Question 1

Which of the following must you verify when considering weaning an obtunded patient?
1) Adequate gag reflex
2) No depressant drugs
3) Adequate cough

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 2

Above what pressure-time index (PTI) will most patients be unable to sustain spontaneous breathing?

Accepted Answer

A)  0.03 
B)  0.05 
C)  0.10 
D)  0.15 
A)  0.03 
B)  0.05 
C)  0.10 
D)  0.15

Question 3

A physician has selected a pressure support protocol to wean a patient off ventilatory support. Which of the following pressure levels would you recommend to begin the weaning process?

Accepted Answer

A)  Pressure sufficient to obtain a VT of 3 to 5 ml/kg of predicted body weight (PBW) 
B)  Pressure sufficient to overcome the imposed workload 
C)  Pressure sufficient to obtain a VT of 4 to 8 ml/kg PBW 
D)  Pressure equal to 30% of the volume-cycled peak inspiratory pressure 
A)  Pressure sufficient to obtain a VT of 3 to 5 ml/kg of predicted body weight (PBW) 
B)  Pressure sufficient to overcome the imposed workload 
C)  Pressure sufficient to obtain a VT of 4 to 8 ml/kg PBW 
D)  Pressure equal to 30% of the volume-cycled peak inspiratory pressure

Question 4

Which of the following is false about the P0.1 measure?

Accepted Answer

A)  P0.1 correlates well with central respiratory drive. 
B)  P0.1 is the airway pressure measured 100 msec after occlusion. 
C)  P0.1 is an effort-dependent measure of respiratory drive. 
D)  Chronic obstructive pulmonary disease (COP
D)  patients with a P0.1 greater than 6 cm H2O are difficult to wean. 
A)  P0.1 correlates well with central respiratory drive. 
B)  P0.1 is the airway pressure measured 100 msec after occlusion. 
C)  P0.1 is an effort-dependent measure of respiratory drive. 
D)  Chronic obstructive pulmonary disease (COP
D)  patients with a P0.1 greater than 6 cm H2O are difficult to wean.

Question 5

Which of the following techniques can help to decrease a patient's imposed work of breathing during weaning from ventilatory support?
1) Use of pressure-supported ventilation (PSV)
2) Trigger breath by flow, not pressure
3) Application of small amounts of continuous positive airway pressure (CPAP) or positive end expiratory pressure (PEEP)
4) Use of automatic tube compensation (ATC)

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 6

Which factors lead to the development of computer-based weaning protocols?
1) Respiratory therapists are unable to successfully wean most patients using protocols.
2) Computer-based weaning protocols are relatively easy to develop.
3) Weaning is time-consuming.
4) Weaning is a labor-intensive process.

Accepted Answer

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

Question 7

What patients are at high risk for postextubation upper airway obstruction?
1) Those with neuromuscular disorders
2) Those who have had major neck surgery
3) Those with infectious masses or abscesses

Accepted Answer

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

Question 8

While monitoring a patient during a T tube weaning trial, you notice the following: an increase in heart rate from 86 to 100/min; an increase in respiratory rate from 12 to 23/min; an increase in PaCO2 from 39 to 45 mm Hg; and a decrease in PaO2 from 82 to 73 mm Hg. Which of the following actions would be appropriate at this time?

Accepted Answer

A)  Reconnect the patient to the ventilator with prior settings. 
B)  Request that the patient be administered a mild sedative. 
C)  Suction the patient after manual hyperinflation or oxygenation. 
D)  Encourage the patient to relax, and continue careful monitoring. 
A)  Reconnect the patient to the ventilator with prior settings. 
B)  Request that the patient be administered a mild sedative. 
C)  Suction the patient after manual hyperinflation or oxygenation. 
D)  Encourage the patient to relax, and continue careful monitoring.

Question 9

Which of the following are useful strategies in managing the psychological problems encountered in weaning some patients from ventilator support?
1) Secure a psychiatric consult.
2) Decrease environmental stress.
3) Avoid mental stimulation.
4) Teach relaxation methods.

Accepted Answer

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

Question 10

The physician has requested that the respiratory therapist determine a patient's rapid shallow breathing index (RSBI) before placing the patient on PSV. The patient has a respiratory rate of 32/min and VT of 300 ml. What is the patient's RSBI?

Accepted Answer

A)  107 
B)  110 
C)  112 
D)  114 
A)  107 
B)  110 
C)  112 
D)  114

Question 11

A patient receiving ventilator support has a spontaneous rate of breathing of 26/min and an average VT of 300 ml. What is this patient's rapid-shallow breathing index?

Accepted Answer

A)  12 
B)  87 
C)  105 
D)  66 
A)  12 
B)  87 
C)  105 
D)  66

Question 12

Which of the following health care disciplines should be involved in the care of a patient who is considered difficult to wean?
1) Physical therapy
2) Speech therapy
3) Social services
4) Occupational therapy

Accepted Answer

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

Question 13

What are some factors that indicate a patient's readiness for extubation?
1) Adequate oxygenation or ventilation with spontaneous breathing
2) Minimal risk for upper airway obstruction
3) Adequate airway protection or minimal aspiration risk
4) Adequate clearance of pulmonary secretions

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 14

What is the most important prerequisite for weaning a patient from ventilatory support?

Accepted Answer

A)  Improvement in the original problem requiring mechanical ventilation 
B)  Assurance that the patient's ventilatory demand exceeds the patient's capacity 
C)  Objective evidence indicating good respiratory muscle endurance 
D)  Ability to maintain adequate oxygenation with an FiO2 less than 0.4 
A)  Improvement in the original problem requiring mechanical ventilation 
B)  Assurance that the patient's ventilatory demand exceeds the patient's capacity 
C)  Objective evidence indicating good respiratory muscle endurance 
D)  Ability to maintain adequate oxygenation with an FiO2 less than 0.4

Question 15

While monitoring a patient being weaned through a T tube protocol, signs indicating that mechanical ventilation should be restored include which of the following?
1) Development of cardiac arrhythmias
2) Asynchronous or paradoxical breathing
3) Development of severe hypotension
4) Moderate rise in respiratory rate

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 cardiovascular changes would you consider a bad sign during weaning a patient from ventilatory support?

Accepted Answer

A)  Development of chest pain 
B)  Increase in both stroke volume and cardiac index 
C)  Increase in heart rate from 95 to 110/min 
D)  Fall in blood pressure from 143/95 to 126/88 mm Hg 
A)  Development of chest pain 
B)  Increase in both stroke volume and cardiac index 
C)  Increase in heart rate from 95 to 110/min 
D)  Fall in blood pressure from 143/95 to 126/88 mm Hg

Question 17

Who should make the decisions related to terminal weaning?

Accepted Answer

A)  Patient 
B)  Patient's family and patient's physician 
C)  Nurse 
D)  Respiratory therapist 
A)  Patient 
B)  Patient's family and patient's physician 
C)  Nurse 
D)  Respiratory therapist

Question 18

Which of the following drug categories can depress ventilatory drive and hinder weaning?
1) Analgesics
2) Narcotics
3) Hypnotics
4) Antibiotics

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 19

In an effort to determine a patient's need for ventilatory support, which of the following factors increase(s) ventilatory workload?
1) Decreased lung compliance
2) Decreased thoracic compliance
3) Increased airway resistance
4) Artificial airways

Accepted Answer

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

Question 20

Prerequisites for successful weaning include:
1) psychological readiness.
2) adequate gag and swallow reflexes.
3) ability to follow instructions.
4) adequate cough.

Accepted Answer

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

Exam 52: Discontinuing Ventilatory Support

Which of the following must you verify when considering weaning an obtunded patient? 1) Adequate gag reflex 2) No depressant drugs 3) Adequate cough

Above what pressure-time index (PTI) will most patients be unable to sustain spontaneous breathing?

A physician has selected a pressure support protocol to wean a patient off ventilatory support. Which of the following pressure levels would you recommend to begin the weaning process?

Which of the following is false about the P0.1 measure?

What patients are at high risk for postextubation upper airway obstruction? 1) Those with neuromuscular disorders 2) Those who have had major neck surgery 3) Those with infectious masses or abscesses

Which of the following are useful strategies in managing the psychological problems encountered in weaning some patients from ventilator support? 1) Secure a psychiatric consult. 2) Decrease environmental stress. 3) Avoid mental stimulation. 4) Teach relaxation methods.

The physician has requested that the respiratory therapist determine a patient's rapid shallow breathing index (RSBI) before placing the patient on PSV. The patient has a respiratory rate of 32/min and VT of 300 ml. What is the patient's RSBI?

A patient receiving ventilator support has a spontaneous rate of breathing of 26/min and an average VT of 300 ml. What is this patient's rapid-shallow breathing index?

Which of the following health care disciplines should be involved in the care of a patient who is considered difficult to wean? 1) Physical therapy 2) Speech therapy 3) Social services 4) Occupational therapy

What are some factors that indicate a patient's readiness for extubation? 1) Adequate oxygenation or ventilation with spontaneous breathing 2) Minimal risk for upper airway obstruction 3) Adequate airway protection or minimal aspiration risk 4) Adequate clearance of pulmonary secretions

What is the most important prerequisite for weaning a patient from ventilatory support?

Which of the following cardiovascular changes would you consider a bad sign during weaning a patient from ventilatory support?

Who should make the decisions related to terminal weaning?

Which of the following drug categories can depress ventilatory drive and hinder weaning? 1) Analgesics 2) Narcotics 3) Hypnotics 4) Antibiotics

In an effort to determine a patient's need for ventilatory support, which of the following factors increase(s) ventilatory workload? 1) Decreased lung compliance 2) Decreased thoracic compliance 3) Increased airway resistance 4) Artificial airways

Prerequisites for successful weaning include: 1) psychological readiness. 2) adequate gag and swallow reflexes. 3) ability to follow instructions. 4) adequate cough.

History of Respiratory Care

Delivering Evidence-Based Respiratory Care

Quality, Patient Safety, and Communication, and Recordkeeping

Principles of Infection Prevention and Control

Ethical and Legal Implications of Practice

Physical Principles of Respiratory Care

E-Medicine in Respiratory Care

Fundamentals of Respiratory Care Research

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

Interpreting Clinical and Laboratory Data

Interpreting the Electrocardiogram

Analysis and Monitoring of Gas Exchange

Pulmonary Function Testing

Review of Thoracic Imaging

Flexible Bronchoscopy and the Respiratory Therapist

Nutrition Assessment

Pulmonary Infections

Obstructive Lung Disease: Chronic Obstructive Pulmonary Disease Copd, Asthma, and Related Diseases

Interstitial Lung Disease

Pleural Diseases

Pulmonary Vascular Disease

Acute Respiratory Distress Syndrome

Trauma, Burns and Near Drowning

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

Airway Clearance Therapy Act

Respiratory Failure and the Need for Ventilatory Support

Mechanical Ventilators

Physiology of Ventilatory Support

Patient Ventilator Interaction

Initiating and Adjusting Invasive Ventilatory Support

Noninvasive Ventilation

Extracorporeal Life Support Ecls

Monitoring the Patient in the Intensive Care Unit

Neonatal and Pediatric Respiratory Care

Patient Education and Health Promotion

Cardiopulmonary Rehabilitation

Respiratory Care in Alternative Settings

Filters

Which of the following is false about the P_0.1 measure?

A patient receiving ventilator support has a spontaneous rate of breathing of 26/min and an average V_T of 300 ml. What is this patient's rapid-shallow breathing index?