Deck 51: Monitoring the Patient in the Intensive Care Unit

Question 1

What is considered normal for the PaO₂/FiO₂ ratio?

A) Greater than 50
B) Greater than 150
C) Greater than 250
D) Greater than 400

Answer 1

D
Explanation: A normal PaO₂/FiO₂ ratio while breathing room air is approximately 400 to 500 mm Hg.

Question 2

What is the normal approximate value for O₂ consumption?

A) 150 ml/min
B) 200 ml/min
C) 250 ml/min
D) 300 ml/min

Answer 2

C
Explanation: Normal resting O₂ consumption is approximately 250 ml/min and O₂ consumption increases with activity, stress, and temperature.

Question 3

Seasonal variation

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
Explanation: Signals or values are susceptible to variability due to artifacts, factitious events, physiologic variation, and instrument drift.

Question 4

Which of the following parameters are major factors in determining tissue oxygenation?
1) Arterial oxygenation
2) Tissue perfusion
3) Oxygen (O₂) uptake
4) P/F ratio

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

Answer 4

B

Question 5

Your patient has a P(A-a)O₂ of 200 mm Hg while breathing 100% O₂. What is the estimated percentage shunt?

A) 5%
B) 10%
C) 20%
D) 30%

Question 6

Which of the following are reasons monitoring is needed?
1) Continuous assessment
2) Analysis of vital signs
3) Measurement of values that caregivers cannot detect

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

Question 7

What is the best single measure of effective ventilation in the intensive care unit patient?

A) Dead space-tidal volume ratio
B) PaCO₂
C) End-tidal PCO₂
D) Q_s/Q_t

Question 8

While monitoring patients, signals, or values are susceptible to variability due to which of the following?

Question 9

Which of the following parameters are used in calculating the Murray lung injury score of a patient with acute lung injury?
1) Results of chest radiograph
2) PEEP setting
3) Lung compliance
4) Cardiac output

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

Question 10

Which parameter is considered to be the most accurate and reliable measure of oxygenation efficiency?

A) PaO₂/FiO₂ ratio
B) P(A-a)O₂/PaO₂ ratio
C) Q_s/Q_t
D) PaO₂/SaO₂ ratio

Question 11

Which of the following are likely to cause errors in SpO₂ readings?
1) Anemia
2) Deeply pigmented skin
3) Motion due to shivering
4) Significant tachycardia

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

Question 12

What method(s) is/are used to measure O₂ consumption?
1) Fick method
2) Analysis of inspired and expired gases
3) V/Q scans

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

Question 13

Instrument drift

Question 14

What is the best measure of the efficiency of gas exchange in the lung?

A) PaCO₂
B) V_DS/V_T
C) End-tidal PCO₂
D) PaCO₂/PETCO₂

Question 15

In low-perfusion patients, what site would be best for monitoring SpO₂?

A) Finger
B) Earlobe
C) Nose
D) Forehead

Question 16

What is the normal range for P(A-a)O₂ in a healthy 30-year-old person breathing room air?

A) 0 to 10 mm Hg
B) 5 to 15 mm Hg
C) 10 to 20 mm Hg
D) Cannot predict

Question 17

Factitious events

Question 18

You are monitoring blood pressure during mechanical ventilation of a patient with pneumonia. A temporary increase in blood pressure occurs when the patient coughs. This temporary spike in blood pressure represents what type of variability?

A) Artifact
B) Factitious event
C) Physiologic variation
D) Instrument drift

Question 19

Temporary variation in pulmonary artery pressure readings due to movement of the hemodynamic monitoring line is an example of what type of variability?

A) Artifact
B) Factitious event
C) Physiologic variation
D) Instrument drift

Question 20

What is the normal range for the percent of O₂ consumption consumed by the respiratory muscles?

A) 2% to 5%
B) 5% to 10%
C) 10% to 15%
D) 20% to 25%

Question 21

A vital capacity (VC) value below what value indicates significant muscle weakness?

A) 10 to 15 ml/kg
B) 20 to 25 ml/kg
C) 30 to 40 ml/kg
D) 50 to 60 ml/kg

Question 22

Artifacts

Question 23

Which of the following two parameters are most commonly used for bedside assessment of respiratory muscle strength?

A) Vital capacity and maximum inspiratory pressure
B) Vital capacity and peak flow
C) Maximum inspiratory pressure and MVV
D) MVV and vital capacity

Question 24

What is the normal disparity between end-tidal PCO₂ and PaCO₂?

A) End-tidal PCO₂ is 1 to 5 mm Hg less than PaCO₂
B) End-tidal PCO₂ is 5 to 10 mm Hg less than PaCO₂
C) End-tidal PCO₂ is 1 to 5 mm Hg higher than PaCO₂
D) End-tidal PCO₂ is 5 to 10 mm Hg higher than PaCO₂

Question 25

What is the value of determining the lower inflection point during measurement of the pressure-volume curve?

A) Best tidal volume
B) Best PEEP level
C) To determine best airway size
D) To determine type of ventilator inspiratory flow pattern

Question 26

Which of the following factors is/are associated with an increased risk for auto-PEEP?
1) Mechanical ventilation of a patient with obstructive lung disease
2) High-minute volume during mechanical ventilation
3) Acute respiratory distress syndrome (ARDS) patients
4) Pulmonary fibrosis

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

Question 27

What is the upper limit for plateau airway pressure that is recommended during mechanical ventilation?

A) Less than 28 cm H₂O
B) 30 to 40 cm H₂O
C) 40 to 50 cm H₂O
D) Depends on the patient

Question 28

Which of the following values of V_D/V_T, are suitable for weaning?
1) 0.10
2) 0.20
3) 0.30
4) 0.60

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

Question 29

Which of the following lead to an increased end-tidal PCO₂?
1) Decreased effective ventilation
2) Increased metabolic rate
3) Decreased minute ventilation
4) Exercise

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

Question 30

What is the normal range for lung compliance?

A) 40 to 60 ml/cm H₂O
B) 60 to 100 ml/cm H₂O
C) 80 to 120 ml/cm H₂O
D) 100 to 120 ml/cm H₂O

Question 31

Which of the following breathing patterns suggests respiratory muscle decompensation?

A) Rapid and deep breaths
B) Rapid and shallow breaths
C) Slow and shallow breaths
D) Slow and deep breaths

Question 32

What is the average total work of breathing for healthy persons?

A) 0.31 to 0.2 J/L
B) 0.3 to 0.5 J/L
C) 0.5 to 0.8 J/L
D) 0.8 to 1.5 J/L

Question 33

In which of the following disorders would an increased V_D/V_T ratio not be likely?

A) Congestive heart failure
B) Pulmonary embolism
C) Acute lung injury
D) Hypothalamus tumor

Question 34

Which of the following are associated with auto-PEEP?
1) Erroneous calculation of static lung compliance
2) Hemodynamic compromise
3) Barotraumas
4) Increasing mean airway pressure

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

Question 35

Which of the following are causes of increased airway resistance?
1) Small endotracheal tube
2) High gas flow
3) Increased secretions
4) Frequent suctioning

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

Question 36

What is the normal range for V_D/V_T?

A) 0.10 to 0.20
B) 0.20 to 0.40
C) 0.30 to 0.50
D) 0.40 to 0.55

Question 37

What is the best parameter to measure when trying to assess respiratory muscle endurance?

A) FVC
B) MIP
C) MVV
D) NIF

Question 38

Which of the following are associated with a decreased end-tidal PCO₂?
1) Decreased metabolic rate
2) Increase in lung perfusion
3) Rapid and very shallow breathing
4) Decreased CO₂ production

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

Question 39

Which of the following is the R_aw of intubated patients receiving ventilatory support?

A) 1 to 2 cm H₂O/L/sec
B) 3 to 5 cm H₂O/L/sec
C) 5 to 10 cm H₂O/L/sec
D) 10 to 20 cm H₂O/L/sec

Question 40

Which of the following conditions is associated with an increased lung compliance measurement?

A) Atelectasis
B) Pneumonia
C) Emphysema
D) Bronchial intubation

Question 41

What is the normal central venous pressure reading?

A) 2 to 6 mm Hg
B) 5 to 12 mm Hg
C) 8 to 16 mm Hg
D) 12 to 22 mm Hg

Question 42

At what level of intracranial pressure will venous drainage be impeded and cerebral edema develop in uninjured tissue?

A) 10 to 15 mm Hg
B) 20 to 30 mm Hg
C) 30 to 35 mm Hg
D) 40 to 45 mm Hg

Question 43

What medication is associated with dilated and fixed pupils in the intensive care unit patient?

A) Atropine
B) Lidocaine
C) Vanceril
D) Aminophylline

Question 44

What hemodynamic parameter is best useful for estimated left ventricular end-diastolic pressure?

A) CVP
B) PCWP
C) SVR
D) PVR

Question 45

What is the normal range for cardiac output?

A) 2 to 4 L/min
B) 4 to 8 L/min
C) 5 to 10 L/min
D) Depends on patient age

Question 46

Which of the following are used to determine a patient's neurologic status?
1) Measuring V_D/V_T ratio
2) Pupillary response and eye movement
3) Corneal and gag reflex
4) Respiratory rate and pattern

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

Question 47

Which of the following levels of albumin are consistent with severe malnutrition?

A) Less than 3.0 g/dl
B) Less than 2.5 g/dl
C) Less than 2.2 g/dl
D) Less than 4.0 g/dl

Question 48

What is the normal mean pulmonary artery pressure?

A) 5 mm Hg
B) 10 mm Hg
C) 15 mm Hg
D) 20 mm Hg

Question 49

What level of urine output is considered anuria?

A) Less than 500 ml/day
B) Less than 250 ml/day
C) Less than 150 ml/day
D) Less than 50 ml/day

Question 50

What parameter is best used to assess left ventricular afterload?

A) CVP
B) PCWP
C) SVR
D) PVR

Question 51

Which of the following physical findings is not consistent with starvation?

A) Temporal muscle wasting
B) Sunken supraclavicular fossae
C) Decreased adipose stores
D) Less than 50 ml/day

Question 52

What is the most common method of estimating GFR?

A) Blood urea nitrogen
B) Blood urea nitrogen and creatinine
C) Plasma creatinine and creatinine clearance
D) Urine output

Question 53

What is the normal range for mean arterial pressure?

A) 60 to 80 mm Hg
B) 50 to 100 mm Hg
C) 80 to 100 mm Hg
D) 90 to 120 mm Hg

Question 54

What is the Glasgow Coma Scale (GCS) score that requires intracranial pressure monitoring?

A) Less than 8
B) Less than 9
C) Less than 10
D) Less than 11

Question 55

What is the normal range for pulmonary capillary wedge pressure?

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

Question 56

Which of the following should be considered first if medical and mechanical problems have been excluded and the patient continues to fight the ventilator or exhibit high levels of agitation or distress?

A) Paralytics
B) Sedatives
C) Narcotics
D) Anesthetics

Question 57

Which of the following are global monitoring indexes?
1) APACHE
2) APS
3) TISS
4) ATS

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

Question 58

Elevation of which of the following substances is consistent with hepatic inflammation?

A) Aspartate aminotransferase
B) Bilirubin
C) Alkaline phosphatase
D) Blood urea nitrogen

Question 59

Which of the following are associated with an increase in central venous pressure?
1) Right heart failure
2) Pulmonary valvular stenosis
3) Pulmonary embolism
4) Dehydration

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

Question 60

Which of the following are common purposes of using ventilator graphics?
1) To detect auto-PEEP
2) To assess effects of bronchodilators
3) To determine patient ventilator synchrony
4) To determine best FiO₂

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

Question 61

Which of the following are primary reasons to measure intracranial pressure (ICP)?
1) To monitor patients at risk of life-threatening intracranial hypertension
2) To monitor for evidence of infection
3) To assess the effects of therapy aimed at reducing ICP
4) To maintain the mean ICP greater than 20 mm Hg

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

Question 62

Which of the following bedside assessment of respiratory muscle strength is commonly used on ventilated patients?

A) Tidal volume
B) Maximal inspiratory pressure
C) Minute ventilation
D) Respiratory rate

Question 63

Which of the following are included in the Berlin definition of moderate ARDS?
1) Bilateral infiltrates on chest radiograph
2) Absence of left ventricular failure
3) PaO₂/FiO₂ 100 - 200 mm Hg
4) Oxygenation index (OI) less than 10

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

Question 64

Which of the following factors affect cardiac performance?
1) Preload
2) Afterload
3) Contractility
4) Cardiac output

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