Question 1

A 68-year-old woman was admitted to the ICU with pneumonia and was intubated when she developed progressive hypoxemia.She has been on the ventilator for 5 days and has been tolerating this therapy well.The patient has suddenly become severely agitated and appears to be fighting the ventilator.The ventilator's high pressure alarm is sounding continuously.The respiratory therapist disconnects the patient from the ventilator and begins manual ventilation with 100% oxygen and PEEP.The resuscitator bag is difficult to squeeze,breath sounds are present on the left with no adventitious sounds and absent on the right side,and percussion reveals hyperresonance over the right side.The most appropriate action to address this situation is which of the following?

Accepted Answer

A)   Pull the endotracheal tube back until bilateral breath sounds are heard.
B)   Administer a bronchodilator and suction the endotracheal tube.
C)   Extubate the patient and reintubate with a larger endotracheal tube.
D)   Insert a 14-gauge needle in the second intercostal space, midclavicular line, right side. D

Question 2

A patient is intubated and set up on VC-CMV.After stabilization and suctioning of the ET tube,the peak inspiratory pressure (PIP)is 25 cm H₂O.The low pressure and high pressure alarms should be set at _____________ cm H₂O and _____________ cm H₂O,respectively.

Accepted Answer

A)   5; 35
B)   10; 30
C)   12; 40
D)   15; 35 D

Question 3

During ventilation with VC-CMV,pleural drainage leaks sometimes can be compensated for by increasing which of the following?

Accepted Answer

A)   The number of chest tubes
B)   The set tidal volume
C)   The set pressure limit
D)   The set peak inspiratory flow B

Question 4

The respiratory therapist is called to the bedside of a patient mechanically ventilated in the VC-CMV mode because the low pressure,low exhaled tidal volume,and low exhaled minute volume alarms all have activated.Which of the following could be the cause of this situation?

Accepted Answer

A)   Patient biting the endotracheal tube
B)   Rupture of the endotracheal tube cuff
C)   Slipping of the endotracheal tube into the right mainstem
D)   Plugging of the airways by airway secretions and mucus

Question 5

When an alarm is activated on a ventilator,the respiratory therapist's first priority is to ______________.

Accepted Answer

A)   assess the patient's level of consciousness
B)   ensure adequate ventilation and oxygenation
C)   assess lung compliance and airway resistance
D)   ensure that bilateral and equal breath sounds are present

Question 6

At 1030 the respiratory therapist is called to the bedside of a patient being mechanically ventilated with VC-IMV.The patient is a 55-kg female who has been intubated with a size 8 endotracheal tube.Currently,the ET tube is located 20 cm at the gum line.During spontaneous breathing,the patient shows lack of coordinated chest wall movement,and the respiratory therapist notes some retraction of the intercostal spaces.The respiratory therapist performs a system check.The current and past few patient-ventilator system checks reveal the following information:
$\begin{array} { | l | l | l | l | l | } 
\hline \text { Time } & 0430 & 0640 & 0835 & 1030 \
\hline P I P \left( \mathrm {~cm} \mathrm { H } _ { \mathbf { 2 } } \mathrm { O } \right) & 28 & 31 & 34 & 41 \
\hline \mathrm { P } _ { \mathrm { qht.nu } } \left( \mathrm { cm } \mathrm {} \mathrm { H } _ { 2 } \mathrm { O } \right) & 18 & 21 & 19 & 20 \
\hline
\end{array}$
The most appropriate action to take in this situation is which of the following?

Accepted Answer

A)   Deflate the cuff and reposition the endotracheal tube.
B)   Request that the patient receive haloperidol and midazolam.
C)   Administer albuterol via an in-line metered-dose inhaler.
D)   Switch the mode to PC-IMV and increase the rate.

Question 7

The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the high pressure,low exhaled volume,and low Vᴇ alarms active.This situation could be caused by which of the following?

Accepted Answer

A)   Improper flow rate and flow pattern
B)   Migration of the ET into the upper airway
C)   The patient is out of synchrony with the ventilator.
D)   The ventilator has an internal malfunction.

Question 8

You are called into a patient's room by the nurse because blood is spurting from the tracheostomy site,which was placed 2 weeks ago.The patient is receiving mechanical ventilatory support and has a history of liver failure and CHF.Which of the following conditions is the most likely cause?

Accepted Answer

A)   Acute pulmonary edema
B)   Rupture of the innominate artery
C)   Pulmonary hemorrhage
D)   Pneumothorax

Question 9

The respiratory therapist is performing a patient-ventilator system check on a patient who was in a motor vehicle accident 2 days earlier.The therapist gathers the following information from the flow sheet:

Which condition most likely has produced the changes reflected in these data?

Accepted Answer

A)   Bronchospasm
B)   Abdominal distention
C)   Secretion retention
D)   Mucosal edema

Question 10

The respiratory therapist is assessing a mechanically ventilated patient for whom the high pressure alarm is active and the flow-volume loop shows the following:

The action that could alleviate this problem is which of the following?

Accepted Answer

A)   Place a bite block into the patient's mouth.
B)   Perform a recruitment maneuver and increase PEEP.
C)   Administer a fast-acting bronchodilator and suction the ET tube.
D)   Insert a 14-gauge needle into the second intercostal space, midclavicular line, and right side.

Question 11

Use of an externally powered,small-volume nebulizer for aerosol delivery during partial ventilatory support with PSV may cause which of the following?
1)High Vᴛ alarm activation
2)Triggering difficulties
3)Low pressure alarm activation
4)Ventilator inoperative alarm

Accepted Answer

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

Question 12

The following two graphic loops show which of the following conditions?

Accepted Answer

A)   Leak in the patient-ventilator circuit
B)   Increased airway resistance
C)   Decreased lung compliance
D)   Active exhalation

Question 13

Reduction of preload and afterload is important in the management of which of the following?

Accepted Answer

A)   Pulmonary embolism
B)   Dynamic hyperinflation
C)   Cardiogenic pulmonary edema
D)   Noncardiogenic pulmonary edema

Question 14

A mechanically ventilated patient with COPD is receiving partial ventilatory support with PSV.The respiratory therapist notes a sudden rise at the end of each breath on the pressure-time graphic.What action should the respiratory therapist take at this time?

Accepted Answer

A)   Change the mode to PRVC.
B)   Change the mode to VC-CMV.
C)   Lower the flow cycle setting.
D)   Adjust the pressure support level.

Question 15

An increased arterial-to-end-tidal partial pressure CO2 gradient can help identify which of the following?

Accepted Answer

A)   Pulmonary embolism
B)   Dynamic hyperinflation
C)   Cardiogenic pulmonary edema
D)   Noncardiogenic pulmonary edema

Question 16

The initial step in the management of patient-ventilator asynchrony is which of the following?

Accepted Answer

A)   Lower the high pressure alarm setting.
B)   Check the endotracheal tube cuff pressure.
C)   Ventilate the patient with a manual resuscitator bag.
D)   Check the low and high pressure alarm settings.

Question 17

The flow-volume loop below is representative of which of the following conditions?

Accepted Answer

A)   System leak
B)   Intrinsic PEEP
C)   Inadequate flow
D)   Active exhalation

Question 18

The high-pressure alarm activates on a patient receiving mechanical ventilatory support.The patient is tachycardic and tachypnic with absent breath sounds on the right side.Which of the following condition(s)could be the cause?
1)Pneumothorax
2)Pulmonary edema
3)Disconnection from the ventilator
4)Increased airway resistance

Accepted Answer

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

Question 19

An intubated patient is receiving mechanical ventilation with the following settings: VC-CMV,rate = 18,Vᴛ = 850 mL (10 mL/kg),PEEP = 5 cm H₂O,flow rate = 40 L/min.The patient is sedated and is not assisting the ventilator.During a patient-ventilator system check,the respiratory therapist observes the following ventilator graphic:

The respiratory therapist should do which of the following?

Accepted Answer

A)   Decrease the flow rate.
B)   Increase the PEEP.
C)   Decrease the rate.
D)   Increase the Vᴛ.

Question 20

Which of the following can activate an apnea alarm?

Accepted Answer

A)   Secretions
B)   Auto-PEEP
C)   Loss of PEEP
D)   Active inhalation

Exam 18: Troubleshooting and Problem Solving

A patient is intubated and set up on VC-CMV.After stabilization and suctioning of the ET tube,the peak inspiratory pressure (PIP) is 25 cm H₂O.The low pressure and high pressure alarms should be set at _ cm H₂O and _ cm H₂O,respectively.

During ventilation with VC-CMV,pleural drainage leaks sometimes can be compensated for by increasing which of the following?

The respiratory therapist is called to the bedside of a patient mechanically ventilated in the VC-CMV mode because the low pressure,low exhaled tidal volume,and low exhaled minute volume alarms all have activated.Which of the following could be the cause of this situation?

When an alarm is activated on a ventilator,the respiratory therapist's first priority is to ______________.

The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the high pressure,low exhaled volume,and low Vᴇ alarms active.This situation could be caused by which of the following?

You are called into a patient's room by the nurse because blood is spurting from the tracheostomy site,which was placed 2 weeks ago.The patient is receiving mechanical ventilatory support and has a history of liver failure and CHF.Which of the following conditions is the most likely cause?

The respiratory therapist is performing a patient-ventilator system check on a patient who was in a motor vehicle accident 2 days earlier.The therapist gathers the following information from the flow sheet: Which condition most likely has produced the changes reflected in these data?

The respiratory therapist is assessing a mechanically ventilated patient for whom the high pressure alarm is active and the flow-volume loop shows the following: The action that could alleviate this problem is which of the following?

Use of an externally powered,small-volume nebulizer for aerosol delivery during partial ventilatory support with PSV may cause which of the following? 1) High Vᴛ alarm activation 2) Triggering difficulties 3) Low pressure alarm activation 4) Ventilator inoperative alarm

The following two graphic loops show which of the following conditions?

Reduction of preload and afterload is important in the management of which of the following?

A mechanically ventilated patient with COPD is receiving partial ventilatory support with PSV.The respiratory therapist notes a sudden rise at the end of each breath on the pressure-time graphic.What action should the respiratory therapist take at this time?

An increased arterial-to-end-tidal partial pressure CO₂ gradient can help identify which of the following?

The initial step in the management of patient-ventilator asynchrony is which of the following?

The flow-volume loop below is representative of which of the following conditions?

Which of the following can activate an apnea alarm?

Exam 18: Troubleshooting and Problem Solving

A patient is intubated and set up on VC-CMV.After stabilization and suctioning of the ET tube,the peak inspiratory pressure (PIP) is 25 cm H₂O.The low pressure and high pressure alarms should be set at _____________ cm H₂O and _____________ cm H₂O,respectively.

During ventilation with VC-CMV,pleural drainage leaks sometimes can be compensated for by increasing which of the following?

The respiratory therapist is called to the bedside of a patient mechanically ventilated in the VC-CMV mode because the low pressure,low exhaled tidal volume,and low exhaled minute volume alarms all have activated.Which of the following could be the cause of this situation?

When an alarm is activated on a ventilator,the respiratory therapist's first priority is to ______________.

The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the high pressure,low exhaled volume,and low Vᴇ alarms active.This situation could be caused by which of the following?

You are called into a patient's room by the nurse because blood is spurting from the tracheostomy site,which was placed 2 weeks ago.The patient is receiving mechanical ventilatory support and has a history of liver failure and CHF.Which of the following conditions is the most likely cause?

The respiratory therapist is performing a patient-ventilator system check on a patient who was in a motor vehicle accident 2 days earlier.The therapist gathers the following information from the flow sheet: Which condition most likely has produced the changes reflected in these data?

The respiratory therapist is assessing a mechanically ventilated patient for whom the high pressure alarm is active and the flow-volume loop shows the following: The action that could alleviate this problem is which of the following?

Use of an externally powered,small-volume nebulizer for aerosol delivery during partial ventilatory support with PSV may cause which of the following? 1) High Vᴛ alarm activation 2) Triggering difficulties 3) Low pressure alarm activation 4) Ventilator inoperative alarm

The following two graphic loops show which of the following conditions?

Reduction of preload and afterload is important in the management of which of the following?

A mechanically ventilated patient with COPD is receiving partial ventilatory support with PSV.The respiratory therapist notes a sudden rise at the end of each breath on the pressure-time graphic.What action should the respiratory therapist take at this time?

An increased arterial-to-end-tidal partial pressure CO2 gradient can help identify which of the following?

The initial step in the management of patient-ventilator asynchrony is which of the following?

The flow-volume loop below is representative of which of the following conditions?

Which of the following can activate an apnea alarm?

A patient is intubated and set up on VC-CMV.After stabilization and suctioning of the ET tube,the peak inspiratory pressure (PIP) is 25 cm H₂O.The low pressure and high pressure alarms should be set at _ cm H₂O and _ cm H₂O,respectively.

An increased arterial-to-end-tidal partial pressure CO₂ gradient can help identify which of the following?