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