MV2 Final Flashcards
pneumonia that was no incubated at the time of admission is one that develops a minimum of how many hours after admission?
a. 12 hours
b. 24 horus
c. 48 hours
d. 72 hours
c. 48 hours
the type of organism that most often causes ventilator-acquired pneumonia is which of the following
a. fungi
b. bacteria
c. viruses
d. protozoa
b. bacteria
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. nonhospital acquired pneumonia
d. nonhospital acquired pneumonia
The mortality rate for VAP associated with prolonged hospital stays is which of the following?
a. 5-25%
b. 15-40%
c. 25-50%
d. 45-75%
c. 25-50%
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
a. Aerobic gram-negative bacilli
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
c. Methicillin-resistant Staphylococcus aureus (MRSA)
Patients with chronic obstructive pulmonary disease (COPD) are at higher risk for infection with which of the following organisms? 1. Haemophilus influenzae 2. Pseudomonas aeruginosa 3. Moraxella catarrhalis 4. Staphylococcus aureus
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 4 only
d. 3 and 4 only
b. 1 and 3 only
The incidence of ventilator-associated pneumonia for all intubated patients is ___________.
a. 8-28%
b. 15-35%
c. 25-50%
d. 38-76%
a. 8-28%
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
b. 2 and 3 only
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
a. Haemophilus sp.
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
c. bronchial alveolar lavage
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 are 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 12,800.
a. CPIS = 5
b. CPIS = 6
c. CPIS = 7
d. CPIS = 8
c. CPIS = 7
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
d. CPIS = 7
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
c. gram-negative bacilli
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
d. decreased mucosal immunoglobulin A
Relying on clinical findings for the treatment of ventilator-associated pneumonia may do which of the following?
a. Decrease the morbidity of VAP.
b. Decrease the mortality of VAP.
c. Create multidrug-resistant organisms.
d. Reduce the need for invasive microbiologic procedures
c. Create multidrug-resistant organisms.
The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus
aureus in a patient with late-onset VAP is which of the following?
a. Linezolid
b. Gentamicin
c. Tobramycin
d. Ciprofloxacin
a. linezolid
The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus
aureus in a patient with early-onset VAP is which of the following?
a. Linezolid
b. Vancomycin
c. Gentamicin
d. Levofloxacin
d. levofloxican
A 63-year-old male, post head trauma, is intubated and has been mechanically ventilated for
78 hours. The respiratory therapist notes the following during ICU rounds: partial pressure of oxygen in the arteries (PaO2) is 82 mm Hg on 60% supplemental oxygen with a positive end expiratory pressure (PEEP) of 8 cm H2O; static compliance is averaging 38-41 cm H2O/L; breath sounds are diminished bilaterally. Bronchoalveolar lavage (BAL) results are pending, but MRSA is suspected. Chest radiograph shows bilateral, patchy infiltrates. Patient has a temperature of 38.8° C, and the most recent white blood cell (WBC) count is 11,300. The most appropriate recommendation for this patient is which of the following?
a. Monotherapy with an antipseudomonal carbepenem
b. Monotherapy with an antipseudomonal fluoroquinolone
c. Combination therapy with two types of antipseudomonal agents and vancomycin
d. Combination therapy with ampicillin/sulbactam and linezolid
c. Combination therapy with two types of antipseudomonal agents and vancomycin
Which of the following is not a method to reduce the risk of VAP?
a. Nasally intubate whenever possible.
b. Provide intermittent nasogastric tube feedings.
c. Keep patient in a semirecumbent position.
d. Use heat/moisture exchangers when possible
a. nasally intubate whenever possible
Which pathogen is commonly found in patients who had percutaneous tracheostomies?
a. Klebsiella spp.
b. Pseudomonas sp.
c. Enterobacter spp.
d. Candida albicans
b. pseudomonas sp.
To avoid ventilator-associated pneumonia, how often should ventilator circuits be changed?
a. Every 24 hours
b. Every 48 hours
c. Once weekly
d. When visibly dirty
d. when visibly dirty
The main strategy for the management of VAP focuses on which of the following?
a. Pharmacological treatment
b. Early diagnosis and treatment
c. Prophylactic antibiotic therapy
d. Reduction of host-related risk factors
b. early diagnosis and treatment
. A “ventilator bundle” may include which of the following?
- Keeping the head of the bed at 30 degrees from the horizontal.
- Changing the ventilator circuits every 48 hours.
- Using heated humidifiers whenever possible.
- Using noninvasive positive pressure ventilation (NPPV) whenever possible.
a. 1 and 3 only
b. 1 and 4 only
c. 2 and 3 only
d. 1, 2, and 4 only
b. 1 and 4 only
According to the Centers for Disease Control (CDC) and National Healthcare Safety Network
(NHSN), the proposed and updated definition for VAP includes which of the following?
1. Objective data
2. Patient’s family history
3. A clearly defined time criteria
4. Chest radiograph images
a. 1 and 3 only
b. 2 and 3 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4
a. 1 and 3 only
The pathogenesis of VAP involves:
- colonization of the aerodigestive tract.
- aspiration of contaminated secretions into the lower airways.
- increased use of silver-coated endotracheal tubes.
- colonization of lower airways and lung parenchyma.
a. 2 and 3 only
b. 2, 3, and 4 only
c. 1, 2, and 3 only
d. 1, 2, and 4 only
d. 1, 2, and 4 only
A mechanically ventilated patient is being assessed for her level of sedation. The patient is
semiasleep and responds to verbal commands. What score on the Ramsay Sedation Scale
should be assigned to this patient?
a. 2
b. 3
c. 4
d. 5
b. 3
Which of the following is the sedation scale that uses a graduated single category?
a. Comfort Scale
b. Motor Activity Assessment Scale
c. Ramsay Sedation Scale
d. Sedation-Agitation Scale
c. ramsay sedation scale
What range of scores on the Ramsay Sedation Scale indicates adequate sedation?
a. 1-3
b. 2-4
c. 3-5
d. 5-6
b. 2-4
The group of drugs that interact with GABA receptor complex on neurons in the brain is
which of the following?
a. Opioids
b. Paralytics
c. Benzodiazepines
d. Depolarizing agents
c. Benzodiazepines
A patient with hypovolemic shock secondary to widespread second- and third-degree burns is
being mechanically ventilated. The patient appears agitated, and the respiratory therapist is
unable to synchronize the ventilator to the patient. Which drug can the respiratory therapist
suggest to the ICU team to sedate this patient and synchronize ventilation?
a. Fentanyl
b. Morphine
c. Propofol
d. Succinylcholine
a. Fentanyl
What drug reverses the sedative effects of benzodiazepines?
a. Naloxone
b. Flumazenil
c. Fentanyl
d. Vecuronium
b. Flumazenil
The drug of choice for sedating mechanically ventilated patients in the ICU for longer than 24
hours is which of the following?
a. Lorazepam (Ativan)
b. Midazolam (Versed)
c. Diazepam (Valium)
d. Propofol (Diprivan)
a. lorazepam (ativan)
A patient who is receiving mechanical ventilation in the ICU is found to be wildly agitated.
The most appropriate drug to control this delirium is which of the following?
a. Propofol
b. Fentanyl
c. Haloperidol
d. Lorazepam
c. Haloperidol
A patient with head trauma and an elevated ICP is being ventilated postoperatively and shows signs of asynchrony with the mechanical ventilator. The most appropriate medication to sedate
this patient is which of the following?
a. Morphine
b. Propofol
c. Propofol and morphine
d. Fentanyl
c. Propofol and morphine
Caution should be used when administering propofol for longer than 48 hours in pediatric
patients because of what adverse effect?
a. Lethargy
b. Lactic acidosis
c. Cardiac dysrhythmias
d. Reduced cerebral blood flow
b. Lactic acidosis
Which of the following drugs has the potential for causing bronchospasm in patients with
asthma and hypersensitive airways?
a. Fentanyl
b. Propofol
c. Diazepam
d. Morphine
d. Morphine
Neuromuscular blocking agents are commonly used in mechanically ventilated patients when which of the following occurs?
a. The patient is in severe pain.
b. Cardiac arrhythmias are present.
c. The patient develops anxiety as a result of ICU psychosis.
d. Patient-ventilator dysynchrony cannot be corrected.
d. patient-ventilator dysynchrony cannot be corrected
The neuromuscular blocking agent that resembles acetylcholine in chemical structure is which
of the following?
a. Succinylcholine
b. Pancuronium
c. Vecuronium
d. Cisatracurium
a. Succinylcholine
. Permissive hypercapnia is needed to protect patients with ARDS from atelectrauma. Which of the following medications is appropriate to facilitate this?
a. Propofol
b. Fentanyl
c. Midazolam
d. Cisatracurium
d. Cisatracurium
The train-of-four response is used to assess a patient’s level of paralysis during high frequency oscillatory ventilation, and the patient’s foot twitches four times. The most appropriate evaluation of this circumstance is which of the following?
a. Nothing need be done; paralysis is adequate.
b. The paralyzing agent is moderately effective.
c. The paralyzing agent needs to be re-administered.
d. Propofol needs to be added to enhance the effect.
c. The paralyzing agent needs to be re-administered.
The paralytic agent associated with precipitation of malignant hyperthermia is which of the
following?
a. Vecuronium
b. Cisatracurium
c. Pancuronium
d. Succinylcholine
d. Succinylcholine
Which of the following describes moderate sedation?
a. The patient can respond to verbal commands, although cognitive function may be
impaired.
b. The patient is not easily aroused but can respond to painful stimulation.
c. The patient can perform purposeful response following repeated or painful stimulation.
d. The patient cannot be aroused, even by painful stimulation
c. The patient can perform purposeful response following repeated or painful stimulation.
The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?
a. CPAP
b. IMV
c. IMV with PEEP
d. VC-CMV with PEEP
d. VC-CMV with PEEP
High tidal volumes and/or high levels of PEEP can cause which of the following?
a. Improvement in pulmonary blood flow
b. Increased right ventricular afterload
c. Interventricular septum shifts to the right
d. Increased myocardial perfusion
b. Increased right ventricular afterload
Normovolemic patients experience decreases in cardiac output above what level of PEEP?
a. 5 cm H2O
b. 8 cm H2O
c. 12 cm H2O
d. 15 cm H2O
d. 15 cmH2O
Which of the following patient conditions is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?
a. ARDS
b. emphysema
c. kyphoscoliosis
d. third degree chest wall burns
a. ARDS
The harmful cardiovascular effects of PPV are influenced most by which of the following
pressures?
a. Peak inspiratory pressure
b. Mean airway pressure
c. Positive end-expiratory pressure
d. Transpulmonary pressure
b. mean airway pressure
Which of the following ventilator parameters would result in the highest mean airway
pressure?
a. PIP = 30 cm H2O; PEEP = 10 cm H2O; TI = 0.5 sec; TCT = 5 sec
b. PIP = 50 cm H2O; PEEP = 10 cm H2O; TI = 0.5 sec; TCT = 5 sec
c. PIP = 30 cm H2O; PEEP = 15 cm H2O; TI = 0.5 sec; TCT = 5 sec
d. PIP = 50 cm H2O; PEEP = 10 cm H2O; TI = 0.5 sec; TCT = 5 sec
c. PIP = 30 cm H2O; PEEP = 15 cm H2O; TI = 0.5 sec; TCT = 5 sec
Which of the following can increase the physiological dead space in apneic patients receiving
volume control ventilation?
a. I:E ratio >1:1
b. A slow flow rate
c. Adding an inflation hold
d. Inspiratory time <0.5 second
d. inspiratory time <05 second
During spontaneous breathing, the fall in intrapleural pressure that draws air into the lungs
during inspiration also draws blood into the major thoracic vessels. This phenomenon
increases which of the following?
a. Systemic vascular resistance
b. Right ventricular afterload
c. Right ventricular preload
d. Pulmonary capillary resistance
c. right ventricular preload
Calculate the cerebral perfusion pressure when the mean arterial blood pressure is 120 mm Hg
and the ICP is 14 mm Hg.
a. 134 mm Hg
b. 106 mm Hg
c. 120/14 mm Hg
d. 134/106 mm Hg
b. 106 mmHg
