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25 Cards in this Set

  • Front
  • Back
The flow wave pattern that is characterized by a high initial flow that tapers off as inspiration continues is called?
a.Square wave (constant flow)
b.Sine wave
c.Decelerating wave (descending ramp)
d.Accelerating wave (ascending ramp)
(C) - The Decelerating wave (descending ramp) flow pattern is characterized by a high initial flow that tapers off as inspiration continues. This flow pattern benefits patients with low compliance. The decelerating pattern may improve the distribution of gas in the lungs
and increase oxygenation by increasing the mean and plateau airway pressures. The decelerating pattern will cause an increase in the inspiratory time.
A Guillain-Barre patient is receiving mechanical ventilation in your ICU. The ventilator settings
include: Control mode, Tidal Volume of 900 ml, rate of 10, FI02 - 40%, PEEP of 5 cmH20. Arterial blood gases show a pH - 7.51, PaC02 - 28, torr, Pa02 - 91 torr, HC03 - 26 mEq/L. Whichof the following actions should the therapist do first?
a.decrease the tidal volume
b.add mechanical deadspace
c.do nothing
d.increase the PEEP
e.decrease the rate
(B) - The use of dead space may be useful for patients who require large tidal volumes for the relief of dyspnea such as Guillain-Barre syndrome. According to NBRC testing, when the therapist needs to normalize a low PaC02 the deadspace should be increased first.
Secondly, the respiratory rate should be decreased and thirdly the tidal volume should be decreased.
A large obese 36-year-old woman is placed on mechanical ventilation in the emergency room.She weighs 135 kg (297 lbs) and is 162 cm (5 ft 4 inches) tall. Which of the following tidal volumes and rates would you initially recommend?
a.Vt - 560 ml / Rate - 6
b.Vt - 800 ml / Rate - 12
c.Vt - 1200 ml / Rate - 10
d.Vt - 1600 ml / Rate - 8
(B) - The ideal body weight equation in pounds for women is: 105 + 5 (height in inches-60). A patient weighing 135 kg (297 lbs) and is 162 cm (5 ft 4 inches) tall should have a tidal volume between 560 to 840 ml. The initial ventilator rate should be between 8 and 12.
Which of the following characteristics of a pressure-cycled ventilator is incorrect?
a.the ventilation is adjusted by increasing or decreasing the tidal volume
b.volumes will vary as the lung compliance and/or airway resistance changes
c.when a preset inspiratory pressure is reached, inspiration ends
d.pressure can be delivered during machine breaths or spontaneous breaths
e.it reduces the chance of overdistention (barotrauma)
(A) - On a pressure-cycled ventilator, ventilation is adjusted by increasing or decreasing the
preset pressure.
Which of the following characteristic of a volume-cycled ventilator is incorrect?
a.a preset tidal volume is delivered to the patient with each machine breath b.inspiratory pressure changes to maintain the preset tidal volume
c.changes in compliance and airway resistance will vary the inspiratory pressure
d.alveolar overdistention is a common problem
e.the minute volume will vary with inspiratory pressures
(E) - With a volume-cycled ventilator, minute ventilation should not vary with inspiratory pressures. Of course, if inspiratory pressures exceed the high pressure alarm setting then the ventilator will cycle off prematurely thereby decreasing the delivered tidal volume.
Increasing the flowrate on a volume-cycled ventilator while maintaining all other variables constant will change which of the following?
a.will increase the inspiratory time
b.will decrease the inspiratory time
c.will increase the total cycle time
d.will decrease the expiratory time
(B) - Increasing the flowrate on a volume-cycled ventilator will decrease the inspiratory time. This is the most common method of correcting an I:E ratio alarm problem.
Which of the following values are consistent with a mechanically ventilated patient with
increasing airway resistance?

a.Peak Pressure - 22 / Plateau Pressure - 15 / Tidal Volume 800 ml
b.Peak Pressure - 25 / Plateau Pressure - 21 / Tidal Volume 800 ml
c.Peak Pressure - 46 / Plateau Pressure - 24 / Tidal Volume 800 ml
d.Peak Pressure - 60 / Plateau Pressure - 55 / Tidal Volume 800 ml
(C) - Peak Pressure - 46 / Plateau Pressure - 24 shows a 22 cmH20 pressure difference between the two. The airway resistance is increasing since the plateau and peak pressure gradient is widening.
The flow wave pattern on the mechanical ventilator that is most like a person's normal spontaneously breathing flow pattern is called?

a.Square wave (constant flow)
b.Sine wave
c.Decelerating wave (descending ramp)
d.Accelerating wave (ascending ramp)
(B) - The Sine wave is most like a normal spontaneously breathing flow pattern. Flow gradually accelerates from the beginning of inspiration and then tapers off towards
expiration.
When using a free-standing CPAP system, the most important alarm will be?

a.low pressure alarm
b.high pressure alarm
c.I:E ratio alarm
d.low tidal volume alarm
(A) - When using a free-standing CPAP system, the most important alarms will be the low pressure and apnea alarm since the system requires spontaneous ventilation from the patient.
Which of the following is not a potential problem when using the Assist-Control mode for mechanical ventilation?

a.respiratory alkalosis
b.decreased mean airway pressures
c.auto-PEEP
d.respiratory muscle atrophy
e.decrease in cardiac output
(B) - The Assist-Control mode may have a tendency to increase mean airway pressures especially if the patient initiates breaths above the set rate.
In order to maintain a patient's oxygenation status while being mechanically ventilated you are asked to increase the levelof PEEP from 5 to 10 cmH20. Which of the following would be an indication that this may be determinal to the patient?
a.blood pressure decreases
b.urinary output increases
c.lung compliance increases
d.P(A-a) gradient decreases
(A) - A major problem with the use of PEEP is decreased venous return and therefore decreased cardiac output.
In order to maintain a patient's oxygenation status while being mechanically ventilated you are asked to increase the levelof PEEP from 5 to 10 cmH20. Which of the following would be an indication that this may be determinal to the patient?
a.blood pressure decreases
b.urinary output increases
c.lung compliance increases
d.P(A-a) gradient decreases
(C)- Plateau pressure is an inspiratory hold at peak inspiration for 1 to 2 seconds. Once the flow is held, a plateau pressure will occur as the lungs fall back to a resting position at peak inspiration. The Plateau pressure is used to obtain a static lung compliance calculation.
A patient with pneumonia is receiving mechanical ventilation. The ventilator settings include:SIMV mode, Tidal Volume of 700 ml, rate of 8, FI02: 35%, PEEP none. Arterial blood gases show a pH - 7.46, PaC02 - 34, torr, Pa02 - 78 torr, HC03 - 24 mEq/L. Which of the following actions should the therapist should take?
a.decrease the SIMV rate to 6
b.increase the FI02 to .45
c.decrease the tidal volume to 600 ml
d.increase the mechanical deadspace
(A) - Decreasing the SIMV rate to 6 is the best option.
What is the alveolar ventilation of a 150 lb. (68 kg) patient with a tidal volume of 500 and a rate 15?
a.7.500 Liters
b.6.480 Liters
c.5.250 Liters
d.4.230 Liters
(C) - The alveolar ventilation of a 150 lb. (68 kg) patient with a tidal volume of 500 and a rate 15 is 5.250 Liters. 500 - 150 = 350 x 15 = 5.250
Which of the following is not a characteristic of pressure control ventilation?
a.pressure control can be used with Assist-control and SIMV
b.breaths are time or patient triggered
c.tidal volume is based on the patient's lung compliance and resistance
d.pressure control produces an ascending flow ramp curve e.breaths are time-cycled and pressure limited
(D) - Pressure control produces an descending flow ramp curve. The initial flow is high and decelerates based on the volume in a patient’s lungs (decelerating ramp flow curve).
You are asked to adjust the tidal volume of a mechanically ventilated patient on pressure control ventilation and maintain it at 600 ml. Which of the following controls would you adjust to achieve this volume?
a.adjust the tidal volume
b.adjust the pressure levels
c.adjust the flowrate
d.adjust the respiratory rate
(B) - The pressure control level is used to maintain adequate tidal volumes when using pressure control ventilation.
Which of the following is not a common application for using Pressure Support ventilation?
a.to overcome the resistance of the E-T tube and the ventilator circuit
b.to provide supported spontaneous breaths when using CPAP and SIMV modes
c.to provide full ventilatory support using maximum pressure support (PSmax)
d.as a weaning tool in conjunction with SIMV or CPAP
e.to deliver mandatory positive pressure breathes
(E) - Pressure support is always an assist mode or patient triggered with no preset tidal volume or frequency. It is used in patients who are capable of spontaneous breathing.
A dead space to tidal volume ratio (Vd/Vt) test is used to determine the amount of dead space ventilation in a patient with a pulmonary embolus. Which of the following is incorrect concerning this test?
a.it is calculated by using the Bohr equation
b.the average exhaled C02 (PEC02) can be obtained by using an airtight bag to collect all of
the person's exhaled gas
c.a dead space/tidal volume ratio of 30% or more is an indication for mechanical ventilation
d.factors that may decrease the dead space/tidal volume ratio may include a pneumonectomy
.(C) - A dead space/tidal volume ratio of 60% or more is an indication for mechanical ventilation.
An agitiated patient is trying to be maintained on the ventilator without success. The decision is made to paralyze the patient. Which of the following drugs would be the best choice with the least chance of side effects?
a.d-Tubocurarine (Curare)
b.Succinylcholine (Anectine)
c.Pancuronium bromide (Pavulon)
d.Pentamidine
(C) - Pancuronium bromide (Pavulon) is the best choice of drugs listed for maintenance of the combative patient on the ventilator. Pavulon paralyzes the patient but does not produce sedation. Therefore, sedatives should always be given along with this drug.
The values below pertain to a patient who is being mechanically ventilated.

6:00 a.m. / 34 PIP / 29 Plateau / 700 tidal volume
7:00 am. / 32 PIP / 27 Plateau / 700 tidal volume
8:00 a.m. / 31 PIP / 26 Plateau / 700 tidal volume
9:00 a.m. / 29 PIP / 24 Plateau / 700 tidal volume
Which of the following is indicated by this information?
a.airway resistance is increasing
b.lung compliance is improving
c.lung compliance is decreasing
d.airway resistance is
(B) - Both the plateau and peak airway pressures are decreasing simultaneously revealing an improved lung compliance.
Calculate the static compliance figure for a ventilator patient whose exhaled volume is 600 ml,peak pressure of 30 cmH20, plateau pressure of 25 cmH20, with 5 cmH20 PEEP.


a.20 ml/cmH20
b.26 ml/cmH20
c.30 ml/cmH20
d.38 ml/cmH20
(C) - Cst = The corrected tidal volume in mL (tidal volume - circuit compressed volume) is divided by the Pressure change (Plateau airway pressure - PEEP) in cm H20. 600 / (25 - 5)= 30
What would be the dynamic compliance figure be for the same patient?


a.12 ml/cmH20
b.14 ml/cmH20
c.16 ml/cmH20
d.24 ml/cmH20
(D) - Cdyn = The corrected tidal volume in mL (tidal volume - circuit compressed volume) divided by the Pressure change (Peak airway pressure - PEEP) in cm H20. 600 / (30 - 5) =24
Which of the following must be occurring when obtaining accurate static and dynamic compliance figures?


a.the patient must be assisting the measured breaths
b.two or three breaths should be taken for accuracy
c.the patient must be taken off the ventilator for accurate measurements
d.compliance checks are calculated using end-expiration figures
(B) - When obtaining accurate static and dynamic compliance figures two or three breaths
should be taken for accuracy.
Which of the following would not be used to normalize a low PaC02?


a.increase the deadspace
b.decrease respiratory rate
c.decrease tidal volume
d.increase the FI02
(D) - Increasing the FI02 would not be used to normalize a low PaC02.
To decrease a high Pa02 in a mechanically ventilated patient, the therapist should do which of the following first?


a.decrease FI02 to 50% or less, then decrease PEEP
b.decrease PEEP first, then decrease FI02 to 50% or less c.decrease PEEP while increasing FI02
d.decrease the FI02 while increasing PEEP levels
(A) - To decrease a high Pa02 in a mechanically ventilated patient, the therapist should first decrease the FI02 to 50% or less and then decrease the PEEP level.