Quiz 3 Study Guide

Question 1

An adult patient who is spontaneously breathing an FiO2 of 0.40 via air-entrainment (venturi) mask has the following ABG results:

pH: 7.46
CO2: 33 mmHg
PaO2: 48 mm Hg
HCO3: 23
Be: 0
SaO2: 83%

What should you do first?

A. Sedate the patient
B. Intubate the patient
C. Administer 2.5 mg Albuterol
D. Switch to a nonrebreather mask

Answer 1

D. Switch to a nonrebreather mask

Question 2

A 64 year old 168 cm tall female arrives in the emergency department with a COPD exacerbation. You place the patient on BiPAP with an oronasal mask on the following settings:

BiPAP S/T: 10
IPAP: 6
EPAP: 0.50
FiO2: 0.50
Spontaneous TV: 250 mL

ABG results as follows:

pH: 7.28
CO2: 65 mmHg
PO2: 75 mmHg
HCO3: 34
BE: +6
SaO2: 94%

What should you recommend?

A. Increase the EPAP
B. Increase the FiO2
C. Increase the IPAP
D. Change the mode to AVAPS

Answer 2

C. Increase the IPAP

Question 3

A 63 year old patient with COPD is being seen in the pulmonary clinic for a routine appointment. An ABG has been drawn on the patient while breathing room air with the following result:

pH: 7.40
CO2: 57 mmHg
PO2: 42 mmHg
HCO3: 35
BE: +8
SaO2: 77%

What is the appropriate next step?

A. Nothing. This is the patient’s new normal
B. Place the patient on supplemental oxygen.
C. Admit the patient to the hospital
D. Educate the patient on deep breathing exercises.

Answer 3

B. Place the patient on supplemental oxygen

Question 4

While assessing a 32 year old 193 cm tall male receiving mechanical ventilation, you note a sudden decrease in breath sounds. The cuff pressure is 5 cm H20 and airflow is coming from the patient’s mouth during each positive pressure breath. The ETT is 21 cm at the lip. Air is added to the cuff, but the cuff pressure is not maintained. What should you do next?

A. ABG analysis
B. Increase the tidal volume
C. Reintubate, using an endotracheal tube changer
D. Advance the ETT 4 cm

Answer 4

C. Reintubate, using an endotracheal tube changer.

Question 5

A 25 year old male who is 177.8 cm and weighs 175 lbs is receiving AC/PCV via mechanical ventilation. The patient has periods of apnea. ABG results are as follows:

pH: 7.20
CO2: 65 mmHg
PO2: 70 mmHg
HCO3: 25
BE: -4
SaO2: 94%

What should you recommend increasing?

A. The expiratory time
B. The trigger sensitivity
C. The set inspiratory pressure
D. The peak flow

Answer 5

B. The trigger sensitivity

Question 6

You are evaluating a 75 kg, 180 cm tall male, who is receiving mechanical ventilation via VC/SIMV. The following data is obtained:

FiO2: 0.40
Mandatory Rate: 8 breaths/min
Tidal Rate: 8 breaths/min
Tidal volume: 525 mL
PEEP: 8 cm H20

What should you recommend?

A. Maintain current settings
B. Increase the mandatory rate to 11 breaths/min
C. Decrease the FiO2 to 0.21
D. Decrease the tidal volume to 40 mL

Answer 6

A. Maintain current settings

Question 7

A 61 year old 175 cm tall male weighing 88 kg is receiving mechanical ventilation post-op after a thoracotomy. The ventilation is PRVC with the following settings:

FiO2: 0.40
Mandatory rate: 12 breaths/min
Tidal volume: 560 mL
PEEP: 5 cm H20

The patient is alert, oriented, and following commands. You collect the following data:

SpO2: 98%
NIF: -40 cm H20
FVC: 18 mL
Exhaled VT: 575 mL

What is the best method for weaning this patient?

A. A spontaneous breathing trial
B. SIMV mode, mandatory rate 8, set tidal volume 350 mL
C. PS ventilation at 15 cm H20
D. CPAP/PS of 10/8 cm H20

Answer 7

A. A spontaneous breathing trial

Question 8

Following placement of a subclavian venous catheter, the high peak pressure alarm on the patient’s ventilator begins alarming. After 10 minutes, the patient’s peak inspiratory pressure has increased from 40 cm H20 to 60 cm H20 and the mean arterial blood pressure has decreased from 80 mmhg to 40 mmhg. What would you recommend happens first?

A. Increase the peak flow
B. Start patient on vasopressors
C. Suction the endotracheal tube
D. Needle decompression

Answer 8

D. Needle decompression

Question 9

A 40 year old female with a PBW of 55 kg is septic following bariatric surgery five days ago. The patient is intubated and receiving VC/AC via mechanical ventilation with the following settings:

FIO2: 0.50
Mandatory rate: 18 breaths/min
Tidal volume: 350 mL
PEEP: 12 cm H20

Upon returning for a trip to CT, the patient’s peak inspiratory pressure is 50 cm H20 and the plateau has increased from 26 to 35. ABG results as follows:

pH: 7.39
CO2: 38 mmHg
PO2: 49 mmhg
HCO3: 23
BE: -2
SPO2: 84%

What should you recommend?

A. Increase the mandatory rate
B. A lung recruitment maneuver
C. Decrease the tidal volume
D. Duoneb inline with the ventilator

Answer 9

B. A lung recruitment maneuver