Deck 16: Extrapulmonary Effects of Mechanical Ventilation

Question 1

Positive pressure ventilation has which of the following effects on the kidneys?

A) Increases blood flow to the kidneys.
B) Redistributes blood flow in the kidneys.
C) Decreases sodium reabsorption in the kidneys.
D) Increases urinary output.

Answer 1

Redistributes blood flow in the kidneys.

Question 2

Malnutrition during mechanical ventilation can cause which of the following?

A) Increased oxygen consumption
B) Increased carbon dioxide production
C) Increased work of breathing
D) Decreased spontaneous ventilation

Answer 2

Decreased spontaneous ventilation

Question 3

Normovolemic patients experience decreases in cardiac output above what level of PEEP?

A) 5 cm H₂O
B) 8 cm H₂O
C) 12 cm H₂O
D) 15 cm H₂O

Answer 3

15 cm H₂O

Question 4

The conditions that must exist to cause the interventricular septum to move to the left during positive pressure ventilation include which of the following?

A) Volume overload
B) Cardiac tamponade
C) Mean airway pressure >15 cm H₂O
D) Decreased coronary artery perfusion

Question 5

Positive pressure ventilation increases splanchnic resistance,decreases splanchnic venous outflow,and may contribute to gastric mucosal ischemia.This last change contributes to which of the following?

A) Liver metastases
B) Tracheal malacia
C) Gastric ulcers
D) Increased portal blood flow

Question 6

An otherwise healthy 19-year-old male is currently intubated and being mechanically ventilated after a motorcycle accident in which he sustained a closed head injury and multiple rib fractures.Before the patient is taken to the operating room for cranial surgery,the respiratory therapist notices that he has jugular vein distention.The most likely cause of this problem is which of the following?

A) Increased cardiac output
B) Decreased ventricular preload
C) Increased intracranial pressure
D) Decreased systemic vascular resistance

Question 7

Calculate the cerebral perfusion pressure when the mean arterial blood pressure is 120 mm Hg and the ICP is 14 mm Hg.

A) 134 mm Hg
B) 106 mm Hg
C) 120/14 mm Hg
D) 134/106 mm Hg

Question 8

A patient with which of the following is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?

A) ARDS
B) Emphysema
C) Kyphoscoliosis
D) Third-degree chest wall burns

Question 9

Mechanical ventilation has an effect on the hormone _____________,which causes a decrease in urinary output.

A) cortisol
B) arginine vasopressin
C) parathyroid hormone
D) thyroid-stimulating hormone

Question 10

Physiological dead space may be increased in apneic patients receiving volume control ventilation by which of the following?

A) I:E ratio >1:1
B) A slow flow rate
C) Adding an inflation hold
D) Inspiratory time <0.5 sec

Question 11

Which of the following ventilator parameters would result in the highest mean airway pressure?

A) PIP = 30 cm H₂O;PEEP = 10 cm H₂O;T_I = 0.5 sec;TCT = 5 sec
B) PIP = 50 cm H₂O;PEEP = 10 cm H₂O;T_I = 0.5 sec;TCT = 5 sec
C) PIP = 30 cm H₂O;PEEP = 15 cm H₂O;T_I = 0.5 sec;TCT = 5 sec
D) PIP = 50 cm H₂O;PEEP = 10 cm H₂O;T_I = 0.5 sec;TCT = 5 sec..

Question 12

The harmful cardiovascular effects of PPV are influenced most by which of the following pressures?

A) Peak inspiratory pressure
B) Mean airway pressure
C) Positive end expiratory pressure
D) Transpulmonary pressure

Question 13

High tidal volumes and/or high levels of PEEP cause which of the following?

A) Improvement in pulmonary blood flow
B) Increased right ventricular afterload
C) Interventricular septum shifts to the right
D) Increased myocardial perfusion

Question 14

Urinary output is severely reduced when the renal arterial pressure decreases below what level?

A) 75 mm Hg
B) 85 mm Hg
C) 95 mm Hg
D) 105 mm Hg

Question 15

The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?

A) CPAP
B) SIMV
C) SIMV with PEEP
D) VC-CMV with PEEP

Question 16

During spontaneous breathing,the fall in intrapleural pressure that draws air into the lungs during inspiration also draws blood into the major thoracic vessels.This phenomenon increases which of the following?

A) Systemic vascular resistance
B) Right ventricular afterload
C) Right ventricular preload
D) Pulmonary capillary resistance

Question 17

The most likely cause of uneven ventilation includes which of the following?

A) Low set tidal volumes
B) High inspiratory flow rates
C) High mean airway pressures
D) Elevated peak inspiratory pressures