Question 1

What flow pattern is least optimal for ventilating a patient with cardiovascular instability?

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

Question 2

Noninvasive positive-pressure ventilation (NPPV) should not be considered for which patients?
I.those who require an artificial airway
II.those who are prone to aspiration
III.those who have excessive secretions
IV.those who are hemodynamically unstable

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 3

A ventilator has separate rate and VT controls. If you set a VT of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

Accepted Answer

A) 7800 ml/min (7.8 L/min) 
B) 8500 ml/min (8.5 L/min) 
C) 9600 ml/min (9.6 L/min) 
D) 10,200 ml/min (10.2 L/min) 
A) 7800 ml/min (7.8 L/min) 
B) 8500 ml/min (8.5 L/min) 
C) 9600 ml/min (9.6 L/min) 
D) 10,200 ml/min (10.2 L/min)

Question 4

When titrating the FIO2 level downward from 100% to 40%, what is the maximum increment that should be applied between estimates of oxygenation?

Accepted Answer

A) 5% 
B) 10% 
C) 20% 
D) 25% 
A) 5% 
B) 10% 
C) 20% 
D) 25%

Question 5

A chronic obstructive pulmonary disease (COPD) patient receiving ventilatory support in the CMV assist-control mode at a rate of 14 and a VT of 750 ml exhibits clinical signs of air-trapping. Which of the following would you recommend to correct this problem?
I.	Decrease “E” time.
II.	Increase the inspiratory flow rate.
III.	Decrease the assist-control rate.

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

In which of the following clinical situations is the incidence of auto-PEEP the greatest?
I.patients with high respiratory rates
II.intubated patients with obstructive lung disease
III.patients with low minute volumes

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 7

Compared to a pressure-controlled strategy, what is the primary advantage of volume-controlled ventilatory support?

Accepted Answer

A) provides a decelerating flow pattern 
B) limits and controls peak airway pressures 
C) improves patient-ventilator synchrony 
D) guarantees a minimum minute volume 
A) provides a decelerating flow pattern 
B) limits and controls peak airway pressures 
C) improves patient-ventilator synchrony 
D) guarantees a minimum minute volume

Question 8

What is considered to be the single best indicator of effective ventilation?

Accepted Answer

A) PaO2 
B) SaO2 
C) PaCO2 
D) pH 
A) PaO2 
B) SaO2 
C) PaCO2 
D) pH

Question 9

What is the recommended range for the tidal volume for the initial ventilator settings in the volume control mode?

Accepted Answer

A) 5 to 7 ml/kg 
B) 8 to 10 ml/kg 
C) 10 to 12 ml/kg 
D) 12 to 15 ml/kg 
A) 5 to 7 ml/kg 
B) 8 to 10 ml/kg 
C) 10 to 12 ml/kg 
D) 12 to 15 ml/kg

Question 10

To prevent atelectasis and improve gas exchange, most thoracic surgery patients placed on ventilatory support receive which of the following?

Accepted Answer

A) 0 cm H2O PEEP 
B) 5 cm H2O PEEP 
C) 8 cm H2O PEEP 
D) 10 cm H2O PEEP 
A) 0 cm H2O PEEP 
B) 5 cm H2O PEEP 
C) 8 cm H2O PEEP 
D) 10 cm H2O PEEP

Question 11

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H2O pressure is required to deliver the preset VT of 950 ml. What high-pressure limit would you now set for this patient?

Accepted Answer

A) 60 cm H2O 
B) 70 cm H2O 
C) 80 cm H2O 
D) 90 cm H2O 
A) 60 cm H2O 
B) 70 cm H2O 
C) 80 cm H2O 
D) 90 cm H2O

Question 12

When titrating the FIO2 down from 50% to 21%, in what increments should it be reduced?

Accepted Answer

A) all at once is acceptable 
B) no more than 5% 
C) 5% to 10% 
D) 10% to 20% 
A) all at once is acceptable 
B) no more than 5% 
C) 5% to 10% 
D) 10% to 20%

Question 13

A physician orders intubation and mechanical ventilation in the synchronized intermittent mandatory ventilation mode for a 170-lb adult man with neuromuscular disease. Which of the following initial settings would you recommend? $\quad\text { Rate } \quad\quad \underline{V_{T}}$
A. $ 8 / \mathrm{min} \quad 900 \mathrm{ml} $
B. $ 15 / \mathrm{min} \quad 1100 \mathrm{ml} $
C. $ 14 / \mathrm{min} \quad 700 \mathrm{ml} $
D. $ 16 / \mathrm{min} \quad 1000 \mathrm{ml} $

Accepted Answer

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

Question 14

What mode of ventilation will automatically vary the pressure support provided as patient effort changes to maintain a "normal" work of breathing?

Accepted Answer

A) synchronized intermittent mandatory ventilation 
B) proportional assist ventilation (PAV) 
C) volume-control continuous mandatory ventilation 
D) assist-control volume ventilation 
A) synchronized intermittent mandatory ventilation 
B) proportional assist ventilation (PAV) 
C) volume-control continuous mandatory ventilation 
D) assist-control volume ventilation

Question 15

An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5 L/min: pH = 7.20; PaCO2 = 67 mm Hg; HCO3- = 27 mEq/L; PaO2 = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FIO2 would you recommend to start with?

Accepted Answer

A) 0.21 
B) 0.30 
C) 0.50 
D) 0.90 
A) 0.21 
B) 0.30 
C) 0.50 
D) 0.90

Question 16

What is the primary advantage of negative-pressure ventilation?

Accepted Answer

A) no need for artificial airway 
B) easier to prevent bedsores 
C) better cardiac output 
D) portability of device 
A) no need for artificial airway 
B) easier to prevent bedsores 
C) better cardiac output 
D) portability of device

Question 17

During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD) patient with chronic hypercapnia, what PaCO2 is most likely used as a target value?

Accepted Answer

A) 30 mm Hg 
B) 40 mm Hg 
C) 55 mm Hg 
D) 75 mm Hg 
A) 30 mm Hg 
B) 40 mm Hg 
C) 55 mm Hg 
D) 75 mm Hg

Question 18

In what clinical condition has pressure-controlled ventilation with a prolonged inspiratory time been shown to be helpful?

Accepted Answer

A) ARDS/acute lung injury 
B) pulmonary embolism 
C) bilateral pneumonia 
D) severe pulmonary fibrosis 
A) ARDS/acute lung injury 
B) pulmonary embolism 
C) bilateral pneumonia 
D) severe pulmonary fibrosis

Question 19

Physiological goals of artificial ventilatory support include which of the following?
I.support or manipulate gas exchange
II.reduce or manipulate the work of breathing
III.increase lung volume

Accepted Answer

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

Question 20

Which of the following is FALSE about flow-triggered ventilatory support?

Accepted Answer

A) The work of breathing with flow-triggering is less than with pressure triggering. 
B) Flow-triggered systems respond to changes in flow rather than pressure. 
C) Pressure-triggering on new ventilators may be as sensitive as flow-triggering. 
D) Flow-triggering will decrease the work of breathing in patients with small endotracheal tubes and auto-PEEP. 
A) The work of breathing with flow-triggering is less than with pressure triggering. 
B) Flow-triggered systems respond to changes in flow rather than pressure. 
C) Pressure-triggering on new ventilators may be as sensitive as flow-triggering. 
D) Flow-triggering will decrease the work of breathing in patients with small endotracheal tubes and auto-PEEP.

Exam 44: Initiating and Adjusting Ventilatory Support

What flow pattern is least optimal for ventilating a patient with cardiovascular instability?

Noninvasive positive-pressure ventilation (NPPV) should not be considered for which patients? I.those who require an artificial airway II.those who are prone to aspiration III.those who have excessive secretions IV.those who are hemodynamically unstable

A ventilator has separate rate and VT controls. If you set a VT of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

When titrating the FIO2 level downward from 100% to 40%, what is the maximum increment that should be applied between estimates of oxygenation?

In which of the following clinical situations is the incidence of auto-PEEP the greatest? I.patients with high respiratory rates II.intubated patients with obstructive lung disease III.patients with low minute volumes

Compared to a pressure-controlled strategy, what is the primary advantage of volume-controlled ventilatory support?

What is considered to be the single best indicator of effective ventilation?

What is the recommended range for the tidal volume for the initial ventilator settings in the volume control mode?

To prevent atelectasis and improve gas exchange, most thoracic surgery patients placed on ventilatory support receive which of the following?

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H2O pressure is required to deliver the preset VT of 950 ml. What high-pressure limit would you now set for this patient?

When titrating the FIO2 down from 50% to 21%, in what increments should it be reduced?

What mode of ventilation will automatically vary the pressure support provided as patient effort changes to maintain a "normal" work of breathing?

An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5 L/min: pH = 7.20; PaCO2 = 67 mm Hg; HCO3- = 27 mEq/L; PaO2 = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FIO2 would you recommend to start with?

What is the primary advantage of negative-pressure ventilation?

During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD) patient with chronic hypercapnia, what PaCO2 is most likely used as a target value?

In what clinical condition has pressure-controlled ventilation with a prolonged inspiratory time been shown to be helpful?

Physiological goals of artificial ventilatory support include which of the following? I.support or manipulate gas exchange II.reduce or manipulate the work of breathing III.increase lung volume

Which of the following is FALSE about flow-triggered ventilatory support?

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 ventilator has separate rate and V_T controls. If you set a V_T of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

When titrating the FIO₂ level downward from 100% to 40%, what is the maximum increment that should be applied between estimates of oxygenation?

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H₂O pressure is required to deliver the preset V_T of 950 ml. What high-pressure limit would you now set for this patient?

When titrating the FIO₂ down from 50% to 21%, in what increments should it be reduced?

An adult patient in respiratory failure has the following blood gases on a nasal cannula at 5 L/min: pH = 7.20; PaCO₂ = 67 mm Hg; HCO₃^- = 27 mEq/L; PaO₂ = 89 mm Hg. The attending physician orders intubation and ventilatory support. What FIO₂ would you recommend to start with?

During initial mechanical ventilation of the chronic obstructive pulmonary disease (COPD) patient with chronic hypercapnia, what PaCO₂ is most likely used as a target value?