Review Questions Flashcards
On the Sensormedics 3100B the distance the piston travels determines:
a. The frequency
b. The amplitude
c. The mean airway pressure
d. All of the above
b.The amplitude
The frequency will be determined by how fast the piston is moving as it is the RR, which is determine and set with Hertz (RRx60). The mean airway pressure will be set and is held constant.
You are ventilating a patient on the Sensormedics 3100B. The control that determines the FRC of a patient is:
a. Amplitude
b. Frequency
c. Mean airway pressure
d. Ti%
c.Mean Airway Pressure
You amplitude in a way is like you tidal volume but as it is the area under the curve it will also be affected by frequency. However tidal volumes in HFV are so small that the lung are practically unmoving which is why amplitude and frequency will not affect the FRC. What does determine the FRC is mean airway pressure which is the pressure that is held in the lung constantly in order to keep them open.
Frequceny and Vt Relationship
Inverse
Frequency and Alkalosis
To deal with alkalosis you should increase frequency
Respiratory Alkalosis Management
When you are in respiratory alkalosis you want increase CO2, and by increasing frequency you are decreasing tidal volume and increasing what is considered the RR. Be increasing the RR you are spending less time in exhalation so you are holding onto more CO2.
You are ventilating your patient on the Sensormedics 3100B. Their recent ABG shows an acute respiratory alkalosis. Which of the following changes would most likely return the ABG to normal values:
a. Increase Ti%
b. Increase frequency
c. Increase MAP
d. Increase the bias flow
b. Increase frequency
When you are in respiratory alkalosis you want increase CO2, and by increasing frequency you are decreasing tidal volume and increasing what is considered the RR. Be increasing the RR you are spending less time in exhalation so you are holding onto more CO2.
When the adjustable MAP alarm (ie. The one set by the operator) is activated on the Sensormedics 3100B, the following occurs:
a. AV alarm
b. Bias flow stops
c. Oscillations cease
d. Dump valve opens
e. All of the above
a.AV alarm
When the alarm sound no changes will be made automatically by the ventilator rather you have to insect the machine and see what is happening.
You are at the bedside of an oscillated patient when they become disconnected from the circuit. The oscillations have stopped and the vent is alarming. The steps you would take to resume oscillations would be:
- reconnect patient, depress the start/stop button
- depress the start/stop button, reconnect patient, press and hold the power fail/reset button
- reconnect patient, press and hold the power fail/reset button, depress start/stop button
- reconnect patient, depress the power fail/reset button
- reconnect patient, press and hold the power fail/reset button, depress start/stop button
PPHN and Oxygenation
You want to give high oxygen to these babies
You are ventilating the patient using a NPB 7200 with the following settings. What is the approximate size of the spontaneous breath?
Mode: SIMV(VC)+PS
Set RR: 8
Vt: 550 mL
Plateau: 0.5 sec
PS: 10 cmH2O
PEEP: 8 cmH2O
FiO2: 0.60
Measured RR: 22
Measure MV: 8.9
PIP: 28 cmH2O (Mechanical Breaths)
First solve for the set minute ventilation
Set Minute Ventilation= 8 x 0.55
Set Minute Ventilation= 4.4
Next subtract the set minute ventilation from the measured minute ventilation
8.9-4.4=4.5
Finally solve for tidal volume with the minute ventilation equation
4.5=(22-8) x Spontaneous Vt
Spontaneous Vt=321 mL
Which of the following statement is/are correct in regards to APRV/BiLevel
a. When set up it is similar to inverse ratio pressure control
b. Meant to be used on sedated comatose patient
c. Breathing on two CPAP levels
d. All of the above
e. A and C
a.A and C
What you are setting is essentially pressure control on a high CPAP level with a low pressure release time. This is setting up a long inspiration and short expiration with an inverse ratio of 4:!. To get the most benefit out of APRV you will want to use it where the patient is able to breath spontaneously (not sedated and comatose.
During ASV ventilation which of the following is true
a. This mode is designed for partial ventilatory support only
b. A setting of 120% minute volume would mean that the ventilator would deliver and 8.4 LPM for a 70 kg patient
c. A patient with a minute volume percent setting of 80%; has 100% spontaneous breathing receiving a Pinsp of 5, FiO2 0.35, PEEP 5, Frequency of 18, Vt of 400mL, Should be considered for ventilator disconnection
d. All of the above
e. B and C
e.B and C
Which of the following mode is appropriate for a comatose patient?
I. ASV
II. CMV PC
III. SIMV APV
IV. PSV
V. Volume Support
I, II, III, V
Which of the following is the true statement in regards to PAV+
PAV+ is based on the equation Pmus = Palveolar + Ptransairway
The breath delivered is a constant set pressure
PAV+ is indicated for neuromuscular patient
PAV+ can be used when there are leaks in the circuit
PAV+ is based on the equation Pmus = Palveolar + Ptransairway
Which of the following is an acceptable method of SBT?
a. SIMV with low respiratory rate, CPAP of 5 cmH2O, and pressure support of 5 cmH2O
b. PEEP of 5 cmH2O and pressure support of 5 cmH2O
c. Volume support, CPAP of 5 and Vt target of 8ml/kg
d. CPAP of 5 cmH2O and tube compensation
e. B and C
B and C
Which of the follow is a goal of ventilation for a patient with pulmonary edema
Decreased workload of the heart
Decreased hypoxemia
Decrease circulating volume
All of the above
.A and B
.A and B
Which of the following is the most appropriate ventilator strategy for a paralyzed and sedated patient with a closed head injury?
Hyperventilate the patient
Keep PaCO2 between 35-45 and SpO2 88-92%
Keep PaCO2 between 35-40 mmHg and well oxygenation
Permissive hypercapnia strategy
Keep PaCO2 between 35-40 mmHg and well oxygenation
We only hyperventilate the patient as a short term treatment to decrease ICP. You want to keep this patient population well oxygenated (PaO2 80-120 mmHg). We are more focused on keeping the patient well oxygenated than we are focused on permissive hypercapnia.
Which of the following is not a goal of NPPV in the acute care setting
Avoid intubation
Decreased incidence of VAP
Decrease length of stay
.Improve mobility
.Improve mobility
You are ventilating a 75 kg patient in CMV (VC) with the following settings
Vt Set: 600 mL
RR Set: 12 bpm
PEEP 5 cmH2O
Flow 80 LPM with a decelerating flow pattern
FiO2 0.4
Measured values include:
PIP 28 cmH2O
RR 20 bpm
ABG: Acute Respiratory Alkalosis with corrected hypoxemia.
What would be the appropriate ventilator changes?
Decreasing RR
Switching to SIMV or CSV with pressure support
Increasing PEEP
Increasing the set Vt
Switching to SIMV or CSV with pressure support
Which of the following will affect patient ventilator synchrony
Sensitivity level
Set flow rate
Auto PEEP
All of the above
All of the above
Given the following ABG while on NPPV, what change is recommended
- 32, 55, 75, 28, +3, 95%
a. Increase FiO2 and increase CPAP
b. Increase EPAP and increase FiO2
c. Increase IPAP
d. Increase CPAP
C. Increase IPAP
Your patient is being non-invasively ventilated in a S/T mode of a non-invasive ventilator. Which of the following is true
Patient triggered breath are flow cycled
Both patient and time triggered breaths are flow cycled
Mandatory breaths are always given at the set rate
Patient triggered breaths are time cycled
Patient triggered breath are flow cycled
A 36 week gestation infant has the following assessment. Which of the following is the best action
RR at 79 with subcostal/intercostal indrawing
FiO2 50% per the head box
CXR shows increased interstitial markings, fluid in the horizontal fissure
CBG: 7.32, 50, 45, 25, -1, 75%
Initiate CPAP at 6 cmH2O
Intubate and place on mechanical ventilator
Increase FiO2 to 60%
Give 5 mg of Lasix
Initiate CPAP at 6 cmH2O
Which of the following best describes proper initial ventilator alarm set up? Patient is 60kgs.
a) High minute volume (MV) alarm set 2 LPM higher than expected. Low MV alarm set 2 LPM lower than expected. High pressure alarm set at 55 cmH2O.
b) High pressure set at 40 cmH2O. Apnea time of 20 seconds. Low inspiratory pressure at 5 cmH2O below PEEP.
c) Apnea parameters set for partial ventilatory support.
d) High MV of 8 LPM, Low minute volume of 4 LPM. VTI of 800 mls.
d) High MV of 8 LPM, Low minute volume of 4 LPM. VTI of 800 mls.
Which of the following is the best choice for initial ventilator settings for full ventilatory support of an adult male who is 5 feet 8 inches tall?
a) CMV VC, frequency 14, Vt 550 mls, Flow 60 LPM decelerating wave, PEEP 5
b) CMV PC, frequency 17, PIP 22 cmH2O, PEEP 7
c) CPAP 5 cmH2O, pressure support of 10 cmH2O
d) SIMV APV, frequency 8, Vt 550 mls, PEEP 5
a) CMV VC, frequency 14, Vt 550 mls, Flow 60 LPM decelerating wave, PEEP 5
According to the equation of motion of the respiratory system, a ventilator can control all of the following variables except:
a) Volume
b) Resistance
c) Pressure
d) Flow
b) Resistance
All of the following are hazards associated with mechanical ventilation except:
a) Reduced cardiac output
b) Liver failure
c) Increased work of breathing
d) Acute lung injury
b) Liver failure
You are ventilating a patient in CMV APV. The latest ABG results are: 7.34, 50, 55, 26, 0, 89%. Which of the following changes will improve oxygenation?
a) Increase ramp time
b) Decrease Ti
c) Increase PEEP
d) Increase FiO2
e) c and d
e) c and d
You are ventilating a patient in ACVC; latest ABG shows: 7.29, 55, 81, 26, -1, 96%. Which of the following will improve oxygenation?
a) Switch from a square to decorating waveform
b) Increase resp rate
c) Increase Vt
d) Increase flow-rate
e) b and c
e) b and c
Which of the following indicate the need for ventilator support of a 62 kg patient?
a) MIP – 18 cmH2O
b) Spontaneous Vt of 300 ml
c) Vital capacity of 990 ml
d) P/F 375
e) All of the above
a) MIP – 18 cmH2O
For which of the following uses might you consider the use of a purely pneumatically powered ventilator?
I. As a backup to electrically powered ventilators
II. When electrical device cannot be used (MRI)
III. During certain types of transport
I, II, III
The first step for basic life support when an unconscious adult is found is?
Assess the pulse
Assess breathing
Early defibrillation
Early chest compressions
Assess breathing
The correct ratio for chest compressions and respirations when an advanced airway is in place for an adult patient is?
30 Compression : 2 Respirations
15 Compressions: 2 Respirations
Continuous Compressions: 8-10 Respirations/min
Continuous Compressions: 12-20 Respirations/min
Continuous Compressions: 12-20 Respirations/min
Which of the following indicates appropriate chest compression for an adult?
Rate ≥ 100/min and PETCO2 > 10mmHg
Depth of ≥ 1 inch
Allow complete recoil
All of the above
A and C
A and C
Which of the following may be appropriate for an adult cardiac arrest in VF/VT
I. CPR
II. Defibrillation
III. 3-5 mg of Epinephrine
IV. 300 mg of amiodarone
I, II, IV
Which of the following may be appropriate for an adult cardiac arrest in asystole/PEA
I. CPR
II. 1 mg of Epinephrine
III. 1 mg of Atropine
IV. 150 mg of Amiodarone
I, II
Which of the following may be appropriate for an unstable adult bradycardia with a pulse
I. Atropine 0.5 mg
II. Dobutamine 2 mcg/kg/min
III. Epinephrine 2 mcg/kg/min
IV. Transcutaneous Pacing
I, III, IV
Which of the following may be appropriate for an unstable adult tachycardia with a pulse?
I. Atropine 0.5 mg
II. Synchronized Cardioversion
III. Adenosine 6 mg
IV. Epinephrine 1 mg
II, III
Which of the following is a correct as an indication for epinephrine in a newborn resuscitation?
Heart Rate of 45/min
Heart Rate of 75/min
Heart rate of 50/min after 30 seconds of effective ventilation and 30 seconds of chest compressions
Unresponsive to resuscitation and known maternal blood loss
Heart rate of 50/min after 30 seconds of effective ventilation and 30 seconds of chest compressions
Which of the following actions are appropriate for Robin Syndrome baby
I. Oral Intubation
II. LMA
III. NPA
IV. Placed in Prone Position
All of the Above
Which of the following action is the most important and effective step in neonatal resuscitation?
a. Ventilation of the lungs
b. Epinephrine
c. Chest Compression
d. Tactile Stimulation
a. Ventilation of the lungs
You assess a 5-year-old who is unresponsive, with no pulse and no breathing, on the pediatric ward. Which is the next appropriate step
a. Call a code and start ventilation
b. Call a code 66 and start ventilation
c. Call a code and start compression
d. Apply a non rebreathe mask
c. Call a code and start compression
A child is placed on a monitor/defibrillator; the child is unconscious, with no pulse and rhythm is VT. Which of the following is the correct action?
a. Apply a non rebreathe mask
b. Immediate cardioversion
c. Give amiodarone
d. Defibrillate
d. Defibrillate
Which of the follow is an appropriate management for cardiogenic or non-cardiogenic pulmonary edema in pediatric patients with respiratory distress
I. Salbutamol
II. NPPV
III. Diuretic
IV. Vasoactive Drug
II, III, IV
Which of the following is indicated for pediatric respiratory distress caused from anaphylaxis?
I. Oxygen
II. Salbutamol
III. Epinephrine
IV. Antibotics
I, II, III
