Deck 20: Discontinuation and Weaning From Mechanical Ventilation

Question 1

The mode of ventilation that maintains a minimum V_E by increasing or decreasing the amount of support (V_T or respiratory rate)given to the patient is ___________________.

A) volume support
B) automatic tube compensation
C) mandatory minute ventilation
D) adaptive support ventilation

Answer 1

mandatory minute ventilation

Question 2

All of the following patients are intubated and receiving mechanical ventilation.The patient most likely to require slow liberation from mechanical ventilation is which of the following?

A) A patient who overdosed on diazepam
B) A postoperative patient who had knee surgery
C) A patient with a severe exacerbation of asthma
D) A patient with chest contusions from an accident

Answer 2

A patient with chest contusions from an accident

Question 3

What ends inspiration in pressure support ventilation?

A) Time
B) Flow
C) Volume
D) Pressure

Answer 3

Flow

Question 4

A recently extubated patient develops a partial upper airway obstruction,which causes stridor.What action can the respiratory therapist take to improve the patient's condition?

A) Aerosolize 11.25 mg of racemic epinephrine.
B) Put a nonrebreathing mask on the patient.
C) Place the patient on NPPV.
D) Suggest the use of lorazepam (Ativan).

Question 5

The ACCP/SCCM/AARC task force recommends that a search for all possible causes that may be contributing to ventilator dependence be undertaken in patients who require mechanical ventilation for longer than ______ hours.

A) 12
B) 24
C) 48
D) 72

Question 6

The closed loop mode used for weaning from mechanical ventilation is which of the following?

A) Pressure support ventilation
B) Adaptive support ventilation
C) Continuous positive airway pressure
D) Intermittent mandatory ventilation

Question 7

A postoperative patient,still under anesthesia,is being ventilated with VC-CMV with Automode.After 2 hours the patient is waking up and beginning to breathe spontaneously.The ventilator will respond by _____________________.

A) switching to the pressure support mode.
B) switching to the volume support mode.
C) delivering time-triggered,pressure-limited breaths.
D) ensuring minimum mandatory minute ventilation.

Question 8

In which patient would continued use of an artificial airway be necessary?

A) A patient with upper airway burns and no peritubular leak
B) A patient who tests positive for a peritubular leak
C) A patient with bronchospasm and supplemental oxygen requirements
D) A patient with a strong cough who expectorates moderate amounts of sputum

Question 9

A 46-year-old male patient (IBW = 85 kg)who was injured in a motor vehicle accident has been receiving invasive mechanical ventilation for 24 hours.The patient is awake and alert and looks comfortable on these settings: VC-SIMV with pressure support of 5 cm H₂O;set rate = 8 breaths/min;set V_T = 500 mL;F_IO₂ = 0.4;PEEP = 5 cm H₂O.A 10-minute spontaneous breathing trial (SBT)yields this information: f = 30 breaths/min,RSBI = 145,P_0.1 = 10 cm H₂O.What should the respiratory therapist suggest to the physician during patient rounds?

A) Sedate the patient and place him on VC-CMV.
B) Continue with the current ventilator settings.
C) Switch to PC-CMV with a rate of 14 breaths/min.
D) Decrease the mandatory SIMV rate to 4 breaths/min.

Question 10

Which mode of ventilation delivers the exact amount of pressure required to overcome the resistive load imposed by the ET tube for the flow measured at the time?

A) Automode
B) Volume-targeted PSV
C) Pressure support ventilation
D) Automatic tube compensation

Question 11

Sixty minutes after a patient is extubated,an arterial blood gas sample is drawn;the results are: pH = 7.20,PaCO₂ = 60 mm Hg,PaO₂ = 55 mm Hg,SaO₂ = 80%,HCO₃^- = 23 mEq/L with a 2 L/min nasal cannula.The patient is SOB and complaining of chest pain.His blood pressure is 92/50 mm Hg.The most likely cause of this weaning failure is which of the following?

A) Chronic obstructive pulmonary disease
B) Acute left ventricular failure
C) Ventilatory muscle weakness
D) Hypophosphatemia

Question 12

Calculate and determine the weanability of patients with this data: C_D = 25 mL/cm H₂O,P_Imax = -28 cm H₂O,PaO₂ = 93 mm Hg,PAO₂ = 158 mm Hg,and f = 22 breaths/min.

A) 2-not weanable
B) 19-weanable
C) 32-not weanable
D) 54-weanable

Question 13

A female intubated patient has been weaned from full ventilatory support to PSV 5 cm H₂O,CPAP 5 cm H₂O,and an F_IO₂ of 0.3.The patient is alert and oriented and doing well.The respiratory therapist performs a cuff leak test.The average peritubular leak is 70 mL.The respiratory therapist should recommend which of the following?

A) Maintain the patient on the current settings and redo the cuff leak test in 24 hours.
B) Increase the PSV to 10 cm H₂O and maintain the CPAP and F_IO₂.
C) Extubate the patient and place her on a heated aerosol generator with an F_IO₂ of 0.4.
D) Pretreat the patient with steroids and/or racemic epinephrine before extubation.

Question 14

If a patient who has failed an SBT still meets the criteria for discontinuation of ventilation,an SBT should be performed every _______ hours to determine weanability.

A) 6
B) 12
C) 24
D) 36

Question 15

A patient is extubated and placed on a cool,bland aerosol with 30% oxygen.Twenty minutes postextubation,the respiratory therapist is called to assess the patient,who has shortness of breath.The respiratory therapist observes intercostal retractions,accessory muscle use,and a respiratory rate of 38 breaths/min.Stridor can be heard without a stethoscope,and the SpO₂ has dropped from 97% to 85%.The patient is given an aerosolized racemic epinephrine treatment and reassessed.Accessory muscle use continues,intercostal retractions decrease slightly,and stridor is heard on auscultation.The patient's respiratory rate is 30 breaths/min,and the SpO₂ is 88%.What should the respiratory therapist recommend?

A) Reintubation and mechanical ventilation
B) Heliox therapy and steroid administration
C) Increase the F_IO₂ on the cool bland aerosol to 40%
D) Use a nonrebreather mask with 15 L/min oxygen

Question 16

A patient is being weaned from invasive mechanical ventilation using VC-SIMV without pressure support.The respiratory therapist reviews the following data from the last few hours. What should the respiratory therapist recommend for this patient?

A) Switch the mode to VC-CMV.
B) Add and titrate pressure support.
C) Extubate and place the patient on NPPV.
D) Increase the set rate to 8 breaths/min.

Question 17

Which parameter is used as the primary index of the drive to breathe?

A) Airway occlusion pressure
B) CROP index
C) Maximum inspiratory pressure
D) Rapid shallow breathing index

Question 18

Assess the following data obtained from the spontaneous breathing trials of four patients.Which patient is most likely to be weaned successfully at this time?

A) Spontaneous rate = 32 breaths/min,V_T = 375 mL,PaO₂ = 98 mm Hg,F_IO₂ = 0.4
B) Spontaneous rate = 15 breaths/min,V_T = 450 mL,PaO₂ = 87 mm Hg,F_IO₂ = 0.6
C) Spontaneous rate = 15 breaths/min,V_T = 650 mL,PaO₂ = 91 mm Hg,F_IO₂ = 0.28
D) Spontaneous rate = 12 breaths/min,V_T = 680 mL,PaO₂ = 79 mm Hg,F_IO₂ = 0.5

Question 19

At what pressure is pressure support not high enough to contribute significantly to ventilatory support but is sufficient to overcome the work imposed by the ventilator system?

A) 2 cm H₂O
B) 5 cm H₂O
C) 8 cm H₂O
D) 10 cm H₂O

Question 20

An SBT should not continue for longer than _____ minutes.

A) 30
B) 60
C) 120
D) 180

Question 21

A patient being actively weaned from mechanical ventilation currently is receiving the following ventilatory support: pressure support = 15 cm H₂O,spontaneous V_T = 575 mL,spontaneous rate = 14 breaths/min,spontaneous V_T = 500 mL,F_IO₂ = 35%,PEEP = 5 cm H₂O.The arterial blood gas results are: pH = 7.42,PaCO₂ = 38 mm Hg,PaO₂ = 94 mm Hg,SaO₂ = 98%,HCO₃^- = 24 mEq/L.What should the respiratory therapist do next?

A) Reduce PEEP to zero.
B) Reduce the F_IO₂ to 30%.
C) Reduce the PS to 10 cm H₂O.
D) Extubate the patient.

Question 22

How long does a tracheostomy site typically take to mature?

A) 2 to 4 days
B) 4 to 6 days
C) 7 to 12 days
D) 10 to 15 days

Question 23

A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until ________ month(s)has/have passed and all weaning attempts during that time have failed.

A) 1
B) 3
C) 6
D) 9