Question 1

In what scenario is pressure-controlled ventilation (PCV) most often used?

Accepted Answer

A) when limiting plateau pressure is needed 
B) when a pneumothorax is present 
C) when the patient has chronic obstructive pulmonary disease 
D) when bilateral pneumonia is present 
A) when limiting plateau pressure is needed 
B) when a pneumothorax is present 
C) when the patient has chronic obstructive pulmonary disease 
D) when bilateral pneumonia is present

Question 2

A patient suffering from postoperative complications has been receiving mechanical ventilation for 6 days with a volume ventilator. A heat-moisture exchanger (HME) is providing control over humidification and airway temperature. Over the past 24 hours, the patient's secretions have decreased in quantity but are thicker and more purulent. Which of the following actions would you suggest at this time?

Accepted Answer

A) Replace the HME. 
B) Switch over to a heated wick humidifier. 
C) Administer acetylcysteine every 2 hours via the nebulizer. 
D) Increase the frequency of suctioning. 
A) Replace the HME. 
B) Switch over to a heated wick humidifier. 
C) Administer acetylcysteine every 2 hours via the nebulizer. 
D) Increase the frequency of suctioning.

Question 3

Air-trapping is a major concern in patients with what diagnosis when using the assist-control mode?

Accepted Answer

A) pneumonia 
B) chronic obstructive pulmonary disease (COP
D)  
C) chest trauma 
D) neuromuscular disease 
A) pneumonia 
B) chronic obstructive pulmonary disease (COP
D)  
C) chest trauma 
D) neuromuscular disease

Question 4

A physician orders intubation and mechanical ventilation in the continuous mandatory ventilation assist-control mode for a 125-lb adult woman with normal lungs. Which of the following initial settings would you recommend? $\begin{array}{ll}&\text { Rate }&\underline{\mathrm{V}_{\mathrm{T}}}\
A.&10 / \mathrm{min} & 1000 \mathrm{ml} \
B.&12 / \mathrm{min} & 500 \mathrm{ml} \
C.&12 / \min & 1000 \mathrm{ml} \
D.&18 / \mathrm{min} & 800 \mathrm{ml}
\end{array}$

Accepted Answer

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

Question 5

A patient receiving continuous mandatory ventilation in the assist-control mode develops auto-PEEP. Which of the following general approaches would you consider to minimize the effects of auto-PEEP in this patient?
I.increasing expiratory time
II.applying PEEP
III.switching ventilating mode to synchronized intermittent mandatory ventilation

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

Question 6

Which of the following statements is NOT true regarding the use of controlled ventilation?

Accepted Answer

A) may allow the muscles of breathing to rest 
B) can use larger I:E ratio and may improve oxygenation 
C) requires use of paralytic agents in spontaneously breathing patients 
D) therapist has little control of needed inspiratory flow and pressure 
A) may allow the muscles of breathing to rest 
B) can use larger I:E ratio and may improve oxygenation 
C) requires use of paralytic agents in spontaneously breathing patients 
D) therapist has little control of needed inspiratory flow and pressure

Question 7

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FIO2 of 0.5: pH = 7.23; PCO2 = 61 mm Hg; HCO3- = 26 mm Hg. The current minute ventilation (VE) is 9.2 L/min. What new VE would you recommend?

Accepted Answer

A) 10.6 L/min 
B) 14.0 L/min 
C) 12.4 L/min 
D) 5.8 L/min 
A) 10.6 L/min 
B) 14.0 L/min 
C) 12.4 L/min 
D) 5.8 L/min

Question 8

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a VT of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H2O. Which of the following actions would you recommend to the patient's physician?

Accepted Answer

A) Decrease the inspiratory flow. 
B) Lower the delivered VT. 
C) Administer a bronchodilator. 
D) Add PEEP. 
A) Decrease the inspiratory flow. 
B) Lower the delivered VT. 
C) Administer a bronchodilator. 
D) Add PEEP.

Question 9

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FIO2 of 0.4: pH = 7.51; PCO2 = 30 mm Hg; HCO3- = 25 mm Hg. Her current minute ventilation (VE) is 7.9 L/min. What new VE would you recommend?

Accepted Answer

A) 9.0 L/min 
B) 6.7 L/min 
C) 7.5 L/min 
D) 5.9 L/min 
A) 9.0 L/min 
B) 6.7 L/min 
C) 7.5 L/min 
D) 5.9 L/min

Question 10

Indications for delivering sigh breaths during mechanical ventilation include all of the following except which of the following?

Accepted Answer

A) before and after suctioning 
B) during chest physical therapy 
C) in patients with stiff lungs 
D) when small VT values are used 
A) before and after suctioning 
B) during chest physical therapy 
C) in patients with stiff lungs 
D) when small VT values are used

Question 11

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

Accepted Answer

A) 9 to 11 L/min below baseline flow 
B) 7 to 9 L/min below baseline flow 
C) 4 to 6 L/min below baseline flow 
D) 1 to 3 L/min below baseline flow 
A) 9 to 11 L/min below baseline flow 
B) 7 to 9 L/min below baseline flow 
C) 4 to 6 L/min below baseline flow 
D) 1 to 3 L/min below baseline flow

Question 12

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a VT of 950 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

Accepted Answer

A) 7900 ml/min (7.9 L/min) 
B) 8600 ml/min (8.6 L/min) 
C) 9400 ml/min (9.4 L/min) 
D) 11,400 ml/min (11.4 L/min) 
A) 7900 ml/min (7.9 L/min) 
B) 8600 ml/min (8.6 L/min) 
C) 9400 ml/min (9.4 L/min) 
D) 11,400 ml/min (11.4 L/min)

Question 13

How long may the clinical benefit of inverse ratio ventilation take to be seen?

Accepted Answer

A) 10 to 20 minutes 
B) 30 to 45 minutes 
C) 1 hour 
D) several hours 
A) 10 to 20 minutes 
B) 30 to 45 minutes 
C) 1 hour 
D) several hours

Question 14

What is the primary concern when using proning to improve oxygenation in the patient with ARDS?

Accepted Answer

A) sudden increase in PaCO2 
B) displacement of tubes and lines 
C) pneumothorax 
D) hemodynamic compromise 
A) sudden increase in PaCO2 
B) displacement of tubes and lines 
C) pneumothorax 
D) hemodynamic compromise

Question 15

What phrase is used to describe the situation where the patient with acute lung injury is ventilated with a smaller tidal volume and the PaCO2 is allowed to increase above normal range to avoid additional lung injury?

Accepted Answer

A) physiologic ventilation 
B) permissive hypercapnia 
C) adjusted ventilation 
D) dialed acidosis 
A) physiologic ventilation 
B) permissive hypercapnia 
C) adjusted ventilation 
D) dialed acidosis

Question 16

When setting the tidal volume on a patient being mechanically ventilated, what criteria should be kept in mind?

Accepted Answer

A) It should never cause the plateau pressure to exceed 30 mm Hg. 
B) It should never cause the peak pressure to exceed 35 mm Hg. 
C) It should result in the static pressure of less than 10 mm Hg. 
D) It should result in a peak pressure of no more than 25 mm Hg. 
A) It should never cause the plateau pressure to exceed 30 mm Hg. 
B) It should never cause the peak pressure to exceed 35 mm Hg. 
C) It should result in the static pressure of less than 10 mm Hg. 
D) It should result in a peak pressure of no more than 25 mm Hg.

Question 17

For adolescents in the 8- to 16-year-old age range, which of the following ranges of ventilator setting would you initially recommend? Rate
$\begin{array}{ll}&\text { Rate }&\underline{\mathrm{V}_{\mathrm{T}}}\
A.&8 \text { to } 12 / \mathrm{min} & 10 \text { to } 12 \mathrm{ml} / \mathrm{kg} \
B.&8 \text { to } 12 / \mathrm{min} & 8 \text { to } 10 \mathrm{ml} / \mathrm{kg} \
C.&20 \text { to } 30 / \mathrm{min} & 10 \text { to } 12 \mathrm{ml} / \mathrm{kg} \
D.&20 \text { to } 30 / \mathrm{min} & 8 \text { to } 10 \mathrm{ml} / \mathrm{kg}
\end{array}$

Accepted Answer

The answer of For adolescents in the 8- to 16-year-old...

Question 18

What is the recommended response to a drop in PaO2 when the PEEP level is reduced in a mechanically ventilated patient?

Accepted Answer

A) Increase the FIO2. 
B) Return the PEEP to the previous level. 
C) Increase the rate of mechanical breaths. 
D) Do nothing. 
A) Increase the FIO2. 
B) Return the PEEP to the previous level. 
C) Increase the rate of mechanical breaths. 
D) Do nothing.

Question 19

A chronic obstructive pulmonary disease (COPD) patient in respiratory failure is receiving ventilatory support in the volume-targeted intermittent mandatory ventilation mode at a rate of 6/min. You measure an auto-PEEP level of 9 cm H2O. Which of the following would you recommend to decrease the effects of auto-PEEP in this patient?

Accepted Answer

A) Decreasing the rate and increasing VT. 
B) Lowering the VT and letting the PaCO2 rise. 
C) Applying 4 to 6 cm H2O PEEP. 
D) Decreasing the peak inspiratory flow. 
A) Decreasing the rate and increasing VT. 
B) Lowering the VT and letting the PaCO2 rise. 
C) Applying 4 to 6 cm H2O PEEP. 
D) Decreasing the peak inspiratory flow.

Question 20

Which of the following inspiratory flow patterns would result in the lowest peak inspiratory pressure?

Accepted Answer

A) accelerating flow pattern 
B) square flow pattern 
C) decelerating flow pattern 
D) constant flow pattern 
A) accelerating flow pattern 
B) square flow pattern 
C) decelerating flow pattern 
D) constant flow pattern

Exam 44: Initiating and Adjusting Ventilatory Support

In what scenario is pressure-controlled ventilation (PCV) most often used?

Air-trapping is a major concern in patients with what diagnosis when using the assist-control mode?

A physician orders intubation and mechanical ventilation in the continuous mandatory ventilation assist-control mode for a 125-lb adult woman with normal lungs. Which of the following initial settings would you recommend? Rate A. 10/ 1000 B. 12/ 500 C. 12/ 1000 D. 18/ 800

Which of the following statements is NOT true regarding the use of controlled ventilation?

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FIO2 of 0.5: pH = 7.23; PCO2 = 61 mm Hg; HCO3- = 26 mm Hg. The current minute ventilation (VE) is 9.2 L/min. What new VE would you recommend?

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a VT of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H2O. Which of the following actions would you recommend to the patient's physician?

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FIO2 of 0.4: pH = 7.51; PCO2 = 30 mm Hg; HCO3- = 25 mm Hg. Her current minute ventilation (VE) is 7.9 L/min. What new VE would you recommend?

Indications for delivering sigh breaths during mechanical ventilation include all of the following except which of the following?

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

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a VT of 950 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

How long may the clinical benefit of inverse ratio ventilation take to be seen?

What is the primary concern when using proning to improve oxygenation in the patient with ARDS?

What phrase is used to describe the situation where the patient with acute lung injury is ventilated with a smaller tidal volume and the PaCO2 is allowed to increase above normal range to avoid additional lung injury?

When setting the tidal volume on a patient being mechanically ventilated, what criteria should be kept in mind?

For adolescents in the 8- to 16-year-old age range, which of the following ranges of ventilator setting would you initially recommend? Rate Rate A. 8 to 12/ 10 to 12/ B. 8 to 12/ 8 to 10/ C. 20 to 30/ 10 to 12/ D. 20 to 30/ 8 to 10/

What is the recommended response to a drop in PaO2 when the PEEP level is reduced in a mechanically ventilated patient?

Which of the following inspiratory flow patterns would result in the lowest peak inspiratory pressure?

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 receiving control-mode continuous mandatory ventilation has the following ABGs on an FIO₂ of 0.5: pH = 7.23; PCO₂= 61 mm Hg; HCO₃^-= 26 mm Hg. The current minute ventilation (V_E) is 9.2 L/min. What new V_E would you recommend?

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a V_T of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H₂O. Which of the following actions would you recommend to the patient's physician?

A patient receiving control-mode continuous mandatory ventilation has the following ABGs on an FIO₂ of 0.4: pH = 7.51; PCO₂ = 30 mm Hg; HCO₃^- = 25 mm Hg. Her current minute ventilation (V_E) is 7.9 L/min. What new V_E would you recommend?

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a V_T of 950 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

What phrase is used to describe the situation where the patient with acute lung injury is ventilated with a smaller tidal volume and the PaCO₂ is allowed to increase above normal range to avoid additional lung injury?

What is the recommended response to a drop in PaO₂ when the PEEP level is reduced in a mechanically ventilated patient?