During operation of a ventilator, the respiratory therapist sets the Vt at 500 mL, the mandatory rate at 10 breaths/min, and an inspiratory flow of 50 L/min. These settings are associated with what type of ventilation?
Pressure-targeted, flow-cycled ventilation
Volume-targeted, flow-cycled ventilation
Volume-Targeted, time-cycled ventilation
Volume-targeted, pressure-cycled ventilation
Which of the following are common phase variables for PC-CMV? 1. Flow Trigger 2. Pressure Limit 3. Time Cycle 4. Flow Limit
1 and 2 only
2,3, and 4 only
1,2, and 3 only
2 and 4 only
What is the normal range of PAO2-PaO2 for healthy young adults breathing room air?
5-10 mmHg
10-20 mmHg
20-30 mmHg
50-90 mmHg
Under normal physiological circumstances, how many mL of O2 are capable of combining with 1 g of Hb?
0.003 mL
0.45 mL
0.82 mL
1.34 mL
Calculate the Total Oxygen content: Hb=18, PaO2= 40 SaO2=73%?
19.5 mL/dL
17.7 mL/dL
16.5 mL/dL
14.8 mL/dL
Calculate the FiO2 needed if the a/A ratio=0.55 and the physician wants a PaO2 of 100 mmHg?
47%
80%
33%
39%
What is the VD/VT ratio if their PaCO2 is 40 mmHg and the PeCO2 is 28 mmHg?
45%
40%
35%
30%
A 70 kg, 183 cm patient who is receiving MV is noted to have a drop in SaO2 from 98% to 87%. The hemithorax is expanding more than the left, and breath sounds are clear on the right side, but decreased on the left. The pts ETT is at the 28 cm mark at the lip. What is the most appropriate action?
Pull the tube back to 23 cm
Push the tube in to 29 cm
Pull the tube back to 19 cm
Pull the tube back to 15 cm
Mechanical ventilation is commonly used to manage all of the following conditions except:
correcting severe hypoxemia
correction of hypercarbia
support of ventilatory failure
compensation of acid base balance
ventilatory failure
metabolic acidosis
chest trauma
postoperative recovery
Airflow obstruction may be caused by all of the following changes except:
Increased lung compliance
retained secretions in the airway
neoplasm of the bronchial muscle structure
tumors compressing the airway
During mechanical ventilation, one of the strategies to reduce airflow resistance is to:
lengthen the ET tube
use the smallest ET tube possible
remove the secretions in the ET tube
add water to the ventilator circuit
On the pressure-volume loop, increase in bowing of the inspiratory limb suggests:
excessive inspiratory flow
insufficient inspiratory flow
increased lung compliance
decreased lung compliance
Mr. Jones, a patient diagnosed with adult respiratory distress syndrome, has a static compliance of 15 mL/cm H2O. Based on the compliance value, which of the following assumptions is most likely true?
the FRC is increased
the elastic recoil of the lungs is decreased
the pt may have an obstructive lung defect
the pts WOB is increased
In conditions where the lung compliance is decreased, the:
PIP is increased
Pplat is decreased
PIP and Pplat are both increased
PIP and Pplat are both decreased
static compliance is increased
dynamic compliance is decreased
static and dynamic compliance are both increased
static and dynamic compliance are both decreased
Measurement of the physiologic deadspace to tidal volume ratio requires:
arterial blood gas sample
mixed expired gas sample
pulmonary artery blood gas sample
arterial and expired gas samples
Which of the following conditions is least likely a cause of alveolar hypoventilation?
depression of breathing centers
neuromuscular disease
airway obstruction
Decreased respiratory drive is one of the indications for mechanical ventilation. Which of the following conditions is least likely to affect a patients normal respiratory drive?
Spinal cord injury at C-2 level
Drug Overdose
Chest Trauma
Head Injury
Excessive ventilatory workload is one of the indications for mechanical ventilation. Which of the following conditions is least likely to increase a patients ventilatory workload?
airflow obstruction
deadspace ventilation
decreased compliance
drug overdose
Failure of the ventilatory pump is one of the indications for mechanical ventilation. Which of the following conditions does not normally lead to failure of the ventilatory pump?
Hyperkalemia
Hypothermia
Flail Chest
Respiratory Muscle fatigue
All of the following clinical conditions may cause the inspiratory phase to end prematurely except:
circuit disconnect
kinking of ET tube
low lung compliance
Hypoventilation and abnormalities in gas exchange can cause all of the following conditions except:
secondary anemia
respiratory acidosis
hypoxemia
secondary polycythemia
A patient has been using PEEP at levels between 15 and 18 cmH2O. The physician asks the therapist to monitor the potential adverse effects caused by PEEP. The therapist should monitor all of the following conditions except:
decreased venous return
increased cardiac output and renal perfusion
barotrauma
increased intracranial pressure
Which of the following is not a goal of mechanical ventilation?
Prevent lung infection
Improve oxygenation and remove carbon dioxide
Relieve excessive work of breathing
improve lung mechanics
Initiation of mechanical ventilation is sometimes withheld:
on patients request
incases of medical futility
to reduce or terminate a patients pain and suffering
all of the above
Tachycardia may be caused by all of the following clinical conditions except:
hypovolemia
fever
hypothermia
Refractory hypoxemia should be treated with oxygen therapy and:
mechanical ventilation
pressure support
hyperbaric oxygen therapy
PEEP
Airway resistance may be increased in all of the following clinical conditions except:
ETT with small internal diameter
Condensation in ventilator Circuit
Tachycardia
CPAP is indicated for treatment of patients with______________?
respiratory failure secondary to shunting
apnea
ventilatory failure with hypercapnia
hypoxemia secondary to V/Q mismatch
An adult patient is being mechanically ventilated following respiratory failure. Settings are: Vt: 800 mL/Rate: 12/Mode: AC/FiO2: .60/PEEP 3cmh2O ABG: ph: 7.37 PaCO2: 41 PaO2: 43 HCO3: 22 Which of the following ventilator changes would you recommend at this time?
increase the FiO2
Decrease the volume
Increase the rate
Increase the PEEP
A patient with CHF is placed on the ventilator. The RRT should
obtain a sputum sample for culture
assess changes in ICP
assess changes in BP
obtain a chest xray
An apneic patient is placed on mechanical ventilation following surgery. What range of rate is typical for initiating mechanical ventilation on an adult patient?
4-8
8-12
12-20
20-30
A patient with ARDS is being mechanically ventilated with a PEEP of 10 cmH2o and an FiO2 of .80. When the patient is removed from the ventilator for suctioning, he experiences decreased oxygen saturationh and increased heart rate. What should the respiratory therpist recommend?
decreasing the PEEP to 5
changing to a closed suctioning system
giving a SVN albuterol treatment
increasing the FiO2 on the ventilator
A 70 kg patient is ventilated on on IMV mode with a rate of 8, tidal volume of 700, FiO2 of .40 Peep of 4 pressure support of 4 and an inspiratory flowrate of 45 L/min. The patient is breathing 22 times per minute in between the machine breaths with a tidal volume of 150 mL. What change should the respiratory therapist recommend?
increasing the peak inspiratory flow rate
increasing the respiratory rate
increasing the set tidal volume
increasing the pressure support
A 50 kg adult female is mechanically ventilated following a cardiac arrest. What tidal volume setting is recommended for this patient?
200 mL
300 mL
400 mL
500 mL
You are working in the CCU and have been asked to set up a ventilator in preparation for Mr. Scott who has just undergone coronary artery bypass surgery. Mr. Scott is 58 years old, 5 ft 10 in tall, weights 180 lbs and has no history of lung disease. Which of the following represents the initial settings you would recommend in mechanically ventilating this patient?
tidal volume 500, rate 8, fiO2 0.50
tidal volume 900, rate 12, fiO2 0.30
tidal volume 800, rate 4, FiO2 0.50
tidal volume 800, rate 8, fiO2 0.40
A 42 year old patient with a cervical spine injury is being mechanically ventilated in control mode. As you enter the room, the low pressure alarm is sounding. The patient is connected to the ventilator, but you do not see his chest moving. Your first action would be to
check the alarm settings
observe the exhaled volumes
manually ventilate the patient with the resuscitation bag
Goals of Mechanical Ventilation
Permit lung and airway healing
Permit muscle atrophy
Improve gas exchange
Treat disease process
improve pulmonary mechanics
avoid complications
relieve respiratory distress
sedate and control difficult patients
Low compliance measurements are usually related to conditions that increase the patients functional residual capacity and total lung capacity.
____________ occurs when the patients minute ventilation cannot keep up with CO2 production.
refractory hypoxemia
oxygenation failure
___________________ is reduced oxygen in the body organs and tissues.
tachypnea
hypoxia
Which of the following is a clinical example of a condition that may lead to ventilatory pump failure?
emphysema
hyperkalemia
pulmonary embolism
COPD
Normal airway resistance in healthy adults is between 0.5 to _________ cm/H2O/sec
1.5
2.0
2.5
3.0
One of the most frequent uses of mechanical ventilation is for the management of postoperative patients recovering from_______.
apnea and impending respiratory arrest
anesthesia and medications
acute severe asthma and heart failure
acute brain injury and flail chest
One of the most common causes of increased airway resistance is COPD.
Your patient has a PaO2 of 48 mmHg on 40%. The doctor wants a PaO2 of 80 mmHg. WHat FiO2 do you need?
48%
60%
67%
82%
An unconscious patient is admitted to the ED and results on room air are 7.23/81/43/33 SpO2 71%. With no other data available is mechanical ventilation indicated?
Yes
No
What settings on the ventilator effect the I:E ratio?
Inspiratory Flow
Frequency
Tidal Volume
FiO2
PIP
Increasing the flow rate will lengthen the I time
Which is an example of the most physiological normal type of Mechanical Ventilation?
Chest Cuirass
BiPAP
CPAP
Positive Pressure Ventilation
Static compliance can be used to assess the disease progression.
Refractory hypoxemia does not respond to high FiO2 oxygen therapy?
What could be the problem if static compliance remains the same but dynamic compliance gets worse?
Disease process worsening
tidal volumes not adaquate
patient biting down on ETT
Pneumothorax
The RT reviews a ventilator flowsheet and finds that the PIP has been gradually rising for the past several hours. Possible causes include:
increased pulmonary compliance
bronchospasms
accumulation of secretions
A patient who is being mechanical ventilation has insufficient time to exhale completely. Which ventilator changes might be appropriate to correct this problem?
increased Flow
decreased ventilator rate
add mechanical deadspace
add inspiratory hold
Which of the following flow settings is required to maintain an I:E ratio of 1:3 and a RR of 15/min status asthmaticus who is being mechanically ventilated?
20 L/min
27 L/min
36 L/min
72 L/min
In which of the following patients should pressure support be initiated?
a pt with absent or depressed respiratory drives with an ETT in place
pt receiving SIMV who exhibits signs of increased spontaneous ventilatory effort
pt with low lung compliance, atelectasis, and severe refractory hypoxemia
a pt in the PACU who requires short term ventilatory support
How to reduce PaCO2 with ventilator settings?
Increase RR
increase Vt
Increase Flow
Increase PIP
Increase FiO2
small diameter ETT
condensation in ventilator circuit
tachycardia
Static compliance is primarily affected by a patients ______________ whereas the dynamic compliance is primarily affected by a patients ___________.
elastic property of the lungs, airflow resistance
elastic property of the lungs, minute ventilation
airflow resistance, elastic property of the lungs
airflow resistance, minute ventilation
The most recent blood gas report shows that a patient is hypoventilating with a PaCO2 of 65. The physician asks the therapist to improve the patients alveolar ventilation by making changes to the ventilator settings. The therapist should:
decrease the tidal volume
increase the mechanical deadspace on the ventilator circuit
increase the frequency
Which of the following causes hypoxemia is least likely to be treated successfully by oxygen therapy alone?
hypoventilation
V/Q mismatch
intrapulmonary shunting
low PiO2
___________ causes decreased O2 pressure gradient.
high altitude
pulmonary edma
___________ causes thickening of the AC membrane and decreases diffusion rate.
