Ch 14 Test, VAP Flashcards
A pneumonia that was not incubating at the time of admission is one that develops a minimum of how many hours after admission?
a. 12 hours
b. 24 hours
c. 48 hours
d. 72 hours
ANS: C
Pneumonias that develop 48 hours after a patient is admitted or placed on a mechanical ventilator are hospital-acquired pneumonias.
DIF: 1 REF: p. 294
The type of organism that most often causes ventilator-acquired pneumonia is which of the following?
a. Fungi
b. Bacteria
c. Viruses
d. Protozoa
ANS: B
Ventilator-associated pneumonia (VAP) is most often caused by bacterial infections, but it can be caused by fungal infections or associated with viral epidemics.
DIF: 1 REF: p. 294
A patient was intubated in the emergency department just after arrival at the hospital from home. This patient develops VAP 36 hours after intubation. What type of pneumonia is this considered?
a. Early-onset VAP
b. Late-onset VAP
c. Health care–associated pneumonia
d. Non–hospital-acquired pneumonia
ANS: D
The development of pneumonia within 48 hours of admission and intubation is a result of an infection that was incubating at the time of admission.
DIF: 2 REF: p. 294
The mortality rate for VAP associated with prolonged hospital stays is which of the following?
a. 5% to 25%
b. 15% to 40%
c. 25% to 50%
d. 45% to 75%
ANS: C
The mortality rate for ventilator-associated pneumonia is 25% to 50%.
DIF: 1 REF: p. 295
Sixty percent of all VAP infections are caused by which of the following?
a. Aerobic gram-negative bacilli
b. Anaerobic gram-negative bacilli
c. Aerobic gram-negative rods
d. Anaerobic gram-positive cocci
ANS: A
Aerobic gram-negative bacilli have accounted for nearly 60% of all VAP infections. The most common of these are Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp.
DIF: 1 REF: p. 295
The most common gram-positive bacterium that causes ventilator-associated pneumonia is which of the following?
a. Streptococcus pneumoniae
b. Enterococcus faecalis
c. Methicillin-resistant Staphylococcus aureus
d. Pseudomonas aeruginosa
ANS: C
The predominant gram-positive bacterium that causes VAP is methicillin-resistant Staphylococcus aureus (MRSA). P. aeruginosa is a gram-negative bacterium.
DIF: 1 REF: p. 295
Patients with chronic obstructive pulmonary disease (COPD) are at higher risk for infection with which of the following organisms?
- Haemophilus influenzae
- Pseudomonas aeruginosa
- Moraxella catarrhalis
- Staphylococcus aureus
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 4 only
d. 3 and 4 only
ANS: B
Patients with COPD have an increased risk for infection with H. influenzae, S. pneumoniae, and M. catarrhalis, whereas patients with cystic fibrosis are susceptible to P. aeruginosa and S. aureus infections.
DIF: 1 REF: p. 296
The incidence of ventilator-associated pneumonia for all intubated patients is ___________.
a. 8% to 28%
b. 15% to 35%
c. 25% to 50%
d. 38% to 76%
ANS: A
The incidence of VAP ranges from 8% to 28% for all intubated patients.
DIF: 1 REF: p. 295
The mortality rate for VAP depends on which of the following?
- Length of stay on the ventilator
- Presence of underlying disease
- Prior antimicrobial therapy
- Presence of a heated humidifier
a. 1 and 2 only
b. 2 and 3 only
c. 1 and 4 only
d. 1, 2, 3, and 4
ANS: B
The overall attributable mortality rate for VAP depends on the infecting organism or organisms, the presence of underlying disease, and prior antimicrobial therapy.
DIF: 1 REF: p. 296
Healthy individuals usually have which of the following bacteria in their upper airways?
a. Haemophilus sp.
b. Acinetobacter sp.
c. Pseudomonas aeruginosa
d. Staphylococcus aureus
ANS: A
The upper airways of healthy individuals typically contain nonpathogenic bacteria, such as the viridans group of streptococci, Haemophilus sp., and anaerobes.
DIF: 1 REF: p. 297
Effective treatment of ventilator-associated pneumonia can be ensured by diagnosis based on findings from which of the following?
a. Chest radiographs
b. Hematological studies
c. Bronchial alveolar lavage
d. Patient signs and symptoms
ANS: C
The American Thoracic Society and the Infectious Diseases Society of America suggest that quantitative cultures of the lower respiratory secretions be obtained by bronchial alveolar lavage or protected specimen brush to ensure effective treatment of patients with VAP. Chest radiographs, hematological studies, and patient signs and symptoms should be used to start empiric antibiotic therapy before the quantitative cultures are performed.
DIF: 1 REF: p. 297
Calculate the Clinical Pulmonary Infection Score (CPIS) for a patient with the following assessments: 56-year-old female, post motor vehicle accident, intubated and mechanically ventilated for 4 days. Static compliance is 42 cm H2O/L. Tracheobronchial suctioning reveals a moderate amount of yellow secretions; culture and sensitivity is pending. Breath sounds reveal bilateral lower lobe coarse rhonchi. Chest radiograph shows diffuse infiltrates. Partial pressure of oxygen in the arteries (PaO2) is 72 mm Hg on 40% supplemental oxygen. Patient has a temperature of 39.2°C, and white blood cell count (WBC) is 12,800μL.
a. CPIS = 5
b. CPIS = 6
c. CPIS = 7
d. CPIS = 8
ANS: C
Using the CPIS criteria found in Table 14-1, the score is calculated as follows: Temperature of 39.2°C = 2 points; white blood cell (WBC) is 12,800μL = 1 point; Secretions are present and nonpurulent = 1point; partial pressure of oxygen in the arteries/fractional inspired oxygen (PaO2/FIO2) = 72/0.4 = 180 with no acute respiratory distress syndrome (ARDS) = 2 points; Chest radiograph shows diffuse infiltrates = 1 point; and compliance and saturation in the blood phase (C & S) is pending = 0 points, for a total of 7 points.
DIF: 2 REF: p. 297; Table 14-1
A patient with which of the following CPIS criteria should be placed on empiric antibiotic therapy pending the outcome of a bronchial alveolar lavage?
a. CPIS = 4
b. CPIS = 5
c. CPIS = 6
d. CPIS = 7
ANS: D
When all six criteria are used, a score > 6 is considered evidence of the presence of VAP. It is generally accepted that measurements of the Clinical Pulmonary Infection Score should be performed at the beginning of antibiotic therapy and after 2 to 3 days to re-evaluate the effectiveness of the treatment.
DIF: 2 REF: p. 297
Critically ill patients receiving invasive mechanical ventilation have been found to have which of the following microorganisms not typically present in healthy individuals?
a. Anaerobes
b. Haemophilus species
c. Gram-negative bacilli
d. Viridans group of streptococci
ANS: C
During critical illnesses, particularly in patients with an endotracheal tube and those receiving mechanical ventilation, a dramatic shift occurs in the flora of the oropharyngeal tract to gram-negative bacilli and Staphylococcus aureus.
DIF: 1 REF: p. 297
Reasons for the shift in oropharyngeal flora in patients receiving invasive mechanical ventilation with endotracheal tubes include which of the following?
a. Lowered pH levels
b. Increase in mucus-producing cells
c. Decreased production of proteases
d. Decreased mucosal immunoglobulin A
ANS: D
The shift in flora is most likely due to a number of factors that compromise host defense mechanisms. These include comorbidities, malnutrition, reduced levels of mucosal immunoglobulin A, increased production of proteases, exposed and denuded mucous membranes, elevated airway pH, and an increased number of airway receptors for bacteria as a result of acute illness and previous antimicrobial use.
DIF: 1 REF: p. 297
