Deck 49: Noninvasive Ventilation

Question 1

Which of the following restrictive thoracic diseases are successfully managed with noninvasive ventilation (NIV)?
1) Postpolio syndrome
2) Neuromuscular disease
3) Spinal cord injuries
4) Severe kyphoscoliosis

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

Answer 1

B

Question 2

Your patient has acute pulmonary edema from left heart failure. Which therapy should be tried first?

A) Noninvasive ventilation (NIV)
B) Continuous positive airway pressure (CPAP)
C) Mechanical ventilation
D) Positive end-expiratory pressure

Answer 2

B
Explanation: CPAP is considered by most first-line therapy for acute cardiogenic pulmonary edema.

Question 3

Which of the following are potential benefits of using noninvasive ventilation (NIV) during weaning?
1) Reduced length of intensive care unit (ICU) stay
2) Reduced incidence of nosocomial pneumonia
3) Reduced mortality rate
4) Reduced incidence of pulmonary embolism

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

Answer 3

B

Question 4

How does noninvasive ventilation (NIV) benefit the patient with restrictive thoracic disease?
1) It rests the respiratory muscles.
2) It lowers the PaCO_2.
3) It improves lung compliance.
4) It improves pulmonary function testing.

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

Question 5

Which of the following noninvasive ventilation (NIV) settings are adequate for a patient with cardiogenic pulmonary edema?

A) CPAP at 10 to 15 cm H₂O with 100% oxygen
B) CPAP at 10 to 15 cm H₂O with 50% oxygen
C) CPAP at 8 to 12 cm H₂O with 100% oxygen
D) CPAP at 8 to 12 cm H₂O with 50% oxygen

Question 6

Which of the following findings are exclusion criteria for using noninvasive ventilation (NIV) in the patient with acute respiratory failure?
1) Apnea
2) Hemodynamic or cardiac instability
3) Low risk of aspiration
4) Lack of cooperation by the patient

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

Question 7

Which of the following are indications to use noninvasive ventilation (NIV) in patients who have chronic obstructive pulmonary disease (COPD) with nocturnal hypoventilation?
1) PaCO₂ greater than 55 mm Hg
2) More than two hospitalizations related to hypercapnic respiratory failure
3) PaCO₂ greater than 65 mm Hg
4) PaCO₂ between 50 and 54 mm Hg with nocturnal desaturation

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

Question 8

All of the following are goals of noninvasive ventilation (NIV) in the acute care setting, except:

A) avoid intubation.
B) decrease incidence of ventilation-associated pneumonia.
C) decrease length of stay.
D) improve mobility.

Question 9

The respiratory therapist has placed a patient on noninvasive ventilation. After 2 hr the patient showing significant improvement in her work of breathing but is experiencing nasal and oral dryness. Which of the following corrective action should be performed?

A) Add heated humidifier.
B) Add ultrasonic nebulizer.
C) Immediately discontinue NIV.
D) Intubate the patient.

Question 10

The use of noninvasive ventilation (NIV) in the long-term care of patients with chronic obstructive pulmonary disease (COPD) will benefit the patient in which the following ways except:
1) better gas exchange.
2) improved sleep quality.
3) resetting the respiratory center to better respond to hypoxemia.
4) unloading the respiratory muscles.

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

Question 11

Which of the following therapies should be considered as first line of therapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD)?

A) Noninvasive ventilation (NIV)
B) Mechanical ventilation
C) High-flow nasal cannula
D) Systemic steroids

Question 12

Why did the use of intermittent positive-pressure breathing decline in the 1980s?

A) Due to a lack of scientific evidence to support its use for delivering aerosolized medication
B) Due to its cost of implementation
C) Due to its complexity
D) Replaced by newer technology

Question 13

Which of the following are benefits of continuous positive airway pressure (CPAP) in postoperative major abdominal surgery?
1) Lower mortality
2) Lower intubation rate
3) Lower incidence of pneumonia
4) Lower rate of sepsis

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

Question 14

Which of the following groups of patients with nocturnal hypoventilation respond to noninvasive ventilation (NIV)?

A) Hypoxic
B) Hypercapnic
C) Acidotic
D) Hypocapnic

Question 15

Which of the following devices is considered to be the first electrically powered negative-pressure ventilator?

A) The Bird
B) The iron lung
C) The chest cuirass
D) The rocking bed

Question 16

Which of the following are contraindications for the use of noninvasive ventilation (NIV)?
1) Nonsupportive family
2) Lack of financial resources
3) Copious amounts of secretions
4) Uncooperative behavior on the part of the patient

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

Question 17

Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of chronic obstructive pulmonary disease and hypercarbia. What is the goal of noninvasive ventilation in this setting with regard to the ABGs?

A) Return the PaCO₂ to 40 to 45 mm Hg.
B) Return the pH to near normal.
C) Return the PaCO₂ to less than 60 mm Hg.
D) Return the bicarbonate level to near normal.

Question 18

Which of the following indications for noninvasive ventilation (NIV) is where the greatest controversy exists?

A) Chronic obstructive pulmonary disease
B) Pneumonia
C) Hypoxemic respiratory failure
D) Nocturnal hypoventilation

Question 19

Which of the following is least likely to indicate the need for noninvasive ventilation (NIV) in the acute care setting?

A) Paradoxical breathing
B) Jugular venous distention
C) Respiratory rate more than 25/min
D) Use of accessory muscles

Question 20

Which of the following groups of patients are considered at risk for reintubation?
1) Patients with APACHE 2 score greater than 12 on the day of extubation
2) Patients older than 45 years
3) Patients with congestive heart failure (CHF)
4) Patients with one or more weaning failure

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

Question 21

Which of the following interfaces appear to be more efficient to improve ventilation?
1) Nasal pillows
2) Full-face mask
3) Nasal mask
4) Oral mask

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

Question 22

Compared with nasal masks, full-face masks are associated with all of the following, except:

A) increase in dead space.
B) risk of aspiration.
C) claustrophobia.
D) hypocapnia.

Question 23

Which of the following interfaces should be used in greater than 90% of the patients with hypoventilation?

A) Full-face mask
B) Nasal mask
C) Nasal pillows
D) Oral mask

Question 24

Which of the following is/are characteristics of most noninvasive ventilators?
1) Electrically powered
2) Blower driven
3) Microprocessor controlled
4) Double-circuit design

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

Question 25

Which of the following is a potential risk of overtightening the straps of the mask?

A) Absence of an air leak
B) Tissue necrosis
C) Eye irritation
D) Claustrophobia

Question 26

Which of the following ventilators is generally only used for chronic noninvasive ventilation (NIV)?

A) Critical care
B) Portable
C) Noninvasive
D) Negative pressure

Question 27

Which of the following is/are the minimum performing characteristics of most noninvasive ventilators?
1) Mandatory rate of 50 breaths/min or less
2) Inspiratory pressure of 30 cm H₂O or less
3) PEEP of 15 cm H₂O or less
4) Inspiratory flow of 180 L/min or less at 20 cm H₂O

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

Question 28

Which of the following is the most important advantage of noninvasive ventilators over other types of ventilators?

A) Cost
B) Ability to trigger and cycle appropriately when small-to-moderate air leaks are present
C) Ability to remove CO₂
D) Ability to oxygenate

Question 29

Which of the following modes are commonly seen on noninvasive ventilators?
1) Continuous positive airway pressure (CPAP)
2) Spontaneous (pressure assist)
3) Pressure assist
4) Volume control

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

Question 30

Which of the following are factors associated with pressure and flow-related complications during noninvasive ventilation?
1) Sinus and ear pain
2) Nasal congestion
3) Upper airway dryness
4) Gastric insufflations

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

Question 31

What mode of ventilation is most often used for noninvasive ventilation (NIV) when a critical care ventilator is in use?

A) Pressure support ventilation (PSV)
B) Continuous positive airway pressure
C) Intermittent mandatory ventilation
D) Control

Question 32

Which of the following statements are true about the use of home care ventilators for delivering noninvasive ventilation (NIV)?
1) They operate only with pressure triggering.
2) They can operate on AC or DC power sources.
3) They can have a single-limb ventilator circuit.
4) Flow delivery pattern can be adjusted.

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

Question 33

Which of the following interfaces that improve ventilation appears to be more tolerated?

A) Nasal pillows
B) Full-face mask
C) Nasal mask
D) Oral mask

Question 34

Which of the following is required for noninvasive ventilators to work properly?

A) Exhalation valve
B) Pressure alarm
C) Leak
D) Blender

Question 35

Your patient is being ventilated with a common critical care ventilator using pressure support ventilation (flow cycled) with a nasal mask. A leak is present that is preventing the appropriate termination of the inspiratory cycle. What is the best response?

A) Switch to volume control mode.
B) Switch to time-cycled mode.
C) Switch to nasal pillows.
D) Switch to full-face mask.

Question 36

Which of the following interfaces is/are most commonly used to apply noninvasive ventilation (NIV) in the acute setting?
1) Nasal or full-face mask
2) Mouthpiece
3) Endotracheal tube
4) Nasal pillows

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

Question 37

Which of the following is the current recommendation for adding humidity while using noninvasive ventilation (NIV)?

A) It is never recommended.
B) It is recommended for short-term application (<1 day).
C) It is recommended for long-term application (>1 day).
D) It is always recommended.

Question 38

What strategy should be used when the patient complains of nasal congestion during the use of a nasal mask for noninvasive ventilation (NIV)?

A) Switch to an oral mask.
B) Switch to a face mask.
C) Add a heated humidifier.
D) Reduce the inspiratory flow.

Question 39

Which of the following are a required ventilator alarm for noninvasive ventilation (NIV)?
1) Loss of power
2) Circuit disconnect
3) Battery failure
4) Blender alarm

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

Question 40

Which level of positive end-expiratory pressure (PEEP) is necessary to prevent rebreathing of carbon dioxide?

A) 1 to 3 cm H₂O
B) 3 to 5 cm H₂O
C) 5 to 7 cm H₂O
D) 7 to 9 cm H₂O

Question 41

What physiologic effect will raising the expiratory positive airway pressure have in the patient receiving noninvasive ventilation?

A) Increase the functional residual capacity.
B) Increase the tidal volume.
C) Decrease the PCO_2.
D) Lower the mean airway pressure.

Question 42

What is the best option for the patient in respiratory failure who continues to deteriorate 30 min after the initiation of noninvasive ventilation?

A) Wait another 30 min and monitor the patient.
B) Begin continuous positive airway pressure.
C) Intubate and begin mechanical ventilation.
D) Ventilate the patient using a bag-valve-mask.

Question 43

What is the recommended initial setting for ventilating pressure when delivering noninvasive ventilation in the pressure triggered timed mode?

A) 2 to 5 cm H₂O
B) 5 to 8 cm H₂O
C) 8 to 12 cm H₂O
D) 12 to 20 cm H₂O

Question 44

What patient population is the only group currently accepted for the use of noninvasive ventilation (NIV) in the hospital ward?

A) Chronic obstructive pulmonary disease (COPD) patients with near normal pH
B) Postoperative patients without pneumonia
C) No-code patients
D) Asthma patients with normal SpO₂

Question 45

Initiating noninvasive ventilation (NIV) can be done in which of the following settings?
1) Emergency department
2) Intensive care unit
3) Hospital ward
4) Nursing home

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

Question 46

Which of the following define successful application of noninvasive ventilation (NIV)?
1) Overall improvement of patient's blood gas
2) Normal blood gas
3) PaO₂ increased
4) PaCO₂ decreased

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

Question 47

What complication associated with noninvasive ventilation (NIV) is most common?

A) Aspiration
B) Hypotension
C) Nasal congestion
D) Air leaks

Question 48

Which of the following are possible solutions to correct a large air leak during noninvasive ventilation?
1) Selecting an appropriately sized mask
2) Applying chin straps
3) Using a full-face mask
4) Decreasing the inspiratory time

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

Question 49

Which of the following techniques are useful to avoid claustrophobia in the patient being ventilated by face mask?
1) Allow patient to hold the mask.
2) Increase the inspiratory flow.
3) Use sedation.
4) Use a larger mask.

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

Question 50

What is the recommended initial setting for positive end-expiratory pressure (PEEP) when delivering noninvasive ventilation in the pressure triggered timed mode?

A) 2 to 5 cm H₂O
B) 5 to 8 cm H₂O
C) 8 to 12 cm H₂O
D) 12 to 20 cm H₂O

Question 51

Which of the following is likely to occur when decreasing the expiratory positive airway pressure in the patient being ventilated using noninvasive ventilation?

A) Improved PaO₂
B) Increased functional residual capacity
C) Increased tidal volume
D) Increased inspiratory positive airway pressure