Question 1

Which of the following statements is false regarding the use of an inspiratory pause during mechanical ventilation?

Accepted Answer

A)  It may be useful in ARDS patients. 
B)  It may be useful when obtaining a chest radiograph. 
C)  It has been shown to increase effectiveness of bronchodilator therapy. 
D)  It will increase mean airway pressure.

Question 2

Which of the following are advantages of Assist Control Volume ventilation?
1) Minimal safe level of ventilation achieved.
2) Patient can set breathing rate.
3) May reduce work of breathing.
4) Pressure is limited.

Accepted Answer

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

Question 3

When using a pressure-volume curve to identify optimal PEEP levels, what does the upper inflection point represent?

Accepted Answer

A)  Point of lung recruitment 
B)  Point of lung over distension 
C)  Optimal PEEP level 
D)  Optimal compliance level

Question 4

Beneficial effects of using high inspiratory flows in patients with chronic airflow obstruction receiving flow-limited mechanical ventilation include which of the following?
1) Decreased work of breathing
2) Improved gas exchange
3) Decreased auto-PEEP

Accepted Answer

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

Question 5

Which of the following ventilator adjustments would decrease inspiratory time?
1) Increase the peak flow.
2) Increase the tidal volume.
3) Change the flow pattern from a decelerating wave to a square wave.

Accepted Answer

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

Question 6

What phrase is used to describe the situation where the patient with acute lung injury is ventilated with a smaller tidal volume and the PaCO2 is allowed to increase above normal range to avoid additional lung injury?

Accepted Answer

A)  Physiologic ventilation 
B)  Permissive hypercapnia 
C)  Adjusted ventilation 
D)  Dialed acidosis

Question 7

A physician orders intubation and mechanical ventilation in the continuous mandatory ventilation mode for a 200-lb predicted body weight (PBW) adult man with acute asthma exacerbation. Which of the following initial ventilator settings would you recommend? Rate VT

Accepted Answer

A)  12 breaths/min 550 ml 
B)  11 breaths/min 450 ml 
C)  14 breaths/min 770 ml 
D)  20 breaths/min 550 ml

Question 8

A patient receiving continuous mandatory ventilation in the assist-control mode develops auto-PEEP. Which of the following general approaches would you consider to minimize the effects of auto-PEEP in this patient?
1) Increasing expiratory time
2) Applying PEEP
3) Switching ventilating mode to synchronized intermittent mandatory ventilation

Accepted Answer

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

Question 9

You have just placed a chronic obstructive pulmonary disease (COPD) patient on intermittent mandatory ventilation at a rate of 8/min, a VT of 550 ml, and an FiO2 of 0.40. To ensure proper equilibration between the alveolar and arterial gas tensions, how long should you wait before drawing a sample for measurement of the ABG?

Accepted Answer

A)  5 min 
B)  10 min 
C)  15 min 
D)  30 min

Question 10

Which of the following criteria represents the recommended starting point for considering the use of PEEP?

Accepted Answer

A)  PaO2 less than 40 to 50 on FiO2 greater than 0.80 - 1.0 
B)  PaO2 less than 50 to 60 on FiO2 greater than 0.40 - 0.50 
C)  PaO2 less than 100 on FiO2 of 1.0 
D)  PaO2 less than 50 on FiO2 greater than 0.75

Question 11

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a VT of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H2O. Which of the following actions would you recommend to the patient's physician?

Accepted Answer

A)  Decrease the inspiratory flow. 
B)  Lower the delivered VT. 
C)  Administer a bronchodilator. 
D)  Add PEEP.

Question 12

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FiO2 of 0.4: pH = 7.51; PCO2 = 30 mm Hg; HCO3- = 25 mm Hg. Her current minute ventilation (VE) is 7.9 L/min. What new VE would you recommend?

Accepted Answer

A)  9.0 L/min 
B)  6.7 L/min 
C)  7.5 L/min 
D)  5.9 L/min

Question 13

What is considered to be the single best indicator of effective ventilation?

Accepted Answer

A)  PaO2 
B)  SaO2 
C)  PaCO2 
D)  pH

Question 14

When titrating the FiO2 level downward from 100% to 40%, what is the maximum increment that should be applied between estimates of oxygenation?

Accepted Answer

A)  5% 
B)  10% 
C)  20% 
D)  25%

Question 15

When the therapist is initially setting the high-pressure alarm on the ventilator and the patient's plateau pressure is less than 30 cm H2O, what should the high-pressure alarm be set at?

Accepted Answer

A)  5 to 10 cm H2O above the peak pressure 
B)  10 to 20 cm H2O above the peak pressure 
C)  10 to 12 cm H2O above the plateau pressure 
D)  10 to 15 cm H2O above the mean airway pressure

Question 16

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FiO2 of 0.5: pH = 7.23; PCO2 = 61 mm Hg; HCO3- = 26 mm Hg. The current minute ventilation (VE) is 9.2 L/min. What new VE would you recommend?

Accepted Answer

A)  10.6 L/min 
B)  14.0 L/min 
C)  12.4 L/min 
D)  5.8 L/min

Question 17

To prevent atelectasis and improve gas exchange, most thoracic surgery patients placed on ventilatory support receive which of the following?

Accepted Answer

A)  0 cm H2O PEEP 
B)  5 cm H2O PEEP 
C)  8 cm H2O PEEP 
D)  10 cm H2O PEEP

Question 18

A patient with ARDS receiving ventilatory support with PEEP through a volume-cycled ventilator has a plateau pressure of 38 cm H2O. ABGs on 55% O2 are as follows: pH = 7.44; PCO2 = 37 mm Hg; HCO3- = 25 mEq; PO2 = 55 mm Hg; SaO2 = 88%. Which of the following would you recommend?

Accepted Answer

A)  Increase the PEEP level. 
B)  Make no changes. 
C)  Reduce the VT. 
D)  Increase the FiO2.

Question 19

What is the recommended range for the tidal volume for the initial ventilator settings in the volume control mode in a patient with normal lungs?

Accepted Answer

A)  4 to 6 ml/kg 
B)  6 to 8 ml/kg 
C)  10 to 12 ml/kg 
D)  12 to 15 ml/kg

Question 20

A dehydrated, feverish patient suffering from acute bacterial pneumonia is being intubated in order to provide mechanical ventilatory support. Which of the following devices would you select to control humidification and airway temperature for this patient?

Accepted Answer

A)  Unheated large-volume wick humidifier 
B)  Heated wick humidifier with servo-control 
C)  Large-reservoir, high-output heated jet nebulizer 
D)  Heat-moisture exchanger

Exam 48: Initiating and Adjusting Invasive Ventilatory Support

Which of the following statements is false regarding the use of an inspiratory pause during mechanical ventilation?

Which of the following are advantages of Assist Control Volume ventilation? 1) Minimal safe level of ventilation achieved. 2) Patient can set breathing rate. 3) May reduce work of breathing. 4) Pressure is limited.

When using a pressure-volume curve to identify optimal PEEP levels, what does the upper inflection point represent?

Beneficial effects of using high inspiratory flows in patients with chronic airflow obstruction receiving flow-limited mechanical ventilation include which of the following? 1) Decreased work of breathing 2) Improved gas exchange 3) Decreased auto-PEEP

Which of the following ventilator adjustments would decrease inspiratory time? 1) Increase the peak flow. 2) Increase the tidal volume. 3) Change the flow pattern from a decelerating wave to a square wave.

What phrase is used to describe the situation where the patient with acute lung injury is ventilated with a smaller tidal volume and the PaCO₂ is allowed to increase above normal range to avoid additional lung injury?

A physician orders intubation and mechanical ventilation in the continuous mandatory ventilation mode for a 200-lb predicted body weight (PBW) adult man with acute asthma exacerbation. Which of the following initial ventilator settings would you recommend? Rate V_T

Which of the following criteria represents the recommended starting point for considering the use of PEEP?

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a V_T of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H₂O. Which of the following actions would you recommend to the patient's physician?

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FiO₂ of 0.4: pH = 7.51; PCO₂ = 30 mm Hg; HCO₃^- = 25 mm Hg. Her current minute ventilation (V_E) is 7.9 L/min. What new V_E would you recommend?

What is considered to be the single best indicator of effective ventilation?

When titrating the FiO₂ level downward from 100% to 40%, what is the maximum increment that should be applied between estimates of oxygenation?

When the therapist is initially setting the high-pressure alarm on the ventilator and the patient's plateau pressure is less than 30 cm H₂O, what should the high-pressure alarm be set at?

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FiO₂ of 0.5: pH = 7.23; PCO₂ = 61 mm Hg; HCO₃^- = 26 mm Hg. The current minute ventilation (V_E) is 9.2 L/min. What new V_E would you recommend?

To prevent atelectasis and improve gas exchange, most thoracic surgery patients placed on ventilatory support receive which of the following?

A patient with ARDS receiving ventilatory support with PEEP through a volume-cycled ventilator has a plateau pressure of 38 cm H₂O. ABGs on 55% O₂ are as follows: pH = 7.44; PCO₂ = 37 mm Hg; HCO₃^- = 25 mEq; PO₂ = 55 mm Hg; SaO₂ = 88%. Which of the following would you recommend?

What is the recommended range for the tidal volume for the initial ventilator settings in the volume control mode in a patient with normal lungs?

A dehydrated, feverish patient suffering from acute bacterial pneumonia is being intubated in order to provide mechanical ventilatory support. Which of the following devices would you select to control humidification and airway temperature for this patient?