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MVI > MV2 Midterm > Flashcards

MV2 Midterm Flashcards

1
Q

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

A

D. Non hospital acquired pneumonia

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2
Q

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%

A

C. 25-50%

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3
Q

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

A

C. MRSA

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4
Q

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

A. Aerobic gram negative bacilli

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5
Q

The mortality rate for VAP depends in which of the following?

  1. Length of stay on ventilator
  2. Presence of underlying disease
  3. Prior antimicrobial therapy
  4. 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

A

B. 2 and 3 only

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6
Q

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

A

C. Bronchial alveolar lavage

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7
Q

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

A

D. CPIS = 7

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8
Q

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

A

C. Create multidrug resistant organisms

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9
Q

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

A

D. Levofloxican

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10
Q

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

A. Nasally intubate whenever possible

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11
Q

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

A

D. Not unless visibly dirty

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12
Q

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

A

B. Early diagnosis and treatment

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13
Q

A ventilator bundle may include which of the following?

  1. Keeping the head of the bed at 30 degrees from horizontal
  2. Changing the ventilator circuits every 48 hrs
  3. Using heated humidifiers whenever possible
  4. 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

A

B. 1 and 4 only

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14
Q

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

A

B. 3

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15
Q

What range of scores on the Ramsay Sedation Scale indicates adequate sedation?

A. 1 - 3
B. 2 - 4
C. 3 - 5
D. 5 - 6

A

B. 2-4

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16
Q

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

A. Fentanyl

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17
Q

What drug reverses the sedative effects of benzodiazepines?

A. Naloxone
B. Flumazenil
C. Fentanyl
D. Vecuronium

A

B. Flumazenil

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18
Q

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

A. Lorazepam (Ativan)

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19
Q

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

A

C. Haloperidol

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20
Q

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

A

C. Propofol and morphine

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21
Q

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

A

B. Lactic acidosis

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22
Q

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

A

D. Morphine

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23
Q

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

A

D. Patient ventilator dyssynchrony cannot be corrected

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24
Q

The neuromuscular blocking agent that resembles acetylcholine in chemical structure is which of the following?

A. Succinylcholine
B. Pancuronium
C. Vecuronium
D. Cisatracurium

A

A. Succicinylcholine

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25
Q

The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?

A. CPAP
B. SIMV
C. SIMV with PEEP
D. VC - CMV with PEEP

A

D. VC - CMV with PEEP

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26
Q

Normovolemic patients experience decreases in cardiac output above what level of PEEP?

A. 5 cmH20
B. 8 cmH20
C. 12 cmH20
D. 15 cmH20

A

D. 15 cmH2O

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27
Q

The harmful cardiovascular effects of PPV are influenced most by which of the following pressures?

A. PIP
B. Mean airway pressure
C. PEEP
D. Transpulmonary pressure

A

B. Mean airway pressure

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28
Q

Physiological dead space may be increased in apneic patients receiving VC ventilation by which of the following?

A. I:E ration > 1:1
B. A slow flow rate
C. Adding an inflation hold
D. Inspiratory time < 0.5 sec

A

D. Inspiratory time < 0.5 sec

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29
Q

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 increased which of the following?

A. SVR
B. RV afterload
C. RV preload
D. Pulmonary capillary resistance

A

C. RV preload

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30
Q

PPV has which of the following effects on the kidneys?

A. Increases blood flow to the kidneys
B. Redistributes blood flow in the kidneys
C. Decreases sodium reabsorption in the kidneys
D. Increase urinary output

A

B. Redistributes blood flow in the kidneys

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31
Q

Mechanical ventilation has an effect on the hormone __________, which causes a decreases in urinary output.

A. Cortisol
B. Arginine vasopressin
C. Parathyroid hormone
D. Thyroid-stimulating hormone

A

B. Arginine vasopressin

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32
Q

PPV increases splanchnic resistance, decreases splanchnic venous outflow, and may contribute to gastric mucosal ischemia. This last change contributes to which of the following?

A. Liver metastases
B. Tracheal malacia
C. Gastric ulcers
D. Increased portal blood flow

A

C. Gastric ulcers

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33
Q

The most likely cause of uneven ventilation includes which of the following?

A. Low set tidal volumes
B. High inspiratory flow rates
C. High mean airway pressure
D. Elevated peak inspiratory pressures

A

B. High inspiratory flow rates

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34
Q

Malnutrition during mechanical ventilation can cause which of the following?

A. Increase O2 consumption
B. Increase CO2 production
C. Increased WOB
D. Decreased spontaneous ventilation

A

D. Decreased spontaneous ventilation

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35
Q

Biotrauma is caused directly by which of the following?

A. High oxygen levels
B. Overdistention of alveoli
C. Long expiratory times
D. Fast respiratory rates

A

B. Overdistention of alveoli

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36
Q

Alveolar tissue and pulmonary capillary injury is caused by which of the following?

A. Barotrauma
B. Biotrauma
C. Shear stress
D. Overdistention

A

C. Shear stress

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37
Q

Shear stress injury and loss of surfactant from the resulting unstable lung units results in a loss of surfactant. This type of pulmonary trauma is known as ___________.

A. Atelectrauma
B. Barotrauma
C. Biotrauma
D. Volutrauma

A

A. Atelectrauma

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38
Q

Ventilator induced lung injury (VILI) is associated with which of the following?

A. Air trapping
B. Biotrauma
C. Patient ventilator asynchrony
D. VAP

A

B. Biotrauma

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39
Q

Healthy areas of lung tissue in a patient with ARDS can be protected from lung injury caused by overdistention by which of the following?

A. Increasing FiO2
B. Decreasing PEEP
C. Using the prone position
D. Using a Vt of 10-12 mL/kg

A

C. Using the prone position

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40
Q

Which of the following mechanically ventilated patients shows clinical signs of hypoventilation?

A. A patient who is cool to the touch and has negative T waves on the ECG
B. A patient who has twitchy extremities and also has atrial flutter on the ECG
C. A patient who is anxious and hypertensive and has elevated T waves on the ECG
D. A patient who has cool, twitchy extremities and also low, rounded T waves on the ECG

A

C. A patient who is anxious and hypertensive and has elevated T waves on the ECG

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41
Q

Which of the following mechanically ventilated patients shows clinical signs of hyperventilation?

A. A patient who has hot skin and also long P-R intervals on ECG
B. A patient who has cool skin and shows paroxysmal tachycardia on the ECG
C. A patient who is hypertensive and agitated and has S-T segment depression on the ECG
D. A patient who is hypotensive and dyspneic and has widened QRS complexes on the ECG

A

B. A patient who has cool skin and shows paroxysmal tachycardia on the ECG

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42
Q

The RT assess the flow-time scalar from an apneic patient mechanically ventilated in the VC-CMV mode. The most appropriate action for this patient is to do which of the following?

A. Decrease the set flow rate
B. Reduce the set ventilator rate
C. Increase the inspiratory time
D. Decrease the set tidal volume

A

B. Reduce the set ventilator rate

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43
Q

The acceptable lower limit of PaO2 for a mechanically ventilated patient with ARDS is which of the following?

A. 50 mmHg
B. 60 mmHg
C. 70 mmHg
D. 80 mmHg

A

B. 60 mmHg

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44
Q

The combination of _____________ and __________________ increases the risk of absorption atelectasis.

A. high Vt / FiO2 > 0.4
B. High Vt / FiO2 >= 0.7
C. Low Vt / FiO2 > 0.5
D. Low Vt / FiO2 > 0.7

A

D. Low Vt / FiO2 > 0.7

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45
Q

All of the following patients are intubated and receiving mechanical ventilation. Which of them is most likely to require slow liberation from mechanical ventilation?

A. A patient who overdosed on diagram
B. A postoperative patient who had knee surgery
C. A patient with severe exacerbation of asthma
D. A patient with chest contusions from a motor vehicle crash

A

D. A patient with chest contusions from a motor vehicle crash

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46
Q

A patient is being weaned from invasive mechanical ventilation using VC IMV. The RT reviews the following data from the past few hours.

A. Switch the mode to VC CMV
B. Add and titrate PS
C. Extubate and place patient on NPPV
D. Increase the set rate to 8

A

B. Add and titrate PS

47
Q

At what pressure is pressure support NOT high enough to contribute significantly to ventilatory support but is sufficient to overcome the work imposed by the ventilator system?

A. 5 cmh20
B. 8 cmh20
C. 10 cmh20
D. 12 cmh20

A

A. 5 cmH2O

48
Q

Which mode of ventilation. Delivers the exact amount of pressure required to overcome the resistive load imposed by the ET tube for the flow measured at the time?

A. Automate
B. Volume targeted PSV
C. PSV
D. Automatic tube compensation

A

D. Automatic tube compensation

49
Q

Which of the following is considered a closed loop mode used for weaning from mechanical ventilation?

A. PSV
B. Adaptive support ventilation
C. CPAP
D. IMV

A

B. Adaptive support ventilation

50
Q

A postoperative patient, still under anesthesia, is being ventilated with VC CMV with automode. After 2 hours, the patient is waking up ans beginning to breathe spontaneously. The ventilator will respond by

A. Adjusting the pressure support level to equal the raw
B. Switching to the volume support mode
C. Delivering time triggered, pressure limited breaths
D. Ensuring minimum mandatory minute ventilation

A

B. Switching to the volume support mode

51
Q

The ACCP/SCCM/AARC task force recommends that a search for all possible causes that may be contributing to ventilator dependence be undertaken in patients who require mechanical ventilation for longer than _________ hrs.

A. 12
B. 24
C. 48
D. 72

A

B. 24 hours

52
Q

A VAI patient has expressed the desire to be able to speak. The most appropriate speaking device to use in line with this ventilator patient is which of the following?

A. Voice TT
B. Passy-Muir
C. Portex Speaking TT
D. Pittsburg Talking TT

A

B. Passy-Muir

53
Q

A VAI patient with a TT is having a trial of cuff deflation to allow for speech. The patient’s voice is weak and he can speak only 2 or 3 words with each exhalation. The RT could adjust which vent setting to improve the patient’s speech?

  1. Expiratory time
  2. Inspiratory time
  3. Volume
  4. PEEP
A

2 and 4

54
Q

A VAI with amyotrophic lateral sclerosis and a TT is unable to clear secretions from his airway. Which of the following should be considered to manage this patient’s airway clearance problem.

  1. Manual chest percussion and TT suctioning
  2. Autogenic drainage and postural drainage
  3. Positive expiratory pressure
  4. Mechanical insufflation-exsufflation (MI-E)
A

1 and 4

55
Q

A minimum of _____ days should be allowed to obtain insurance verification and authorization and to procure equipment before a ventilated patient is transferred home from the acute care hospital.

A. 3-5
B. 7-14
C. 10-16
D. 21-30

A

B. 7-14

56
Q

A patient with a TT is being discharged home with a ventilator, which he uses only during the night, without supplemental oxygen. During the day he uses a speaking valve. Which of the following equipment must he have in his home?

  1. Suctioning equipment
  2. Oxygen concentrator
  3. Second mechanical ventilator
  4. Manual resuscitator bag
A

1 and 4

57
Q

A patient with muscular dystrophy currently receiving ventilatory support with vc imv is being prepared for discharge home. The case manager asks the RT to recommend a ventilator that will meet the patient’s needs with the least complexity and at the lowest cost. The RT should recommend which of the following ventilators?

A. PLV 102
B. LP 6 PLUS
C. LTV 1000
D. Life are PLV 100

A

C. LTV 1000

58
Q

A patient with which condition is a suitable candidate for home care ventilation?

A. Flail chest due to trauma
B. Amyotrophic lateral sclerosis
C. Severe exacerbation of asthma
D. ARDS

A

B. Amyotrophic lateral sclerosis

59
Q

A quadriplegic partner is getting ready for discharge home from an acute care hospital. He has a TT and requires MV around the clock, but not supplemental O2. What equipment must he have in his home?

  1. Transport vent
  2. Manual resuscitator bag
  3. E cylinder of O2
  4. Vent circuits
A

1, 2, and 4

60
Q

During an education session with the family of a ventilator assisted individual who is being prepared for discharge home, the RT explains ventilator circuit/suction equipment disinfection. Which of the following is an important instruction that should be part of this teaching?

A. A white vinegar/distilled water mix can be reused as a disinfectant solution.
B. Water for humidifiers can be taken directly from the tap
C. Suction catethers and plastic containers must be changed after 8 hr
D. Medicare will reimburse for all the disposable supplies needed for the vent

A

C. Suction catethers and plastic containers must be changed after 8 hr

61
Q

List the potential locations for patients requiring long term ventilatory care in order of cost from most expensive to least expensive.

  1. Patients home
  2. Long term acute care
  3. Intensive care or acute care unit
  4. Extended care facility
A

3, 2, 4, 1

62
Q

One of the goals of long term MV in the home or alternative care site is which of the following?

A. Premit lung healing
B. Reduce hospitalizations
C. Relieve respiratory distress
D. Improve pulmonary gad exchange

A

B. Reduce hospitalizations

63
Q

The American college of chest physicians considers long ventilator assisted patients to be those who require mechanical ventilation for at least ____ hours per day for ____ days or more.

A. 4; 7
B. 6; 14
C. 6; 21
D. 8; 21

A

C. 6; 21

64
Q

The appropriate power source for a wheelchair mounted ventilator is which of the following?

A. AC current
B. Pneumatic
C. Internal DC battery
D. External DC battery

A

D. External DC battery

65
Q

The most important factors to consider when choosing a ventilator for home use include which of the following?

  1. Sophistication
  2. Reliability
  3. Versatility
  4. Cost
A

2, 3, 4

66
Q

The preferred location for ventilator dependent patients is ___________.

A. A skilled nursing facility
B. A subacute care unit
C. Their own homes
D. A long term acute care hospital

A

C. Their own homes

67
Q

What pressure range may be necessary to achieve a sufficient VT using a chest cutlass?

A. -10 to -20 cmh20
B. -25 to -50 cmh20
C. -35 to -60 cmh20
D. -50 to -75 cmh20

A

C. -35 to - 60 cmH2O

68
Q

Which of the following is an essential step the RT must perform when setting up a speaking valve for a ventilator assisted individual?

A. Turn up the required flow to 6-8 L/min
B. Make sure the cuff is inflated before applying the valve
C. Make sure the cuff is deflated before applying the valve
D. Place the speaking valve in a 22 mm corrugated tube

A

C. Make sure the cuff is deflated before applying the valve

69
Q

Which of the following modes do the first generation portable home care ventilators use?

  1. VC CMV
  2. PSV
  3. VC IMV
  4. PC IMV
A

1 and 3

70
Q

Which of the following ventilator requirements for a ventilator assisted individual demonstrates clinical stability and indicated that the patient most likely is ready for discharge home from an acute care hospital?

A. PC CMV f=14 PIP= 30 PEEP= 10 FiO2= 0.5
B. VC SIMV f=8 Vt=400 PS=5 PEEP= 5 FiO2= 0.3
C. VC CMV f=12 Vt= 600 PEEP= 8 FiO2= 0.6
D. PC IMV f= 10 PIP= 25 PS= 10 PEEP= 10 FiO2= 0.8

A

B. VC SIMV f=8 Vt=400 PS=5 PEEP= 5 FiO2= 0.3

71
Q

Which site for MV of patients provides the least patient independence and quality of life?

A. ICU
B. Skilled nursing facility
C. Long term care hospital
D. Chronic assisted ventilator unit

A

A. ICU

72
Q

A patient recently been diagnosed with OSA. The most appropriate treatment includes which of the following?

A. PSV
B. NPPV
C. CPAP
D. PC CMV

A

C. CPAP

73
Q

A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until ____ months has/have passed and all weaning attempts during that time have failed.

A. 1
B. 3
C. 6
D. 9

A

B. 3

74
Q

When an alarm is activated on a ventilator, the RTs first priority is to ____.

A. Assess the patients LOC
B. Ensure adequate ventilation and oxygenation
C. Assess lung compliance and RAW
D. Ensure that bilateral and equal breath sounds ds are present

A

B. Ensure adequate ventilation and oxygenation

75
Q

Removing a patient from a ventilator to ventilate manually can lead to which of the the following?

  1. Barotrauma
  2. Lung decruitment
  3. Increase RAW
  4. VAP
A

1, 2, and 4

76
Q

A 68 year old woman was admitted to the ICU eith pneumonia and was intubated when she developed progressive hypixemia. She has been on the vent for 5 days and has been tolerating this therapy well. The patient has suddenly become severely agitated and appears to be fighting the vent. The high pressure alarm is sounding continuously. The RT disconnects the patient and begins manual ventilation with 100% O2 and PEEP. The resuscitator bag is difficult to squeeze, breath sounds are present on the left with no adventitious sounds and absent on the right side, percussion reveals hyperresonance over the right side. The most appropriate action to address this situation is which of the following?

A. Pull the ET tube back until bilateral breath sounds are heard
B. Administer a bronchodilator and suction the ET tube
C. Extubate the patient and reintubate with a lager ET tube
D. Insert a 14 gauge needle in the second intercontinental space, midclavicular line, right side

A

D. Insert a 14 gauge needle in the second intercontinental space, midclavicular line, right side

77
Q

The RT is called to the bedside of a patient mechanically ventilated in the VC CMV mode because the low pressure, low exhaled tidal volume and low exhaled minute volume alarms all have activated. This situation could be caused by which if the following?

A. Patient biting the ET tube
B. Rupture of the ET cuff
C. Slipping of the ET tube into the right mainstem
D. Plugging of the airways by secretions and mucus.

A

B. Rupture of the ET cuff

78
Q

The initial step in the management of patient ventilator asynchrony is which of the following?
A. Lower the high pressure alarm setting
B. Check the ET tube cuff pressure
C. Ventilate the patient with a manual resuscitator bag
D. Check the low and high pressure alarm settings

A

C. Ventilate the patient with a manual resuscitator bag

79
Q

At 1030 the RT is called to the bedside of a patient being MV with VC IMV. The patient is a 55kg female who has been intubated with a size 8 ET tube. Currently located 20cm at the gum line. During spontaneous breathing, the patient shows lack of coordinated chest wall movement, and the RT notes some retractions of the intercostal spaces. The RT performs a system check. The current and past few patient ventilator system checks reveal the following info:
0430 PIP 28 Plat 18 0640 PIP 31 Plat 21
0835 PIP 34 Plat 19 1030 PIP 41 Plat 20
The most appropriate action to take in this situation is which of the following?

A. Deflate the cuff and reposition the ET tube
B. Request that the patient receive haloperidol and midazolam
C. Administer albuterol via an in line MDI
D. Switch to the mode to PC IMV and increase the rate

A

C. Administer albuterol via an in line MDI

80
Q

A patient with a past medical Hx of COPD was placed on a ventilator after upper abdominal surgery for a serious wound infection. Although the patient was medically stable, a tracheostomy was performed 2 weeks later b/c the patient was unable to be weaned from the vent. The patient is on VC CMV f= 12, Vt=700, FiO2= 40%, PEEP= 5 with an HME. The RT notes that the patient is assisting at a rate of 18 and has bilaterally decreased breath sounds in the bases. The RT suctions a moderate amt of very thick, tenacious yellow sputum from the trach tube. What action should the RT take?

A. The HME should be replaced with an active heated humidifer system
B. No action is necessary
C. The patient should be suctioned on a regular schedule instead of when needed
D. PEEP and FiO2 should be increased and diuretic and positive inotropic agents should be administered

A

A. The HME should be replaced with an active heated humidifer system

81
Q

An intubated patient is receiving MV with the following settings VC CMV F=18 Vt= 850 PEEP= 5 Flow rate= 40. The patient is sedated and is not assisting the ventilator. During a routine check, the RT observes the following ventilator graphic: (Flow/volume loop)
The RT should do which of the following?

A. Decrease the flow rate
B. Increase the PEEP
C. Decrease the rate
D. Increase the Vt

A

C. Decrease the rate

82
Q

The RT enters the room of an intubated and MV patient to find the low pressure, low Vtexh and low Ve alarms active. The ventilator circuit is connected to the patient’s ET tube. This situation could be caused by which of the following?

A. Improper flow rate and flow pattern
B. Poorly responsive internal demand value
C. Migration of the ET tube into the upper AW
D. The patient is continuing to actively inhale

A

C. Migration of the ET tube into the upper AW

83
Q

A patient is intubated and set up on VC CMV. After stabilization and suctioning the ET tube. The PIP is 25 . The low pressure and high pressure alarms should be set at ________ and _________ respectively.

A. 5; 35
B. 10; 30
C. 12; 40
D. 15; 35

A

D. 15; 35

84
Q

The RT enters the room of an intubated and MV patient to find the high pressure, low exhaled volume, and low Ve alarms active. This situation could be caused by which of the following?

A. Improper flow rate and pattern
B. Migration of the ET tube into the upper AW
C. The patient is out of synchrony with the vent
D. The vent has an internal malfunction

A

C. The patient is out of synchrony with the vent

85
Q

The RT is assessing a MV patient for whom the high pressure alarm is active and the flow volume loop shows the following:
The action that could alleviate this problem is which of the following?

A. Place a bite block into the patient’s mouth
B. Perform a recruitment maneuver and increase PEEP
C. Administer a fast acting bronchodilator and suction the ET tube
D. Insert a 14 gauge needle into the right side

A

C. Administer a fast acting bronchodilator and suction the ET tube

86
Q

The graphics below indicate which of the following conditions?

A. Auto PEEP
B. Active exhalation
C. Inadequate flow setting
D. Increased expiratory resistance

A

C. Inadequate flow setting

87
Q

The following two graphic loops show which of the following conditions?

A. Leak in the patient ventilator circuit
B. Increased RAW
C. Decreased Lung compliance
D. Active exhalation

A

A. Leak in the patient ventilator circuit

88
Q

The flow volume loop below is representative of which of the following conditions?

A. System leak
B. Intrinsic PEEP
C. Inadequate flow
D. Active exhalation

A

B. Intrinsic PEEP

89
Q

The graphic below for a patient receiving MV shows which of the following conditions?

A. Leak in the circuit
B. Active inhalation
C. Active exhalation
D. Intrinsic PEEP

A

C. Active exhalation

90
Q

Use of an externally powered, SVN for aerosol delivery during partial ventilatory support with PSV may cause which of the following?

  1. High Vt alarm activation
  2. Triggering difficulties
  3. Low pressure alarm activation
  4. Ventilator inoperative alarm
A

1 and 2

91
Q

During ventilation with VC CMV, pleural drainage leaks sometimes can be compensated for by increasing which of the following?

A. The number of chest tubes
B. The set Vt
C. The set pressure limit
D. The set peak inspiratory flow

A

B. The set Vt

92
Q

A MV patient with COPD is receiving partial ventilatory support with PSV. The RT notes a sudden rise at the end of each breath on the pressure time graphic. What action should the RT take at this time?

A. Change the mode to PRVC
B. Change the mode to VC CMV
C. Lower the flow cycle setting
D. Adjust the pressure support level

A

C. Lower the flow cycle setting

93
Q

The RT is performing a patient ventilator system check on a patient who was in a MVA 2 days earlier. The therapist gathers the following info from the flow sheet.
1720 VC CMV PIP 21 Plat 18 0830 VC CMV PIP28 Plat 25
1840 VC CMV PIP 32 Plat 29 0650 VC CMV PIP41 Plat 38
Which condition most likely has produced the changes reflected in these data?

A. Bronchospasm
B. Abdominal distention
C. Secretion retention
D. Mucosal edema

A

B. Abdominal distention

94
Q 
In the APRV mode, which of the following is considered baseline?
A. P low
B. Phigh
C. Tlow
D. Thigh
A

B. Phigh

95
Q

Compared with pressure controlled inverse ratio ventilation, APRV does which of the following?

A. Decrease CI
B. Reduces the need for sedation
C. Increases the peak AW pressure
D. Increases the CVP

A

B. Reduces the need for sedation

96
Q

The advantage of APRV over VC CMV or PC CMV is which of the following?

A. It enhances CO2 elimination
B. Volume delivery is consistent
C. Independent lung regions are better ventilated
D. It reduces the risk of ventilator induced lung injury

A

D. It reduces the risk of ventilator induced lung injury

97
Q

When T high is set at 5.5 seconds and the T low is set at 0.5 seconds, what is the set ventilator rate?

A. 8
B. 10
C. 14
D. 16

A

B. 10

98
Q

Which variable in APRV is responsible for the removal of CO2 from the body?

A. T low
B. T high
C. P low
D. P high

A

A. T low

99
Q

The variable that allows for an unimpeded expiratory gas flow is which of the following?

A. T low
B. T high
C. P low
D. P high

A

C. P low

100
Q

What is the maximum pressure setting for P high?

A. 20 cmh20
B. 30 cmh20
C. 40 cmh20

A

B. 30 cmH2O

101
Q

A patient being ventilated with APRV has the following settings: Phigh= 24 T high=5 sec Plow= 4 Tlow= 1 sec FiO2= 0.3 The patient’s spontaneous rate is 10 breaths/min. The current ABG values are PaO2= 91 PaCO2= 62. What should the RT recommend for this patient?

A. Increase Plow to 5.5
B. Decrease the Tlow to 0.5 sec
C. Increase the Phigh to 40
D. Decrease the Plow to 0

A

D. Decrease the Plow to 0

102
Q

A patient with ALI is being ventilated using APRV with the following settings: Phigh= 30 Plow= 2 Thigh= 6 Tlow= 0.8 sec FiO2= 0.4. The patient’s spontaneous rate is 12. The current ABG values are PaO2= 61 PaCO2= 43. What change should the RT recommend for this patient?

A. Decrease the Phigh to 25
B. Increase the Thigh 8 sec
C. Decrease the Tlow to 0.5 sec
D. Increase the Plow to 5

A

B. Increase the Thigh 8 sec

103
Q

Weaning from APRV includes which of the following?

A. Increasing the Phigh and Decreasing the Thigh
B. Decreasing the Phigh and Increasing Thigh
C. Increasing the Plow and Decreasing the Tlow
D. Decreasing the Plow and Increasing the Tlow

A

B. Decreasing the Phigh and Increasing Thigh

104
Q

Which of the following is an alternative method of respiratory support for patient with ARDS?

A. IPV
B. ILV
C. HFOV
D. Heliox therapy

A

C. HFOV

105
Q

An adult patient with ARDS is beig MV with VC CMV. Settings are: f=14 Vt= 375 PEEP 16 FiO2= 0.8. ABG values are pH= 7.40 PaCO2= 56 PaO2= 48 and SaO2= 83%. The mean aw pressure is 18. The patient’s physician decides on a trial of HFOV. What initial vent settings should be used?

A. Bias flow=30 mPaw=23 Set power to obtain p=76 f=6 Ti=33% FiO2= 1.
B. Bias flow=35 mPaw=76 set power to obtain p=33 f=10 Ti= 50% FiO2= 1
C. Bias flow=30 mPaw=30 set power to obtain p=76 f=8 Ti=33% FiO2= 1
D. Bias flow=30 mPaw=30 set power to obtain p=56 f=6 Ti=50% FiO2=1

A

A. Bias flow=30 mPaw=23 Set power to obtain p=76 f=6 Ti=33% FiO2= 1.

106
Q

The HFOV setting that directly affects PaO2 is the ________.

A. Power
B. mPaw
C. Amplitude
D. Bias flow

A

B. mPaw

107
Q

The CXR of a patient just placed on HFOV shows the diaphragm at the level of the seventh rib. Which of the following parameters should be adjusted?

A. mPaw
B. Power
C. Bias flow
D. Amplitude

A

A. mPaw

108
Q

The PaCO2 can be reduced during HFOV by doing which of the following?

A. Decreasing the amp
B. Increasing the frequency
C. Increasing the Ti%
D. Decreasing the cuff leak

A

C. Increasing the Ti%

109
Q

Observation of chest wall or the “chest wiggle factor” is used to asses the appropriateness of the ________.

A. mPaw
B. Frequency
C. Bias Flow
D. Power setting

A

D. Power setting

110
Q

The key property of helium that makes it useful as a therapeutic gas is its _________.

A. Low cost
B. Low density
C. Low solubility
D. Abundance in nature

A

B. Low density

111
Q

The most common concentration of heliox is _______________.

A. 50% helium; 50% O2
B. 60% helium; 40% O2
C. 70% helium; 30% O2
D. 80% helium; 20% O2

A

D. 80% helium; 20% O2

112
Q

An 80% heliox 20% O2 mixture is being delivered to an asthmatic patient by NRB mask through an oxygen flow meter set at 8L/min. What is the actual flow delivered to the patient?

A. 10 L/min
B. 12 L/min
C. 14 L/min
D. 18 L/min

A

C. 14 L/min

113
Q

The NAVA mode can be used in which of the following situations?

A. Paralysis
B. Heavy Sedation
C. Injury to the respiratory brain centers
D. Spontaneous breathing

A

D. Spontaneous breathing

MVI (6 decks)

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