MV2 Midterm Flashcards
A patient was intubated in the ED just after arrival at the hospital from home. The patient develops VAP 36 hrs 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
D. Non hospital acquired pneumonia
The mortality rate for VAP associated eith prolonged hospital stays is which of the following?
A. 5-25%
B. 15-40%
C. 25-50%
D. 45-75%
C. 25-50%
The most common gram positive bacterium that causes ventilator associated pneumonia is which of the following?
A. Streptococcus pneumoniae
B. Entericoccus faecalis
C. Methicillin-resistant staphylococcus aureus
D. Pseudomonas aeruginosa
C. MRSA
60% 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 mortality rate for VAP depends in which of the following?
- Length of stay on 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
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
A patient with which of the following CPIS criteria should be placed on empiric anitbiotic therapy pending the outcome of a bronchial alveolar lavage?
A. CPIS = 4
B. CPIS = 5
C. CPIS = 6
D. CPIS =7
D. CPIS = 7
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 MRSA in a patient with early onset of VAP is which of the following?
A. Linezolid
B. Vancomycin
C. Gentamicin
D. Levofloxacin
D. Levofloxican
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 semirecumbent position
D. Use heat/moisture exchangers when possible
A. Nasally intubate whenever possible
To avoid VAP, how often should ventilator circuits be changed?
A. Every 24 hrs
B. Every 48 hrs
C. Once weekly
D. Not unless visibly dirty
D. Not unless 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 horizontal
- Changing the ventilator circuits every 48 hrs
- Using heated humidifiers whenever possible
- Using 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
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
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
A patient with hypovolemic shock secondary to widespread second and third degree burns is being mechanically ventilated. The patient appears agitated, and the RT is unable to synchronize the ventilator to the patient. Which drug can the RT suggest to 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 hrs is which of the following?
A. Lorazepam (Ativan)
B. Midazolam (Versed)
C. Diazepam (Vallium)
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 show 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 hrs in pediatric patients b/c 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 occur?
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 dyssynchrony cannot be corrected
D. Patient ventilator dyssynchrony 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. Succicinylcholine