Question 1

Physiological goals of artificial ventilatory support include which of the following?
1) Support or manipulate gas exchange.
2) Reduce or manipulate the work of breathing.
3) Increase lung volume.

Accepted Answer

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

Question 2

Which of the following statements is false regarding ventilation in the assist-control mode?

Accepted Answer

A)   Every breath is supported by the ventilator.
B)   Usually ensures a minimum safe level of ventilation is given.
C)   Assist-control mode is typically applied using the volume control mode.
D)   It is usually applied with a backup rate of 5 to 8 breaths/min. D

Question 3

What percentage of mechanical ventilated patients has a tracheostomy tube place at some point?

Accepted Answer

A)   5% to 10%
B)   10% to 15%
C)   20% to 25%
D)   30% to 35% A

Question 4

Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the continuous mandatory ventilation assist-control mode. What initial FiO2 would you recommend?

Accepted Answer

A)   1.0
B)   0.8
C)   0.6
D)   0.4

Question 5

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set?
1) Airway temperature
2) Ventilatory support mode
3) O2 concentration (FiO2)
4) Minute ventilation (f, VT)

Accepted Answer

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

Question 6

Air trapping is a major concern in patients with what diagnosis when using the assist-control mode?

Accepted Answer

A)   Pneumonia
B)   Chronic obstructive pulmonary disease (COP
D)  
C)   Chest trauma
D)   Neuromuscular disease

Question 7

Which the following are hazards associated with mechanical ventilation?
1) Reduced cardiac output
2) Liver failure
3) Increased work of breathing
4) Acute lung injury

Accepted Answer

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

Question 8

A chronic obstructive pulmonary disease (COPD) patient in respiratory failure is receiving ventilatory support in the volume-targeted intermittent mandatory ventilation mode at a rate of 6/min. You measure an auto-PEEP level of 9 cm H2O. Which of the following would you recommend to decrease the effects of auto-PEEP in this patient?

Accepted Answer

A)   Decreasing the rate and increasing VT.
B)   Lowering the VT and letting the PaCO2 rise.
C)   Applying 4 to 6 cm H2O PEEP.
D)   Decreasing the peak inspiratory flow.

Question 9

Your patient develops a fever while being mechanically ventilated in the control mode. As a result of the fever, the patient's CO2 production increases while alveolar ventilation is unchanged. What is the probable change in ABGs?

Accepted Answer

A)   Increase in PaCO2
B)   Decrease in PaO2
C)   Decrease in PaCO2
D)   All of the above

Question 10

Compared with a volume-cycled strategy, what are some potential advantages of pressure-targeted ventilatory support?
1) Limit and control of peak airway pressures
2) Direct control over inspiratory time
3) Provision of a decelerating flow pattern

Accepted Answer

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

Question 11

A ventilator has separate rate and VT controls. If you set a VT of 650 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

Accepted Answer

A)   7800 ml/min (7.8 L/min) 
B)   8500 ml/min (8.5 L/min) 
C)   9600 ml/min (9.6 L/min) 
D)   10,200 ml/min (10.2 L/min)

Question 12

Which of the following is an advantage of Pressure Control Ventilation?

Accepted Answer

A)   Higher mean airway pressure can decrease venous return.
B)   VT varies depending on lung compliance, resistance, and patient effort.
C)   Improved gas distribution allows for lower VT.
D)   If VT or minute ventilation alarms are not set properly, alveolar hypoventilation and acidosis may not be detected.

Question 13

What limits should be initially set for high and low VT values and/or minute volume alarms on a ventilatory support device?

Accepted Answer

A)   ±5% to 10%
B)   ±10% to 15%
C)   ±15% to 20%
D)   ±20% to 25%

Question 14

An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5 L/min: pH = 7.20; PaCO2 = 67 mm Hg; HCO3-= 27 mEq/L; PaO2 = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FiO2 would you recommend to start with?

Accepted Answer

A)   0.21
B)   0.30
C)   0.50
D)   0.90

Question 15

During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD) patient with chronic hypercapnia, what PaCO2 is most likely used as a target value?

Accepted Answer

A)   30 mm Hg
B)   40 mm Hg
C)   55 mm Hg
D)   75 mm Hg

Question 16

When setting the tidal volume on a patient being mechanically ventilated, what criteria should be kept in mind?

Accepted Answer

A)   It should never cause the plateau pressure to exceed 28 mm Hg.
B)   It should never cause the peak pressure to exceed 35 mm Hg.
C)   It should result in the static pressure of less than 10 mm Hg.
D)   It should result in a peak pressure of no more than 25 mm Hg.

Question 17

Which of the following are primary goals of mechanical ventilation?
1) Adequate alveolar ventilation (VA)
2) Maintaining adequate hemoglobin levels
3) Restoring acid-base balance
4) Maintaining adequate alveolar oxygenation

Accepted Answer

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

Question 18

A physician orders intubation and mechanical ventilation in volume-controlled ventilation mode for a 170-lb adult man with neuromuscular disease. Which of the following initial settings would you recommend? Rate VT

Accepted Answer

A)   14 breath/min 540 ml
B)   20 breath/min 310 ml
C)   10 breath/min 770 ml
D)   6 breath/min 500 ml

Question 19

For adults with otherwise normal lungs who are receiving ventilatory support in the continuous mandatory ventilation control or assist-control mode, inspiratory flow should be set to provide what 1:E?

Accepted Answer

A)   2:1
B)   3:1
C)   1:1
D)   1:2

Question 20

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H2O pressure is required to deliver the preset VT of 950 ml. What high-pressure limit would you now set for this patient?

Accepted Answer

A)   60 cm H2O
B)   70 cm H2O
C)   80 cm H2O
D)   90 cm H2O

Exam 48: Initiating and Adjusting Invasive Ventilatory Support

Physiological goals of artificial ventilatory support include which of the following? 1) Support or manipulate gas exchange. 2) Reduce or manipulate the work of breathing. 3) Increase lung volume.

Which of the following statements is false regarding ventilation in the assist-control mode?

What percentage of mechanical ventilated patients has a tracheostomy tube place at some point?

Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the continuous mandatory ventilation assist-control mode. What initial FiO₂ would you recommend?

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set? 1) Airway temperature 2) Ventilatory support mode 3) O₂ concentration (FiO₂) 4) Minute ventilation (f, V_T)

Air trapping is a major concern in patients with what diagnosis when using the assist-control mode?

Which the following are hazards associated with mechanical ventilation? 1) Reduced cardiac output 2) Liver failure 3) Increased work of breathing 4) Acute lung injury

Your patient develops a fever while being mechanically ventilated in the control mode. As a result of the fever, the patient's CO₂ production increases while alveolar ventilation is unchanged. What is the probable change in ABGs?

Compared with a volume-cycled strategy, what are some potential advantages of pressure-targeted ventilatory support? 1) Limit and control of peak airway pressures 2) Direct control over inspiratory time 3) Provision of a decelerating flow pattern

A ventilator has separate rate and V_T controls. If you set a V_T of 650 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

Which of the following is an advantage of Pressure Control Ventilation?

What limits should be initially set for high and low V_T values and/or minute volume alarms on a ventilatory support device?

An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5 L/min: pH = 7.20; PaCO₂ = 67 mm Hg; HCO₃^-= 27 mEq/L; PaO₂ = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FiO₂ would you recommend to start with?

During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD) patient with chronic hypercapnia, what PaCO₂ is most likely used as a target value?

When setting the tidal volume on a patient being mechanically ventilated, what criteria should be kept in mind?

Which of the following are primary goals of mechanical ventilation? 1) Adequate alveolar ventilation (V_A) 2) Maintaining adequate hemoglobin levels 3) Restoring acid-base balance 4) Maintaining adequate alveolar oxygenation

A physician orders intubation and mechanical ventilation in volume-controlled ventilation mode for a 170-lb adult man with neuromuscular disease. Which of the following initial settings would you recommend? Rate V_T

For adults with otherwise normal lungs who are receiving ventilatory support in the continuous mandatory ventilation control or assist-control mode, inspiratory flow should be set to provide what 1:E?

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H₂O pressure is required to deliver the preset V_T of 950 ml. What high-pressure limit would you now set for this patient?

Exam 48: Initiating and Adjusting Invasive Ventilatory Support

Physiological goals of artificial ventilatory support include which of the following? 1) Support or manipulate gas exchange. 2) Reduce or manipulate the work of breathing. 3) Increase lung volume.

Which of the following statements is false regarding ventilation in the assist-control mode?

What percentage of mechanical ventilated patients has a tracheostomy tube place at some point?

Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the continuous mandatory ventilation assist-control mode. What initial FiO2 would you recommend?

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set? 1) Airway temperature 2) Ventilatory support mode 3) O2 concentration (FiO2) 4) Minute ventilation (f, VT)

Air trapping is a major concern in patients with what diagnosis when using the assist-control mode?

Which the following are hazards associated with mechanical ventilation? 1) Reduced cardiac output 2) Liver failure 3) Increased work of breathing 4) Acute lung injury

Your patient develops a fever while being mechanically ventilated in the control mode. As a result of the fever, the patient's CO2 production increases while alveolar ventilation is unchanged. What is the probable change in ABGs?

Compared with a volume-cycled strategy, what are some potential advantages of pressure-targeted ventilatory support? 1) Limit and control of peak airway pressures 2) Direct control over inspiratory time 3) Provision of a decelerating flow pattern

A ventilator has separate rate and VT controls. If you set a VT of 650 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

Which of the following is an advantage of Pressure Control Ventilation?

What limits should be initially set for high and low VT values and/or minute volume alarms on a ventilatory support device?

An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5 L/min: pH = 7.20; PaCO2 = 67 mm Hg; HCO3-= 27 mEq/L; PaO2 = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FiO2 would you recommend to start with?

During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD) patient with chronic hypercapnia, what PaCO2 is most likely used as a target value?

When setting the tidal volume on a patient being mechanically ventilated, what criteria should be kept in mind?

Which of the following are primary goals of mechanical ventilation? 1) Adequate alveolar ventilation (VA) 2) Maintaining adequate hemoglobin levels 3) Restoring acid-base balance 4) Maintaining adequate alveolar oxygenation

A physician orders intubation and mechanical ventilation in volume-controlled ventilation mode for a 170-lb adult man with neuromuscular disease. Which of the following initial settings would you recommend? Rate VT

For adults with otherwise normal lungs who are receiving ventilatory support in the continuous mandatory ventilation control or assist-control mode, inspiratory flow should be set to provide what 1:E?

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H2O pressure is required to deliver the preset VT of 950 ml. What high-pressure limit would you now set for this patient?

Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the continuous mandatory ventilation assist-control mode. What initial FiO₂ would you recommend?

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set? 1) Airway temperature 2) Ventilatory support mode 3) O₂ concentration (FiO₂) 4) Minute ventilation (f, V_T)

Your patient develops a fever while being mechanically ventilated in the control mode. As a result of the fever, the patient's CO₂ production increases while alveolar ventilation is unchanged. What is the probable change in ABGs?

A ventilator has separate rate and V_T controls. If you set a V_T of 650 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

What limits should be initially set for high and low V_T values and/or minute volume alarms on a ventilatory support device?

An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5 L/min: pH = 7.20; PaCO₂ = 67 mm Hg; HCO₃^-= 27 mEq/L; PaO₂ = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FiO₂ would you recommend to start with?

During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD) patient with chronic hypercapnia, what PaCO₂ is most likely used as a target value?

Which of the following are primary goals of mechanical ventilation? 1) Adequate alveolar ventilation (V_A) 2) Maintaining adequate hemoglobin levels 3) Restoring acid-base balance 4) Maintaining adequate alveolar oxygenation

A physician orders intubation and mechanical ventilation in volume-controlled ventilation mode for a 170-lb adult man with neuromuscular disease. Which of the following initial settings would you recommend? Rate V_T

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H₂O pressure is required to deliver the preset V_T of 950 ml. What high-pressure limit would you now set for this patient?