Question 1

In which mode does flow asynchrony most commonly occur?

Accepted Answer

A)   Volume ventilation.
B)   Pressure ventilation.
C)   CPAP.
D)   No mode is more susceptible. A

Question 2

Which of the following is considered a patient-related cause of poor patient-ventilator interaction?

Accepted Answer

A)   Abnormal respiratory drive
B)   Asynchrony
C)   Inadequate ventilatory support
D)   Inadequate FiO2 A

Question 3

Which of the following is the primary reason that patients poorly interact with the ventilator?

Accepted Answer

A)   Mode of mechanical ventilation selected
B)   Change in their clinical status
C)   FiO2 setting
D)   PEEP setting B

Question 4

The most important variable affecting trigger asynchrony is:

Accepted Answer

A)   the mode of mechanical ventilation being used.
B)   the tidal volume being delivered.
C)   the presence of auto-PEEP.
D)   the patient's underlying disease process requiring mechanical ventilation.

Question 5

You have determined your patient receiving volume ventilation has flow asynchrony. How can this be improved?
1) Increasing peak flow
2) Decreasing inspiratory time
3) Adjusting rise time
4) Adding an inspiratory pause

Accepted Answer

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

Question 6

Which of the following can cause trigger delay?
1) Auto-PEEP
2) Poor sensitivity setting
3) Water in the circuit
4) Ventilator malfunction

Accepted Answer

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

Question 7

In which mode does double triggering most commonly occur?

Accepted Answer

A)   Volume ventilation.
B)   Pressure ventilation.
C)   CPAP.
D)   No mode is more susceptible.

Question 8

Which of the following is a technique for minimizing the effects of auto-PEEP?

Accepted Answer

A)   Secretion management
B)   Minimizing bronchodilator therapy
C)   Increasing inspiratory time
D)   Smaller sized endotracheal tubes

Question 9

Approximately how deep should an endotracheal tube be placed on an adult male?

Accepted Answer

A)   23 cm at the teeth
B)   21 cm at the teeth
C)   19 cm at the teeth
D)   17 cm at the teeth

Question 10

In which mode does cycle asynchrony most commonly occur?

Accepted Answer

A)   Volume ventilation.
B)   Pressure ventilation.
C)   CPAP.
D)   No mode is more susceptible.

Question 11

What is the normal trigger delay?

Accepted Answer

A)   Less than 100 msec
B)   Less than 150 msec
C)   Less than 200 msec
D)   Less than 250 msec

Question 12

Your patient that is receiving mechanical ventilation has a high ventilatory demand. Which of the following is the most appropriate inspiratory time?

Accepted Answer

A)   0.4 sec
B)   0.7 sec
C)   1.0 sec
D)   1.2 sec

Question 13

Which of the following modes of mechanical ventilation are least likely to cause asynchrony?
1) Proportional assist ventilation
2) Pressure support ventilation
3) Neurally adjusted ventilator assist
4) Volume control/assist ventilation

Accepted Answer

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

Question 14

Possible ways to correct flow asynchrony in volume ventilation include which of the following?
1) Change to decelerating flow.
2) Increase peak flow to be greater than 60 L/min.
3) Match ventilator's inspiratory time to the patient's inspiratory time.
4) Decrease peak flow to be less than 60 L/min.

Accepted Answer

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

Question 15

Which of the following are variables controlled during pressure assist/control mechanical ventilation?
1) Volume
2) Flow
3) Time
4) Pressure

Accepted Answer

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

Question 16

Your patient who is orally intubated and receiving mechanical ventilation was just repositioned by the nursing staff following their bedsheets being changed. Suddenly, airway pressures and tidal volumes rapidly decrease. Which of the following explains this finding?

Accepted Answer

A)   Pneumothorax.
B)   A dislodged mucus plug is obstructing the endotracheal tube.
C)   Acute bronchospasm.
D)   Movement of the endotracheal tube.

Question 17

Your patient's clinical status abruptly changed and the alarms on the ventilator are sounding. What is/are the first step(s) you should take?

Accepted Answer

A)   Silence the alarms and adjust the alarm parameters.
B)   Perform a rapid physical examination.
C)   Remove the patient from the ventilator and manually ventilate.
D)   Check the patency of the airway.

Question 18

How are the effects of auto-PEEP on missed triggering improved in the presence of dynamic airway obstruction?

Accepted Answer

A)   Adjustment of the sensitivity setting
B)   The application of PEEP
C)   Mode change
D)   Administration of a bronchodilator

Question 19

Which of the following can be adversely affected by poor patient-ventilator interaction?
1) Gas exchange
2) Ventilatory patterns
3) Hemodynamics
4) Length of mechanical ventilation

Accepted Answer

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

Question 20

Your patient has relatively normal lungs and is receiving mechanical ventilation following surgery. You observe double triggering. What is the most likely cause?

Accepted Answer

A)   The termination criteria is set too low.
B)   The flow rate is too slow.
C)   Auto-PEEP.
D)   The inspiratory time is too short.

Exam 47: Patient Ventilator Interaction