Question 1

Which of the following is the LEAST frequent cause of acute respiratory failure needing mechanical ventilation?

Accepted Answer

A) sepsis 
B) postoperative respiratory failure 
C) heart failure 
D) aspiration 
A) sepsis 
B) postoperative respiratory failure 
C) heart failure 
D) aspiration D

Question 2

A patient with ARDS receiving ventilatory support with PEEP through a volume-cycled ventilator has a plateau pressure of 38 cm H2O. ABGs on 55% O2 are as follows: pH = 7.44; PCO2 = 37 mm Hg; HCO3- = 25 mEq; PO2 = 55 mm Hg; SaO2 = 88%. Which of the following would you recommend?

Accepted Answer

A) Increase the PEEP level. 
B) Make no changes. 
C) Reduce the VT. 
D) Increase the FIO2. 
A) Increase the PEEP level. 
B) Make no changes. 
C) Reduce the VT. 
D) Increase the FIO2. B

Question 3

Which of the following statements is NOT true regarding the use of intermittent mandatory ventilation (IMV) or synchronized intermittent mandatory ventilation (SIMV)?

Accepted Answer

A) The machine breath is typically time cycled to inspiration. 
B) The patient can breathe spontaneously between machine breaths. 
C) SIMV is easy to apply. 
D) SIMV may help maintain ventilatory muscle strength. 
A) The machine breath is typically time cycled to inspiration. 
B) The patient can breathe spontaneously between machine breaths. 
C) SIMV is easy to apply. 
D) SIMV may help maintain ventilatory muscle strength. A

Question 4

When performing a lung recruitment strategy, which of the following would cause the therapist to stop?
I.mean blood pressure drops of 80 to 65 mm Hg
II.heart rate increases from 88 to 110/min
III.patient has a run of premature ventricular complexes

Accepted Answer

A) I only 
B) II only 
C) III only 
D) I, II, and III 
A) I only 
B) II only 
C) III only 
D) I, II, and III

Question 5

Which of the following would decrease PaCO2 when ventilating a patient using synchronized intermittent mandatory ventilation with pressure support?

Accepted Answer

A) increase the level of pressure support 
B) decrease the tidal volume 
C) decrease the mechanical rate 
D) increase the FIO2 
A) increase the level of pressure support 
B) decrease the tidal volume 
C) decrease the mechanical rate 
D) increase the FIO2

Question 6

What mode of ventilation may be most useful for ventilating a patient with a bronchopulmonary fistula?

Accepted Answer

A) high-frequency jet ventilation 
B) pressure-supported ventilation 
C) high-frequency percussive ventilation 
D) pressure-controlled ventilation 
A) high-frequency jet ventilation 
B) pressure-supported ventilation 
C) high-frequency percussive ventilation 
D) pressure-controlled ventilation

Question 7

If available, the FIO2 alarm should be set to what percentage?

Accepted Answer

A) ±3% 
B) ±5% 
C) ±8% 
D) ±10% 
A) ±3% 
B) ±5% 
C) ±8% 
D) ±10%

Question 8

A patient receiving continuous mandatory ventilation in the assist-control mode develops auto-PEEP. Which of the following changes in ventilatory patterns would you consider to minimize the effects of auto-PEEP in this patient?
I.decreasing the rate or increasing VT
II.using low-rate synchronized intermittent mandatory ventilation
III.decreasing the peak inspiratory flow
IV.lowering the VT and letting the PaCO2 rise

Accepted Answer

A) II and IV 
B) III and IV 
C) I, II, and III 
D) I, II, and IV 
A) II and IV 
B) III and IV 
C) I, II, and III 
D) I, II, and IV

Question 9

What will most likely result if the patient ventilated in the assist-control mode develops a high ventilatory drive?

Accepted Answer

A) respiratory alkalosis 
B) respiratory acidosis 
C) ventilatory failure 
D) large drop in oxygenation 
A) respiratory alkalosis 
B) respiratory acidosis 
C) ventilatory failure 
D) large drop in oxygenation

Question 10

In which of the following conditions is PEEP NOT likely to be useful?

Accepted Answer

A) ARDS 
B) pulmonary edema 
C) acute lung injury 
D) neuromuscular disease 
A) ARDS 
B) pulmonary edema 
C) acute lung injury 
D) neuromuscular disease

Question 11

Your patient develops a fever while being mechanically ventilated in the control mode. As a result of the fever, the patient's CO2 production increases while alveolar ventilation is unchanged. What is the probable change in ABGs?

Accepted Answer

A) increase in PaCO2 
B) decrease in PaO2 
C) decrease in PaCO2 
D) all the above 
A) increase in PaCO2 
B) decrease in PaO2 
C) decrease in PaCO2 
D) all the above

Question 12

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set?
I.airway temperature
II.ventilatory support mode
III.oxygen concentration (FIO2)IV.minute ventilation (f, VT)

Accepted Answer

A) I and III 
B) I, II, and III 
C) II, III, and IV 
D) I, II, III, and IV 
A) I and III 
B) I, II, and III 
C) II, III, and IV 
D) I, II, III, and IV

Question 13

All of the following machine factors can have a major impact on adult patient-ventilator interaction except:

Accepted Answer

A) humidification system 
B) PEEP valve function 
C) trigger sensitivity 
D) tubing compliance 
A) humidification system 
B) PEEP valve function 
C) trigger sensitivity 
D) tubing compliance

Question 14

A physician orders intubation and mechanical ventilation in the synchronized intermittent mandatory ventilation mode for a 200-lb ideal body weight (IBW) adult man with normal lungs. Which of the following initial ventilator settings would you recommend? 
$\begin{array} { l l l } 
& \text { Rate } & V_{T}  \
\text { A. } & 8 / \min & 1100 \mathrm { ml } \
\text { B. } & 10 / \mathrm { min } & 900 \mathrm { ml } \
\text { C. } & 18 / \mathrm { min } & 800 \mathrm { ml } \
\text { D. } & 20 / \mathrm { min } & 800 \mathrm { ml }
\end{array}$

Accepted Answer

The answer of A physician orders intubation and mechanical ventilation...

Question 15

What percentage of mechanical ventilated patients has a tracheostomy tube place at some point?

Accepted Answer

A) 5% 
B) 15% 
C) 25% 
D) 33% 
A) 5% 
B) 15% 
C) 25% 
D) 33%

Question 16

Which of the following would you initially verify in assessing the airway of a patient placed on ventilatory support?
I.cuff pressure
II.tube position
III.tube patency

Accepted Answer

A) I and II 
B) I, II, and III 
C) I and III 
D) II and III 
A) I and II 
B) I, II, and III 
C) I and III 
D) II and III

Question 17

Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the continuous mandatory ventilation assist-control mode. What initial FIO2 would you recommend?

Accepted Answer

A) 1.0 
B) 0.8 
C) 0.6 
D) 0.4 
A) 1.0 
B) 0.8 
C) 0.6 
D) 0.4

Question 18

Which of the following trigger levels is appropriate when setting a ventilator for pressure-triggering?

Accepted Answer

A) 0.5 to 1.5 cm H2O above the baseline pressure 
B) 1.5 to 2.5 cm H2O below the baseline pressure 
C) 0.5 to 1.5 cm H2O below the baseline pressure 
D) 2.5 to 3.5 cm H2O below the baseline pressure 
A) 0.5 to 1.5 cm H2O above the baseline pressure 
B) 1.5 to 2.5 cm H2O below the baseline pressure 
C) 0.5 to 1.5 cm H2O below the baseline pressure 
D) 2.5 to 3.5 cm H2O below the baseline pressure

Question 19

In which of the following clinical conditions is noninvasive positive pressure ventilation (NPPV) NOT recommended?

Accepted Answer

A) management of acute exacerbation of chronic obstructive pulmonary disease (COP
D)  
B) management of premature extubation 
C) management of cardiogenic pulmonary edema 
D) management of acute respiratory distress syndrome (ARDS) 
A) management of acute exacerbation of chronic obstructive pulmonary disease (COP
D)  
B) management of premature extubation 
C) management of cardiogenic pulmonary edema 
D) management of acute respiratory distress syndrome (ARDS)

Question 20

Which of the following factors influence patient-ventilator interaction?
I.artificial airway
II.trigger sensitivity
III.presence of auto-PEEP

Accepted Answer

A) I and II 
B) I and III 
C) II and III 
D) I, II, and III 
A) I and II 
B) I and III 
C) II and III 
D) I, II, and III

Exam 44: Initiating and Adjusting Ventilatory Support

Which of the following is the LEAST frequent cause of acute respiratory failure needing mechanical ventilation?

A patient with ARDS receiving ventilatory support with PEEP through a volume-cycled ventilator has a plateau pressure of 38 cm H2O. ABGs on 55% O2 are as follows: pH = 7.44; PCO2 = 37 mm Hg; HCO3- = 25 mEq; PO2 = 55 mm Hg; SaO2 = 88%. Which of the following would you recommend?

Which of the following statements is NOT true regarding the use of intermittent mandatory ventilation (IMV) or synchronized intermittent mandatory ventilation (SIMV)?

When performing a lung recruitment strategy, which of the following would cause the therapist to stop? I.mean blood pressure drops of 80 to 65 mm Hg II.heart rate increases from 88 to 110/min III.patient has a run of premature ventricular complexes

Which of the following would decrease PaCO2 when ventilating a patient using synchronized intermittent mandatory ventilation with pressure support?

What mode of ventilation may be most useful for ventilating a patient with a bronchopulmonary fistula?

If available, the FIO2 alarm should be set to what percentage?

What will most likely result if the patient ventilated in the assist-control mode develops a high ventilatory drive?

In which of the following conditions is PEEP NOT likely to be useful?

Your patient develops a fever while being mechanically ventilated in the control mode. As a result of the fever, the patient's CO2 production increases while alveolar ventilation is unchanged. What is the probable change in ABGs?

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set? I.airway temperature II.ventilatory support mode III.oxygen concentration (FIO2)IV.minute ventilation (f, VT)

All of the following machine factors can have a major impact on adult patient-ventilator interaction except:

What percentage of mechanical ventilated patients has a tracheostomy tube place at some point?

Which of the following would you initially verify in assessing the airway of a patient placed on ventilatory support? I.cuff pressure II.tube position III.tube patency

Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the continuous mandatory ventilation assist-control mode. What initial FIO2 would you recommend?

Which of the following trigger levels is appropriate when setting a ventilator for pressure-triggering?

In which of the following clinical conditions is noninvasive positive pressure ventilation (NPPV) NOT recommended?

Which of the following factors influence patient-ventilator interaction? I.artificial airway II.trigger sensitivity III.presence of auto-PEEP

History of Respiratory Care

Quality and Evidence-Based Respiratory Care

Patient Safety, Communication, and Record Keeping

Principles of Infection Control

Ethical and Legal Implications of Practice

Physical Principles of Respiratory Care

Computer Applications in Respiratory Care

The Respiratory System

The Cardiovascular System

Ventilation

Gas Exchange and Transport

Solutions, Body Fluids, and Electrolytes

Acid-Base Balance

Regulation of Breathing

Bedside Assessment of the Patient

Interpretation of Clinical Laboratory Data

Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

Pulmonary Function Testing

A Review of Thoracic Imaging

Nutrition Assessment

Pulmonary Infections

Obstructive Lung Disease: Copd, Asthma, and Related Diseases

Interstitial Lung Disease

Pleural Diseases

Pulmonary Vascular Disease

Acute Lung Injury, Pulmonary Edema, and Multiple System Organ

Lung Cancer

Neuromuscular and Other Diseases of the Chest Wall

Disorders of Sleep

Neonatal and Pediatric Respiratory Disorders

Airway Pharmacology

Airway Management

Emergency Cardiovascular Life Support

Humidity and Bland Aerosol Therapy

Aerosol Drug Therapy

Storage and Delivery of Medical Gases

Medical Gas Therapy

Lung Expansion Therapy

Bronchial Hygiene Therapy

Respiratory Failure and the Need for Ventilatory Support

Mechanical Ventilators

Physiology of Ventilatory Support

Noninvasive Positive Pressure Ventilation

Monitoring and Management of the Patient in the Intensive Care Unit

Discontinuing Ventilatory Support

Neonatal and Pediatric Respiratory Care

Patient Education and Health Promotion

Cardiopulmonary Rehabilitation

Respiratory Care in Alternative Settings

Filters

A patient with ARDS receiving ventilatory support with PEEP through a volume-cycled ventilator has a plateau pressure of 38 cm H₂O. ABGs on 55% O₂ are as follows: pH = 7.44; PCO₂ = 37 mm Hg; HCO₃^- = 25 mEq; PO₂ = 55 mm Hg; SaO₂ = 88%. Which of the following would you recommend?

Which of the following would decrease PaCO₂ when ventilating a patient using synchronized intermittent mandatory ventilation with pressure support?

If available, the FIO₂ alarm should be set to what percentage?

Your patient develops a fever while being mechanically ventilated in the control mode. As a result of the fever, the patient's CO₂ production increases while alveolar ventilation is unchanged. What is the probable change in ABGs?

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set? I.airway temperature II.ventilatory support mode III.oxygen concentration (FIO₂)IV.minute ventilation (f, V_T)

Immediately after cardiac arrest and resuscitation, a patient is placed on a ventilator in the continuous mandatory ventilation assist-control mode. What initial FIO₂ would you recommend?