressure-volume loop
4)Volume-time scalar

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