Final exam Flashcards
Given the following data, calculate the alveolar minute ventilation. Tidal volume 450 mL, dead space 100 mL, respiratory rate 16 breaths/min.
5.6L/Min
Choose the mode of ventilation that permits pressure supported spontaneous breathing in between mandatory breaths.
Synchronous intermittent mandatory ventilation (SIMV)
Your patient is suffering from severe pain after experiencing a hip fracture after falling off a roof. Which agent is most appropriate at this time?
Opioid analgesic
A patient who has a decrease in lung compliance due to acute respiratory distress syndrome during volume-limited ventilation will cause which of the following?
Increased peak airway pressures
Your patient has just undergone a hip repair in the operating room. The patient received a non-depolarizing neuromuscular blocking agent for the procedure. Which agent may be used to reverse the paralytic?
Tensilon
A 75-year-old male with a long history of (COPD) is brought to the emergency department with shortness of breath. He has a persistent, productive cough with green purulent sputum, cyanosis of the lips and extremities, and is cooperative. His arterial blood gas values on 2 L/min by nasal cannula are: pH = 7.28; PaCO2 = 80 mm Hg; PaO2 = 50 mm Hg; SaO2 = 80%; HCO3- = 38 mEq/L. The most appropriate action at this time is which of the following?
Non-invasive ventilation using (BiPAP) with a oronasal mask
An expiratory hold maneuver is performed to evaluate for auto-PEEP. What is auto-PEEP also known as?
Intrinsic PEEP
Which is not a potential use for ultrasound in the ICU?
Identify bacterial and viral pathogens
What is the trigger for CPAP/PSV?
Flow
What is the trigger for Volume control ventilation (VCV)?
Volume
What is the trigger for Pressure control ventilation (PCV)?
Time
What is the trigger for Pressure regulated volume control (PRVC)?
Time
Your patient has recently undergone thoracentesis. The laboratory results show high levels of protein. These results are consistent with an exudative pleural effusion. Which is a potential cause?
Cancer
You are bagging an intubated patient in cardiac arrest. The physician has the nurse push an ampule of bicarbonate. Which of the following is true?
You will need to increase the minute ventilation
A respiratory therapist has started pressure regulated volume control (PRVC) ventilation on a patient in acute respiratory failure (ARF). After placing patient on the ventilator, the “pressure limit” alarm is triggered. The high pressure limit (HPL) alarm is set at (35 cm H2O) and the peak inspiratory pressure (PIP) is reaching (30 cm H2O). The inhaled tidal volume is only reaching (300 mL) but tidal volume target is (400 mL). What should the therapist do at this point?
Increase the high pressure alarm limit
Which neuromuscular blocking agents are non-depolarizing? They block the transmission of nerve impulses at the neuromuscular junction. (You may choose more than one).
Vecuronium
Pancuronium
Atracurium
A patient on the mechanical ventilator with the following settings is still having difficulty with oxygenation (PaO2 is 55 torr / 86% SpO2):
PRVC
Vt = 440 mL (7 mL/kg/IBW)
Frequency = 14 breaths/min
I-time = 1.0s
PEEP = 5 cm H2O
FiO2 = 70%
What would be the best option to improve the patient’s PaO2?
Increase the PEEP
You suspect your patient is suffering from hypoxia. Which symptom is not associated with moderate hypoxia?
Mild hypertension
Which laboratory values would you expect to be elevated in a patient with allergic reaction? (you may choose more than one).
Eosinophils
Basophils
A respiratory practitioner is preparing to perform a spontaneous breathing trial (SBT). What mode of ventilation should be chosen in order to complete a (SBT)?
CPAP/Pressure support ventilation
In pressure-limited ventilation the trigger for a patient who is paralyzed is which of the following?
Time
Certain patients are prone to developing auto-PEEP or air-trapping. Choose all patient populations below that might be at higher risk of developing auto-PEEP.
COPD
Asthma
Pressure support plays multiple roles in mechanical ventilation. Choose the common goals when utilizing pressure support (choose all that apply).
Improve patient synchrony and comfort
To evaluate patients endurance for extubation
Reduce patient’s work of breathing (WOB)
You are assessing a patient’s vitals and you note that the heart rate is 40 beats/minute and the patient is light headed, has chest pain, and is short of breath. Which medication is indicated at this time?
Atropine
Which statement is not true regarding plateau pressure?
Under dynamic conditions, (Pplateau) reflects proximal airway pressure
An increase in airway resistance during pressure-limited ventilation will have which of the following effects?
Decrease in tidal volume
An increase of peak inspiratory pressure with no change in plateau pressure is associated with the following:
Increase in airway resistance
You are evaluating a patient on mechanical ventilation for an (SBT) with a history of alcohol abuse. Every time the patients sedation is turned off, they become extremely agitated, and sedation is restarted. The sedation compromises the patients respiratory drive. Which sedative can be used so that the patient may tolerate an (SBT) without respiratory depression?
Precedex
Mean airway pressure equals oxygenation. How can you increase mean airway pressure?
Increase the I-time
Which laboratory results would you expect to see in a patient with renal disease/failure? (You may choose more than one).
Elevated BUN
Elevated Creatinine
Excess mechanical dead space can lead to a decreased volume of gas delivered to the alveoli. This affects gas exchange. Which of the following does not increase mechanical dead space?
Tracheostomy
What patient trigger requires the least amount of effort to initiate a breath during mechanical ventilation?
Flow
What is the (I:E ratio) if the (I-time) is (0.9 seconds) and the (E-time) is (4 seconds)?
1:4.4
Identify the potential causes of ventilator induced lung injury. (You may choose more than one).
Tidal volume of 12 ml/kg/IBW
Atelectasis
A patient arrives in the emergency department with severe congestive heart failure. Which class of drug will improve the patient’s heart contractility
Positive inotrope
Calculate the static compliance for a patient on the following ventilator settings:
AC/Volume Control
Rate: 14
Exhaled tidal volume: 540 mL
Flow: 32 L/min
Inspiratory time: 1.0s
FiO2: 40%
PEEP: 8
Peak inspiratory pressure: 30
Plateau pressure: 26
30 mL/cm H2O
Which is a known cause of relative shunt?
Atelectasis
Your have just calculated the static compliance (CST) on a (COPD) patient that is intubated and on the ventilator. The patients (CST) is (80 mL/cm H2O). What does this indicate?
The patient has decreased compliance.
You calculate a patients airway resistance while they are intubated and on ventilatory support. The patients (RAW) is (8 cm H2O/L/second). What does this indicate?
The patients airway resistance is low.
The application of PEEP has many benefits including lung recruitment and improved oxygenation. What are the potential complications associated with the application of PEEP? (You may choose more than one).
Barotrauma
Decreased venous return to the heart
A 50-year-old female, who is (5 ft 6 inches) tall and weighs (175 lb), arrives in the ICU after undergoing surgery for a bowl resection. She is receiving PC/AC ventilation and the following data is available:
FIO2 = 0.70, mandatory rate = 14 breaths/min, total rate = 16 breaths/min, peak inspiratory pressure = 24 cm H2O, exhaled VT = 350 mL, PEEP = 10 cm H2O.
ABG results: pH 7.36, PaCO2 45, PaO2 100, HCO3- 24, SaO2 98%
Which ventilator change should the respiratory therapist make?
Decrease the FIO2 to 0.60
While assessing a ventilated patient, you note that the patient is making an effort to breathe. The ventilator fails to deliver a breath. What change on the ventilator should you make?
Increase the trigger sensitivity
Observe the following pressure-volume loop. What does the loop indicate?
Decreased compliance
You are assessing a mechanically ventilated patient in the ED. You note that the patient appears asynchronous with the ventilator. Which is a potential risk associated with patient-ventilator asynchrony?
Hypoxemia
Observe the following flow-time scalar. What does the yellow arrow indicate?
Air Trapping
A patient with ARDS has been mechanically ventilated for 4 days. The patient is on the following ventilator settings:
AC/PCV
Pressure 16
Mandatory rate 22
Total rate 22
PEEP 18
FIO2 0.80
SPO2 89%
The patients P/F ratio is 70 mm Hg. Which of the following should you recommend?
Prone positioning
You observe the following flow-volume loop. What does the white arrow indicate?
Airway Obstruction
Calculated the dead space to tidal volume ratio for at patient with a PaCO2 of 65 mm Hg, and an PECO2 of 45 mm Hg.
0.30
Which ventilator setting changes will not decrease PaCO2?
Increase the mechanical dead space
Match the components of the flow-time scalar:
Start of inspiration
Peak inspiratory flow
Inspiration ends
Exhalation
Peak expiratory flow
Baseline
Start of next breath
A 65-year-old male has just been resuscitated after a witnessed cardiac arrest. The physician wants to start therapeutic hypothermia. What is the correct core body temperature and duration?
34 °C for 24 hours
You observe the following ventilator graphic and note a spike (green arrow) on the pressure-time curve. What does the green arrow indicate?
The rise is too fast
A 37-year-old female has had a chest tube placed for a hemothorax following a motor vehicle accident. What is the purpose of the water seal chamber?
Acts as one-way valve, allowing gas to exit the pleural space on exhalation, preventing air from entering the pleural space on inhalation.
A patient in the ICU with severe sepsis has had 4000 mL of IV fluids in the last 24 hours. The patients urine output is 400 mL in the last 24 hours. How would you interpret the patients urine output?
Oliguria
You have just initiated mechanical ventilation on a patient in the ICU. What should you do first?
Patient Assessment
A 31-year-old male is intubated following a motor vehicle crash. The respiratory therapist palpates asymmetrical chest movement during each inspiration when the bag-valve-mask is squeezed. No crepitus is noted. Breath sounds are diminished on the left. What should the therapist do first?
Assess depth of the endotracheal tube
Your patient is being ventilated in the AC/VC mode and you note a sudden increase in the peak inspiratory pressure. Which of the following are potential causes?
I. Secretions
II. Bronchospasm
III. Pneumothorax
IV. Decrease in compliance
All of the above
You are assessing a mechanically ventilated patients’ mental status using the Richmond Agitation Sedation Scale. Your patient moves and opens their eyes to voice but makes no eye contact. What is the patients RASS score?
-3 moderate sedation
You observe the following pressure-time scalar on a mechanically ventilated patient. What change should you make on the ventilator to correct the delayed cycling?
Decrease the I-time
A 47-year-old (6 ft 1 inch) tall male has just been intubated with a 7.5 ETT secured 23 cm at the lip. Breath sounds are diminished in the left lung field, and correct position is verified via CO2 detector. The following chest radiograph is obtained:
Pull the ETT back 3 cm.
While doing an assessment on a ventilated patient, you observe the following ventilator graphic. You note a leak in the volume scalar, and that the respiratory rate correlates with the pulse-ox. What does the graphic indicate?
Auto-trigger
You have just received an order to perform a recruitment maneuver on a ventilated patient suffering from severe ARDS. Which settings would you use?
PEEP of “30 for 30” seconds
Which laboratory studies should be ordered to evaluate kidney function? (You may choose more than one).
BUN
Creatinine
Clinicians must be diligent in preventing ventilator induced lung injury. Which method is “not” used to prevent ventilator induced lung injury?
PEEP of (2 cm H2O)
You have a patient that has been intubated and placed on mechanical ventilation for airway protection after suffering from an ischemic stroke. What could you do to help prevent ventilator associated pneumonia?
Perform subglottic suctioning before moving the endotracheal tube.
Which of the following factors determine tissue oxygenation?
I. Inspired oxygen concentration
II. Ventilation-perfusion relationships
III. Cardiac output
IV. CaO2
All of the Above
A 25-year-old male intubated for acute asthma has arrived in the ICU from the ED. During your assessment you note that the ETT cuff balloon is tight and that the ETT cuff pressure is 60 cm H2O. Which are risks associated with high ETT cuff pressures? (You may choose more than one).
Stenosis
Tracheal mucosal ischemia
Granulation
While listening to heart sounds you note a “Whooshing” sound while auscultating the heart. Which is a potential cause?
Mitral valve regurgitation
You are called to the (ICU) by the (RN) to address a ventilator alarm on a mechanically ventilated patient. The ventilator is alarming low oxygen concentration. The FIO2 is set at 0.50 and is reading 0.21. The patients HR is 125 beats/min, SPO2 is 78%, RR is 35 breaths/min. Patient appears pale, and agitated. What should you do?
Begin bag mask ventilation.
Interpret the following chest radiograph.
Left sided pleural effusion
What are the appropriate oxygenation goals for most patients receiving mechanical ventilation?
PaO2 (60 to 80 mm Hg), SaO2 (90 to 95%), FIO2 (≤0.50 to 0.60)
What disease process does not decrease compliance?
Mucus plugging
Calculate the (PAO2) for a patient breathing (60%) oxygen, at (1 atmosphere) with a (PaCO2) of (65mm HG).
346
With an increase in (Raw), how is the (PIP-Plat) difference affected?
The (PIP- PLAT) is increased
Decreased (PCO2) is a cerebral vasodilator, while increased (PCO2) is a cerebral vasoconstrictor.
False
How Can positive pressure ventilation affect the cardiovascular system?
As A positive pressure increases, cardiac output may decrease.
Positive Pressure ventilation can decrease left ventricular output
A decrease in cardiac output correlates with increasing positive pressure and/or PEEP levels
During volume ventilation, how does a decrease in airway resistance affect the ventilator?
The PIP will decrease
What is the primary difference between relative shunt (V/Q mismatch) versus absolute shunt (intrapulmonary shunt).
Absolute shunt may require higher levels of oxygen and PEEP
Your patient has been on mechanical ventilation for 12 days. The physician asks to evaluate the patient for SBT. The patient is awake, alert and able to follow commands.
MIP: -22cm h20
RR: 32
VT 320 (5ml/kg/IBW)
What is the most likely cause
The patient has diaphragmatic dysfunction
Calculate the Raw for a patient on the following ventilator settings:
Mode: Ac/Vc
TV: 600ml
Rate:12
PEEP: 5cm
I-time: 1.0 second
Flow: 36L/min
FIO2: 30%
PIP 35cm H20
Plat: 25cm H20
17cm H20
What does the bottom portion of the pressure-volume cure represent?
Atelectrauma
Which is a known cause of relative shunt
Retained secretions
Looking at the pressure, flow, volume scalars below, what is the mode of ventilation?
Volume Control VCV
Why is nutritional support important in patient on mechanical ventilation?
insufficient nutritional support can result in respiratory muscle catabolism and atrophy
During HFOV, which settings influence ventilation
frequency (HZ), amplitude, I-time
Your patient has been intubated and on mechanical ventilation for (72hrs). You note that the patient has a fever, increased mucus production, and is requiring higher amounts of oxygen to maintain adequate saturations. The morning chest radiograph shows new consolidation/infiltrates. What is the probable cause?
Ventilator associated pneumonia
An esophageal catheter has just been placed on a patient with spinal cord injury after a mover vehicle accident, and (NAVA) has been initiated. Which statement is true?
When set appropriately, NAVA should allow the patient to drive respiratory rate, maintain PaCO2, while unloading the respiratory muscles
Which best describes “critical illness polyneuropathy?”
Symmetric, distal sensory-motor axonal polyneuropathy that affects motor, sensory and autonomic nerves
What is the oxygen delivery (DO2) a patient receives if the cardiac output is 3.5 L/min and the CaO2 us 15 ml/dl.
525 ml/min
A patient on the mechanical ventilator with the following settings is still having difficulty with oxygenation (Pa02 it 52 mm Hg 84% Spo2)
A/C
Vt: 530mls (8ml/kg/IBW)
Frequency: 14 breaths/min
I-time: 1.0 second
PEEP- 14 cm H20
Fio2= 0.30
What would be the best option to improve the patient’s (PaO2)
Increase the FiO2
Which situation has the highest airway resistance?
PIP 56cm H20, Plat 20cm H20, flow is 35 L/min
Positive pressure ventilation has know affects on the gastrointestinal system. Which of the following is not typically seen?
Increased tolerance to tube feedings.
What is the most common flow waveform/graphic for mandatory breaths in the pressure control mode?
Decending/decelerating
You have just calculated the static compliance on a COPD patient that is intubated and on the ventilator. The patients static compliance is 80ml/cm H20
The patient has increased compliance
You have placed a patient with severe ARDS on High frequency oscillatory ventilation. You set the HZ at 6. what is the frequency? (breaths/min)
360 breaths/min
A patient with a (COPD) exacerbation presents to the emergency department in severe respiratory distress. The patient is subsequently intubated. What are the most appropriate initial ventilator settings?
Male, 5 feet 10 inches tall.
HR 120, SPO2 84%, RR 32, BP 145/96, breath sounds are diminished, with expiratory wheezing,
AC/VC, VT 580, RR 12, PEEP 8, FIO2 100%.
In order to avoid oxygen toxicity, clinicians should attempt to limit use of 100% oxygen to what period of time?
<24 hours
Which is considered a (Level 1) alarm notification on a ventilator?
Exhalation valve failure
What does the flow-time scalar represent?
Graphic display of inspiratory gas flow versus time.
You calculate a patients airway resistance while they are intubated and on ventilatory support. The patients (RAW) is (8 cm H2O/L/second). What does this indicate?
The patients airway resistance is normal.
Development of significant tachycardia, tachypnea, drop in oxygen saturation, or other signs of distress are associated with which of the following?
Failed SBT
Which factors increase exhaled nitric oxide (FENO)?
I. Ciliary diskinesis
II. Asthma
III. Cystic fibrosis
IV. Pulmonary Sarcoidosis
II and IV
Which technique often supplements the physical examination and provides real-time imaging capabilities in the (ICU)?
Ultrasound
What does lung sliding or shimmering virtually rule out?
Pneumothorax
A critically ill patient is being transported to another hospital (30 miles away). Because the ground traffic has major delay due to rush hour traffic and multiple accidents in route, which mode of transportation should be considered?
Rotary Wing
Which factors are associated with readiness to discontinue mechanical ventilation?
PaO2/FIO2 ratio (≥150 mm Hg)
What is the purpose of using continuous positive airway pressure (CPAP)?
I. Minimize the work of breathing
II. Increase respiratory muscle strength
III. Reduce soft tissue obstruction
IV. Restore functional residual capacity
I, III, IV
What are the immediate complications associated with flexible bronchoscopy? (You may choose more than one)
Hypoxemia, Pneumothorax, Bleeding/Hemorrhage
Which ventilator discontinuance technique is the most rapid method for ventilator liberation for most patients?
Spontaneous breathing trials
During (CPR), shockable cardiac rhythms include ventricular fibrillation and which other cardiac rhythm?
Pulseless ventricular tachycardia
You are providing (CPR) to a patient in V-fib arrest. The patient does not have a pulse. There is a end-tidal (CO2) detector inline. How do you know you are providing effective chest compressions?
PETCO2 is reading (20 mm Hg)
Which is not an indication for non-invasive positive pressure ventilation (NPPV)?
Significant facial trauma
Choose the correct statement regarding the effects of right ventricular failure, hypovolemia, blood loss, and shock:
central venous pressure will decrease
Which mechanical factors can contribute to ventilator dependence?
I. Inappropriate ventilator settings
II. Reduced trigger effort
III. Patient-ventilator syncrony
IV. Increased work of breathing due to artificial airway
I and IV
Many factors may affect the accuracy of pulse oximetry. Which of the following affect the accuracy? (You may choose more than one)
Methemoglobinemia, very low oxygen saturation’s, motion artifact
Mr. Jones develops extreme dyspnea, anxiety, and is coughing up pink frothy sputum. His heart rate is (120 bpm) and his breath sounds reveal crackles throughout both lung fields. The PAOP/PAWP is (30 mm Hg). Which is the most likely diagnosis?
Pulmonary edema
Which of the following are used for non-invasive monitoring?
I. Oximetry
II. Capnography
III. Transcutaneous oxygen and carbon dioxide monitoring
IV. Central venous pressures
I, II, III
You have received a patient in the (ED) post gunshot wound. The patient is bleeding profusely from the wound and has lost a significant amount of blood. The team is waiting for blood products. In the meantime, what can be given to increase the patients preload?
IV Fluids
Intravenous fluids with high osmotic pressures, intravenous medications, and parenteral nutrition should be infused using which access point?
central vein
The (ABCDEF) bundle for ventilator liberation includes which of the following?
I. Assess, treat and manage pain
II. Both SATs and SBTs
III. Early mobility and exercise
IV. Functional assessment and support
I, II and III
You are looking through a patients chart after getting report. While looking through the patients labs you note an low platelet count (90,000 mm), an elevated amniotransferase (ALT) 85 IU/L, and an elevated bilirubin of (5 mg/dL). What do these lab values indicate?
Liver failure
Patients who are identified as being at high risk for extubation failure may benefit from extubation directly to which therapeutic intervention?
Prophylactic non-invasive ventilation
While assessing a patient in the (ICU) you not the (MAP) on the monitor is (60 mm Hg). What is indicated at this time?
Vasopressors
For a large hemothorax, the chest tube should be inserted over the rib from the _______ intercostal space along the _______ line
4th and 6th. midaxillary line
Which are criteria for discontinuing mechanical ventilation? (You may choose more than one)
MIP (<-20 cm H2O)
Improvement or reversal of underlying disease state or condition
Which type of catheter is used to assess central venous (right atrial) pressures, right ventricular pressures, pulmonary artery pressures, pulmonary capillary wedge pressures (PCWP), and cardiac output?
Pulmonary artery catheter
A (5ft 9 inchs) tall male is placed on BiPAP (IPAP 12 / EPAP 6 / FIO2 0.5 / backup rate 8) for COPD exacerbation. The measured tidal volume is 400 mLs, RR 28, HR 112, SpO2 96%. A post-BiPAP ABG reveals the following:
pH 7.27
PaCO2 49 mm Hg
PaO2 77 mm Hg
HCO3- 25 mEq/L
SaO2 95%
What should the respiratory practitioner recommend?
Increase the IPAP
What is the primary goal of bronchial brushing during flexible bronchoscopy?
To collect cell samples
Intraosseous access may be used to perform all of the following functions except:
collect arterial blood gas samples
Your are taking care of a patient with the following hemodynamic parameters: PAP (38/18), CVP (6 mm Hg), PCWP (8 mm Hg).
pulmonary hypertension
A (58-year-old) male arrives to the emergency department in severe respiratory distress. He is using accessory muscles, RR 28/min, HR 128 bpm, SPO2 88% on non-rebreather mask. His ABG results are as follows:
pH 7.28
PaCO2 61 mm Hg
PaO2 56 mm Hg
HCO3- 34 mEq/L
SaO2 86%
Which intervention should the respiratory practitioner recommend at this time?
Place patient on NIV (IPAP 12 and EPAP 6)
What are colorimetric (CO2) detectors commonly used for?
Access endotracheal tube placement
