Question 1

Which of the following electrolyte imbalances can hinder weaning from ventilatory support?
1) Hypochloremia
2) Hypomagnesemia
3) Hypokalemia
4) Hyponatremia

Accepted Answer

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

Question 2

A physician is using a pressure support protocol to wean a patient off ventilatory support. The patient is now at a 5 cm H2O pressure level and has a spontaneous respiratory rate of 21/min. Other cardiovascular and respiratory signs indicate that the patient remains stable. Which of the following actions would you recommend at this point?

Accepted Answer

A)  Switch the patient to 5 cm H2O continuous positive airway pressure (CPAP) through the endotracheal tube. 
B)  Extubate the patient and provide supplemental O2. 
C)  Switch the patient to intermittent mandatory ventilation at a rate of 2/min. 
D)  Decrease the pressure support level to 3 cm H2O. 
A)  Switch the patient to 5 cm H2O continuous positive airway pressure (CPAP) through the endotracheal tube. 
B)  Extubate the patient and provide supplemental O2. 
C)  Switch the patient to intermittent mandatory ventilation at a rate of 2/min. 
D)  Decrease the pressure support level to 3 cm H2O. B

Question 3

Which of the following patients are at high risk for severe laryngeal edema after an endotracheal tube extubation?
1) Pediatric burn victim
2) Patient with epiglottitis
3) Smoke inhalation patient
4) Pulmonary fibrosis patient

Accepted Answer

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

Question 4

What is the least reliable weaning index?

Accepted Answer

A)  Vital capacity (V
C)  
B)  Maximum inspiratory capacity (MIP) 
C)  Minute ventilation (V
E)  
D)  Rapid-shallow breathing index (f/VT) 
A)  Vital capacity (V
C)  
B)  Maximum inspiratory capacity (MIP) 
C)  Minute ventilation (V
E)  
D)  Rapid-shallow breathing index (f/VT)

Question 5

Common approaches used to wean patients from ventilatory support include which of the following?
1) T tube alternating with mechanical ventilation
2) Pressure-supported ventilation (PSV)
3) Intermittent mandatory ventilation

Accepted Answer

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

Question 6

What is the best way to decrease the work of breathing imposed by an artificial airway on a patient receiving ventilatory support?

Accepted Answer

A)  Provide pressure support. 
B)  Decrease inspiratory flow. 
C)  Lower the minute ventilation. 
D)  Use low rates of breathing. 
A)  Provide pressure support. 
B)  Decrease inspiratory flow. 
C)  Lower the minute ventilation. 
D)  Use low rates of breathing.

Question 7

A physician orders a T tube trial for a patient receiving ventilatory support in the assist-control mode with an FiO2 of 0.4. What FiO2 would you recommend for this patient during the spontaneous breathing period?

Accepted Answer

A)  0.3 
B)  0.4 
C)  0.5 
D)  0.6 
A)  0.3 
B)  0.4 
C)  0.5 
D)  0.6

Question 8

Which of the following ventilator strategies would you consider as a good alternative to T tube trials when using a rapid weaning protocol?
1) Continuous positive airway pressure (CPAP) with flow-by (flow triggering)
2) Low-level pressure-supported ventilation (PSV)
3) Intermittent mandatory ventilation

Accepted Answer

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

Question 9

Which of the following metabolic factors can hinder weaning?
1) Excessive carbohydrate feeding
2) Amino acid-based parenteral nutrition
3) Calorie intake = 1.5 . resting energy expenditure (REE)

Accepted Answer

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

Question 10

Which of the following changes can be expected when weaning a patient through a T tube trial?
1) Increase in respiratory rate of 10/min
2) Increase in heart rate of 15 to 20/min
3) 5 to 10 mm Hg rise in the arterial PCO2
4) Doubling of the minute ventilation

Accepted Answer

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

Question 11

Which of the following are disadvantages of using the T tube method for weaning?
1) More staff time required
2) Abrupt transition sometimes difficult
3) High imposed work of breathing
4) Lack of alarm systems

Accepted Answer

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

Question 12

Which of the following oxygenation measures support a patient's readiness to wean?
1) PaO2/PAO2 (a/A) = 0.45
2) PaO2/FiO2 (P/F) = 110
3) PAO2 - PaO2 = 240 mm Hg
4) Physiologic shunt (Qs/Qt) = 12%

Accepted Answer

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

Question 13

Which of the following indicate that a patient's renal function is adequate for weaning?
1) Urine output = 20 ml/hr
2) No major weight gain
3) No edema present
4) Normal electrolytes

Accepted Answer

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

Question 14

Which of the following is false about noninvasive positive-pressure ventilation (NIV)?

Accepted Answer

A)  NIV can support ventilation without a tracheal airway. 
B)  NIV should not be used with patients at risk for aspiration. 
C)  Patients likely to fail weaning are good candidates for NIV. 
D)  NIV can be used to prevent reintubation when weaning fails. 
A)  NIV can support ventilation without a tracheal airway. 
B)  NIV should not be used with patients at risk for aspiration. 
C)  Patients likely to fail weaning are good candidates for NIV. 
D)  NIV can be used to prevent reintubation when weaning fails.

Question 15

Which of the following indicate that an adult patient is ready to be weaned from ventilatory support?
1) PAO2 - PaO2 = 430 on 100% O2
2) VD/VT = 0.55
3) MIP = -33 cm H2O
4) PO2 = 76 mm Hg on 40% O2

Accepted Answer

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

Question 16

Which of the following indicate that an adult patient is ready to be weaned from ventilatory support?
1) VC = 1.9 L
2) Spontaneous rate of 32/min
3) Qs/Qt = 8%
4) MIP = -45 cm H2O

Accepted Answer

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

Question 17

Which of the following are disadvantages of using intermittent mandatory ventilation for weaning?
1) Potentially high work of breathing
2) Weaning time possibly prolonged
3) Patient-ventilator asynchrony
4) Higher mean airway pressures

Accepted Answer

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

Question 18

A patient whom you are trying to wean below 5 cm H2O pressure support develops respiratory muscle fatigue. Which of the following would you recommend to overcome this problem?
1) Make sure there is adequate O2 transport or cardiac output.
2) Make sure that the patient is adequately nourished.
3) Check and replace any depleted electrolytes.
4) Clear secretions and provide bronchodilation.

Accepted Answer

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

Question 19

Successful weaning is less likely when a patient's work of breathing exceeds what level?

Accepted Answer

A)  4 J/min 
B)  8 J/min 
C)  12 J/min 
D)  16 J/min 
A)  4 J/min 
B)  8 J/min 
C)  12 J/min 
D)  16 J/min

Question 20

Which of the following cardiovascular signs would indicate that a patient's cardiovascular status is unstable and that weaning should not begin at this time?

Accepted Answer

A)  Cardiac index of 2.5 L/min/m2 
B)  Hemoglobin content of 10 g/dl 
C)  Heart rate of 108/min 
D)  Systolic blood pressure of 80 mm Hg 
A)  Cardiac index of 2.5 L/min/m2 
B)  Hemoglobin content of 10 g/dl 
C)  Heart rate of 108/min 
D)  Systolic blood pressure of 80 mm Hg

Exam 52: Discontinuing Ventilatory Support

Which of the following electrolyte imbalances can hinder weaning from ventilatory support? 1) Hypochloremia 2) Hypomagnesemia 3) Hypokalemia 4) Hyponatremia

Which of the following patients are at high risk for severe laryngeal edema after an endotracheal tube extubation? 1) Pediatric burn victim 2) Patient with epiglottitis 3) Smoke inhalation patient 4) Pulmonary fibrosis patient

What is the least reliable weaning index?

Common approaches used to wean patients from ventilatory support include which of the following? 1) T tube alternating with mechanical ventilation 2) Pressure-supported ventilation (PSV) 3) Intermittent mandatory ventilation

What is the best way to decrease the work of breathing imposed by an artificial airway on a patient receiving ventilatory support?

A physician orders a T tube trial for a patient receiving ventilatory support in the assist-control mode with an FiO2 of 0.4. What FiO2 would you recommend for this patient during the spontaneous breathing period?

Which of the following metabolic factors can hinder weaning? 1) Excessive carbohydrate feeding 2) Amino acid-based parenteral nutrition 3) Calorie intake = 1.5 . resting energy expenditure (REE)

Which of the following changes can be expected when weaning a patient through a T tube trial? 1) Increase in respiratory rate of 10/min 2) Increase in heart rate of 15 to 20/min 3) 5 to 10 mm Hg rise in the arterial PCO2 4) Doubling of the minute ventilation

Which of the following are disadvantages of using the T tube method for weaning? 1) More staff time required 2) Abrupt transition sometimes difficult 3) High imposed work of breathing 4) Lack of alarm systems

Which of the following oxygenation measures support a patient's readiness to wean? 1) PaO2/PAO2 (a/A) = 0.45 2) PaO2/FiO2 (P/F) = 110 3) PAO2 - PaO2 = 240 mm Hg 4) Physiologic shunt (Qs/Qt) = 12%

Which of the following indicate that a patient's renal function is adequate for weaning? 1) Urine output = 20 ml/hr 2) No major weight gain 3) No edema present 4) Normal electrolytes

Which of the following is false about noninvasive positive-pressure ventilation (NIV)?

Which of the following indicate that an adult patient is ready to be weaned from ventilatory support? 1) PAO2 - PaO2 = 430 on 100% O2 2) VD/VT = 0.55 3) MIP = -33 cm H2O 4) PO2 = 76 mm Hg on 40% O2

Which of the following indicate that an adult patient is ready to be weaned from ventilatory support? 1) VC = 1.9 L 2) Spontaneous rate of 32/min 3) Qs/Qt = 8% 4) MIP = -45 cm H2O

Which of the following are disadvantages of using intermittent mandatory ventilation for weaning? 1) Potentially high work of breathing 2) Weaning time possibly prolonged 3) Patient-ventilator asynchrony 4) Higher mean airway pressures

Successful weaning is less likely when a patient's work of breathing exceeds what level?

Which of the following cardiovascular signs would indicate that a patient's cardiovascular status is unstable and that weaning should not begin at this time?

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Filters

A physician orders a T tube trial for a patient receiving ventilatory support in the assist-control mode with an FiO₂ of 0.4. What FiO₂ would you recommend for this patient during the spontaneous breathing period?

Which of the following changes can be expected when weaning a patient through a T tube trial? 1) Increase in respiratory rate of 10/min 2) Increase in heart rate of 15 to 20/min 3) 5 to 10 mm Hg rise in the arterial PCO₂ 4) Doubling of the minute ventilation

Which of the following oxygenation measures support a patient's readiness to wean? 1) PaO₂/PAO₂ (a/A) = 0.45 2) PaO₂/FiO₂ (P/F) = 110 3) PAO₂ - PaO₂ = 240 mm Hg 4) Physiologic shunt (Q_s/Q_t) = 12%

Which of the following indicate that an adult patient is ready to be weaned from ventilatory support? 1) PAO₂ - PaO₂ = 430 on 100% O₂ 2) V_D/V_T = 0.55 3) MIP = -33 cm H₂O 4) PO₂ = 76 mm Hg on 40% O₂

Which of the following indicate that an adult patient is ready to be weaned from ventilatory support? 1) VC = 1.9 L 2) Spontaneous rate of 32/min 3) Q_s/Q_t = 8% 4) MIP = -45 cm H₂O