Question 1

Which pathogen is commonly found in patients who had percutaneous tracheostomies?

Accepted Answer

A)  Klebsiella spp. 
B)  Pseudomonas sp. 
C)  Enterobacter spp. 
D)  Candida albicans 
A)  Klebsiella spp. 
B)  Pseudomonas sp. 
C)  Enterobacter spp. 
D)  Candida albicans B

Question 2

The pathogenesis of VAP involves:
1)colonization of the aerodigestive tract.
2)aspiration of contaminated secretions into the lower airways.
3)increased use of silver-coated endotracheal tubes.
4)colonization of lower airways and lung parenchyma.

Accepted Answer

A)  2 and 3 only 
B)  2, 3, and 4 only 
C)  1, 2, and 3 only 
D)  1, 2, and 4 only 
A)  2 and 3 only 
B)  2, 3, and 4 only 
C)  1, 2, and 3 only 
D)  1, 2, and 4 only D

Question 3

Healthy individuals usually have which of the following bacteria in their upper airways?

Accepted Answer

A)  Haemophilus sp. 
B)  Acinetobacter sp. 
C)  Pseudomonas aeruginosa 
D)  Staphylococcus aureus 
A)  Haemophilus sp. 
B)  Acinetobacter sp. 
C)  Pseudomonas aeruginosa 
D)  Staphylococcus aureus A

Question 4

The incidence of ventilator-associated pneumonia for all intubated patients is ___________.

Accepted Answer

A)  8-28% 
B)  15-35% 
C)  25-50% 
D)  38-76% 
A)  8-28% 
B)  15-35% 
C)  25-50% 
D)  38-76%

Question 5

Relying on clinical findings for the treatment of ventilator-associated pneumonia may do which of the following?

Accepted Answer

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)  Decrease the morbidity of VAP. 
B)  Decrease the mortality of VAP. 
C)  Create multidrug-resistant organisms. 
D)  Reduce the need for invasive microbiologic procedures.

Question 6

Reasons for the shift in oropharyngeal flora in patients receiving invasive mechanical ventilation with endotracheal tubes include which of the following?

Accepted Answer

A)  Lowered pH levels 
B)  Increase in mucus-producing cells 
C)  Decreased production of proteases 
D)  Decreased mucosal immunoglobulin A 
A)  Lowered pH levels 
B)  Increase in mucus-producing cells 
C)  Decreased production of proteases 
D)  Decreased mucosal immunoglobulin A

Question 7

Sixty percent of all VAP infections are caused by which of the following?

Accepted Answer

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 
B)  Anaerobic gram-negative bacilli 
C)  Aerobic gram-negative rods 
D)  Anaerobic gram-positive cocci

Question 8

The most common gram-positive bacterium that causes ventilator-associated pneumonia is which of the following?

Accepted Answer

A)  Streptococcus pneumoniae 
B)  Enterococcus faecalis 
C)  Methicillin-resistant Staphylococcus aureus 
D)  Pseudomonas aeruginosa 
A)  Streptococcus pneumoniae 
B)  Enterococcus faecalis 
C)  Methicillin-resistant Staphylococcus aureus 
D)  Pseudomonas aeruginosa

Question 9

The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with early-onset VAP is which of the following?

Accepted Answer

A)  Linezolid 
B)  Vancomycin 
C)  Gentamicin 
D)  Levofloxacin 
A)  Linezolid 
B)  Vancomycin 
C)  Gentamicin 
D)  Levofloxacin

Question 10

A 63-year-old male,post head trauma,is intubated and has been mechanically ventilated for 78 hours.The respiratory therapist notes the following during ICU rounds: partial pressure of oxygen in the arteries (PₐO₂)is 82 mm Hg on 60% supplemental oxygen with a positive end-expiratory pressure (PEEP)of 8 cm H₂O; static compliance is averaging 38-41 cm H₂O/L; breath sounds are diminished bilaterally.Bronchoalveolar lavage (BAL)results are pending,but MRSA is suspected.Chest radiograph shows bilateral,patchy infiltrates.Patient has a temperature of 38.8° C,and the most recent white blood cell (WBC)count is 11,300 $\mu$L.The most appropriate recommendation for this patient is which of the following?

Accepted Answer

A)  Monotherapy with an antipseudomonal carbepenem 
B)  Monotherapy with an antipseudomonal fluoroquinolone 
C)  Combination therapy with two types of antipseudomonal agents and vancomycin 
D)  Combination therapy with ampicillin/sulbactam and linezolid 
A)  Monotherapy with an antipseudomonal carbepenem 
B)  Monotherapy with an antipseudomonal fluoroquinolone 
C)  Combination therapy with two types of antipseudomonal agents and vancomycin 
D)  Combination therapy with ampicillin/sulbactam and linezolid

Question 11

The mortality rate for VAP depends on which of the following?
1)Length of stay on the ventilator
2)Presence of underlying disease
3)Prior antimicrobial therapy
4)Presence of a heated humidifier

Accepted Answer

A)  1 and 2 only 
B)  2 and 3 only 
C)  1 and 4 only 
D)  1, 2, 3, and 4 
A)  1 and 2 only 
B)  2 and 3 only 
C)  1 and 4 only 
D)  1, 2, 3, and 4

Question 12

Effective treatment of ventilator-associated pneumonia can be ensured by diagnosis based on findings from which of the following?

Accepted Answer

A)  Chest radiographs 
B)  Hematological studies 
C)  Bronchial alveolar lavage 
D)  Patient signs and symptoms 
A)  Chest radiographs 
B)  Hematological studies 
C)  Bronchial alveolar lavage 
D)  Patient signs and symptoms

Question 13

Patients with chronic obstructive pulmonary disease (COPD)are at higher risk for infection with which of the following organisms?1.Haemophilus influenzae
2)Pseudomonas aeruginosa
3)Moraxella catarrhalis
4)Staphylococcus aureus

Accepted Answer

A)  1 and 2 only 
B)  1 and 3 only 
C)  2 and 4 only 
D)  3 and 4 only 
A)  1 and 2 only 
B)  1 and 3 only 
C)  2 and 4 only 
D)  3 and 4 only

Question 14

A patient was intubated in the emergency department just after arrival at the hospital from home.This patient develops VAP 36 hours after intubation.What type of pneumonia is this considered?

Accepted Answer

A)  Early-onset VAP 
B)  Late-onset VAP 
C)  Health care-associated pneumonia 
D)  Nonhospital-acquired pneumonia 
A)  Early-onset VAP 
B)  Late-onset VAP 
C)  Health care-associated pneumonia 
D)  Nonhospital-acquired pneumonia

Question 15

According to the Centers for Disease Control (CDC)and National Healthcare Safety Network (NHSN),the proposed and updated definition for VAP includes which of the following?
1)Objective data
2)Patient's family history
3)A clearly defined time criteria
4)Chest radiograph images

Accepted Answer

A)  1 and 3 only 
B)  2 and 3 only 
C)  2, 3, and 4 only 
D)  1, 2, 3, and 4 
A)  1 and 3 only 
B)  2 and 3 only 
C)  2, 3, and 4 only 
D)  1, 2, 3, and 4

Question 16

Calculate the Clinical Pulmonary Infection Score (CPIS)for a patient with the following assessments: 56-year-old female,post motor vehicle accident,intubated,and mechanically ventilated for 4 days.Static compliance is 42 cm H₂O/L.Tracheobronchial suctioning reveals a moderate amount of yellow secretions; culture and sensitivity are pending.Breath sounds reveal bilateral lower lobe coarse rhonchi.Chest radiograph shows diffuse infiltrates.Partial pressure of oxygen in the arteries (PₐO₂)is 72 mm Hg on 40% supplemental oxygen.Patient has a temperature of 39.2° C,and white blood cell count (WBC)is 12,800 $\mu$L.

Accepted Answer

A)  CPIS = 5 
B)  CPIS = 6 
C)  CPIS = 7 
D)  CPIS = 8 
A)  CPIS = 5 
B)  CPIS = 6 
C)  CPIS = 7 
D)  CPIS = 8

Question 17

To avoid ventilator-associated pneumonia,how often should ventilator circuits be changed?

Accepted Answer

A)  Every 24 hours 
B)  Every 48 hours 
C)  Once weekly 
D)  When visibly dirty 
A)  Every 24 hours 
B)  Every 48 hours 
C)  Once weekly 
D)  When visibly dirty

Question 18

The mortality rate for VAP associated with prolonged hospital stays is which of the following?

Accepted Answer

A)  5-25% 
B)  15-40% 
C)  25⁻⁵0% 
D)  45-75% 
A)  5-25% 
B)  15-40% 
C)  25⁻⁵0% 
D)  45-75%

Question 19

The type of organism that most often causes ventilator-acquired pneumonia is which of the following?

Accepted Answer

A)  Fungi 
B)  Bacteria 
C)  Viruses 
D)  Protozoa 
A)  Fungi 
B)  Bacteria 
C)  Viruses 
D)  Protozoa

Question 20

Which of the following is not a method to reduce the risk of VAP?

Accepted Answer

A)  Nasally intubate whenever possible. 
B)  Provide intermittent nasogastric tube feedings. 
C)  Keep patient in a semirecumbent position. 
D)  Use heat/moisture exchangers when possible. 
A)  Nasally intubate whenever possible. 
B)  Provide intermittent nasogastric tube feedings. 
C)  Keep patient in a semirecumbent position. 
D)  Use heat/moisture exchangers when possible.

Exam 14: Ventilator-Associated Pneumonia

Which pathogen is commonly found in patients who had percutaneous tracheostomies?

The pathogenesis of VAP involves: 1)colonization of the aerodigestive tract. 2)aspiration of contaminated secretions into the lower airways. 3)increased use of silver-coated endotracheal tubes. 4)colonization of lower airways and lung parenchyma.

Healthy individuals usually have which of the following bacteria in their upper airways?

The incidence of ventilator-associated pneumonia for all intubated patients is ___________.

Relying on clinical findings for the treatment of ventilator-associated pneumonia may do which of the following?

Reasons for the shift in oropharyngeal flora in patients receiving invasive mechanical ventilation with endotracheal tubes include which of the following?

Sixty percent of all VAP infections are caused by which of the following?

The most common gram-positive bacterium that causes ventilator-associated pneumonia is which of the following?

The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with early-onset VAP is which of the following?

The mortality rate for VAP depends on which of the following? 1)Length of stay on the ventilator 2)Presence of underlying disease 3)Prior antimicrobial therapy 4)Presence of a heated humidifier

Effective treatment of ventilator-associated pneumonia can be ensured by diagnosis based on findings from which of the following?

Patients with chronic obstructive pulmonary disease (COPD)are at higher risk for infection with which of the following organisms?1.Haemophilus influenzae 2)Pseudomonas aeruginosa 3)Moraxella catarrhalis 4)Staphylococcus aureus

A patient was intubated in the emergency department just after arrival at the hospital from home.This patient develops VAP 36 hours after intubation.What type of pneumonia is this considered?

According to the Centers for Disease Control (CDC)and National Healthcare Safety Network (NHSN),the proposed and updated definition for VAP includes which of the following? 1)Objective data 2)Patient's family history 3)A clearly defined time criteria 4)Chest radiograph images

To avoid ventilator-associated pneumonia,how often should ventilator circuits be changed?

The mortality rate for VAP associated with prolonged hospital stays is which of the following?

The type of organism that most often causes ventilator-acquired pneumonia is which of the following?

Which of the following is not a method to reduce the risk of VAP?

Basic Terms and Concepts of Mechanical Ventilation

How Ventilators Work

How a Breath Is Delivered

Establishing the Need for Mechanical Ventilation

Selecting the Ventilator and the Mode

Initial Ventilator Settings

Final Considerations in Ventilator Setup

Initial Patient Assessment

Ventilator Graphics

Assessment of Respiratory Function

Hemodynamic Monitoring

Methods to Improve Ventilation in Patient-Ventilator Management

Improving Oxygenation and Management of ARDS

Sedatives, Analgesics, and Paralytics

Extrapulmonary Effects of Mechanical Ventilation

Effects of Positive Pressure Ventilation on the Pulmonary System

Troubleshooting and Problem Solving

Basic Concepts of Noninvasive Positive-Pressure Ventilation

Weaning and Discontinuation from Mechanical Ventilation

Long-Term Ventilation

Neonatal and Pediatric Ventilation

Special Techniques in Ventilatory Support

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