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  1. Which of the following conditions will adversely affect pulse oximeter readings?

    A) anemia
    B) hypovolemia
    C) anemia
    D) methemoglobinemia
    B) hypovolemia
    (this multiple choice question has been scrambled)
  2. Which of the following actions is indicated when there is a disparity between the SpO2, SaO2, and the clinical presentation of the patient?

    A) replacing the pulse oximeter probe
    B) moving the probe to an alternate site to check for SpO2
    C) measuring arterial oxygen saturation by co-oximetry
    D) disregarding the SaO2
    B) moving the probe to an alternate site to check for SpO2
    (this multiple choice question has been scrambled)
  3. Which of these two parameters does a pulse oximeter measure?

    A) Hb & COHb
    B) O2Hb & Hb
    C) COHb & MetHb
    D) O2Hb & COHb
    A) Hb & COHb
    (this multiple choice question has been scrambled)
  4. An indistinct Phase III on a capnograph is most often associated with:

    A) rebreathing exhaled gas
    B) Cheyne-Stokes Breathing
    C) COPD
    D) anemia
    C) COPD
    (this multiple choice question has been scrambled)
  5. In the clinical setting, the Pa(a-et)CO2 is normally:

    A) 4 to 6 mm Hg
    B) -2 to -5 mm Hg
    C) 1 to 3 mm Hg
    D) 10 to 15 mm Hg
    D) 10 to 15 mm Hg
    (this multiple choice question has been scrambled)
  6. Which of the following data should be recorded when making transcutaneous measurements?

    A) date and time of measurement and site
    B) site of the electrode placement on the patient
    C) patient activity level and body position and electrode temperature
    D) date and time of measurement and pateint's activity level and body position and site of electrode placement
    B) site of the electrode placement on the patient
    (this multiple choice question has been scrambled)
  7. Which of the following conditions could lead to an elevated RQ(>1,0)?

    A) sepsis
    B) starvation
    C) hyperventilation
    D) diabetes mellitus
    D)diabetes mellitus
    (this multiple choice question has been scrambled)
  8. Which of the following conditions is associated with hypermetabolism?

    A) anesthesia
    B) hyperthyroidism
    C) starvation
    D) pregnancy
    D) pregnancy
    (this multiple choice question has been scrambled)
  9. The following data were obtained from a mechanically ventilated patient: Vt = 600ml; PIP = 30 cm H2O; Pplat = 20 cm H2O. What is the patient's static compliance

    A) 0.20 L/cm H2O
    B) 0.60 L/cm H2O
    C) 0.30 L/cm H2O
    D) 0.25 L/cm H2O
    B) 0.60 L/cm H2O
    (this multiple choice question has been scrambled)
  10. Which of the following conditions will cause a decrease in static and dynamic compliance?

    A) bronchospasm and CHF
    B) CHF and altelectasis
    C) bronchospasm and atlectasis
    D) CHF and partial occlusion of the ETT
    D) CHF and partial occlusion of the ETT
    (this multiple choice question has been scrambled)
  11. ___________ is associated with an increase in the WOB in mechanically ventilated patients?

    A) switching from CMV to assisted mechanical ventilation
    B) decreased spontaneous breathing frequency
    C) bronchodilation
    D) using a larger ETT
    D) using a larger ETT
    (this multiple choice question has been scrambled)
  12. Phase Three of an SBCO2 curve represents which of the following?

    A) dead space
    B) alveolar dead space
    C) a mixture of airway and alveolar gas
    D) alveolar gas
    B) alveolar dead space
    (this multiple choice question has been scrambled)
  13. THE PEEP is increased in a patient receiving mechanical ventilation. A simultaneous shift to the right occurs in the SBCO2 curve and Zone Y increases in area. THis would indicate which of the following?

    A) increased alveolar dead space from reduced pulmonary perfusion
    B) decreased PaCO2 from improvement in oxygenation
    C) lung receuitment and emptying of previously collapsed alveoli
    D) increase in rebreathed volume
    A) increased alveolar dead space from reduced pulmonary perfusion
    (this multiple choice question has been scrambled)
  14. Tracings from a patient undegoing cardiac catheterization demonstrated a left ventricular systolic pressure of 180 mm Hg and a peak systolic aortic pressure of 110 mm Hg. The patient C/O SOB, fatigue and syncope. Which of the following would you associate with these findings?

    A) tricuspid insufficiency
    B) aortic stenosis
    C) mitral regurgitation
    D) pulmonary stenosis
    B) aortic stenosis
    (this multiple choice question has been scrambled)
  15. Which of the following is incorrectly matched for a resting, healthy 154 lbs (70 kg) sedentary subject?

    A) LV stroke volume = 120 ml
    B) Mean RA pressure = 5 mm Hg
    C) LV end-systolic volume = 50 ml
    D) peak systolic LV pressure = 120 mm Hg
    A) LV stroke volume = 120 ml
    (this multiple choice question has been scrambled)
  16. For a heart rate of 75 bpm, the cardiac cycle will last approximately ___ seconds.

    A) 1.2
    B) 0.8
    C) 1.0
    D) 0.4
    B) 0.8
    (this multiple choice question has been scrambled)
  17. Which of the following conditions will cause a decrease in cardiac output?

    A) increased sympathetic tone
    B) fever
    C) exercise
    D) hypovolemia
    D) hypovolemia
    (this multiple choice question has been scrambled)
  18. Which of the following is a characteristic finding in patients with hypovolemia?

    A) low RAP
    B) increased PA pressure
    C) decreased HR
    D) elevated PAOP
    A) low RAP
    (this multiple choice question has been scrambled)
  19. Which of the following will cause an elevation in PA pressure?

    A) hemorrhage
    B) breathing an enriched oxygen mixture
    C) fluid overload
    D) administration of nitric oxide
    C) fluid overload
    (this multiple choice question has been scrambled)
  20. Which of the following measurements is a good indicator of LV contractility?

    A) dp/dt, ejection fraction and stroke volume
    B) dp/dt & ejection fraction
    C) ejection fraction & stroke volume & LVEDV
    D) dp/dt & stroke volume
    A) dp/dt, ejection fraction and stroke volume
    (this multiple choice question has been scrambled)
  21. Which of the following variables are used to calculate PVR?

    A) CO & Mean PAP
    B) CO & Mean LAP
    C) CO, Mean LAP and Mean RAP
    D) CO, mean LAP and mean PAP
    D) CO, mean LAP and mean PAP
    (this multiple choice question has been scrambled)
  22. Which of the following will typically lead to a decrease in CO?

    A) increase in afterload
    B) increase in HR
    C) increase in preload
    D) increase in contractility
    B) increase in HR
    (this multiple choice question has been scrambled)
  23. When properly inserted, the proximal lumen of the PA Catheter will be positioned in the:

    A) LA
    B) PA
    C) RV
    D) RA
    D) RA
    (this multiple choice question has been scrambled)
  24. The proximal lumen can be used for all of the following except:

    A) fluid administration
    B) monitoring of RAP
    C) monitoring of wedge pressure
    D) CO injection insertion
    C) monitoring of wedge pressure
    (this multiple choice question has been scrambled)
  25. The primary function of the transducer dome in a fluid-filled system is to:

    A) amplify the weak biologic signal
    B) convert a pressure signal into an electric signal
    C) respond to pressure changes in the fluid column
    D) filter clots from the system
    C) respond to pressure changes in the fluid column
    (this multiple choice question has been scrambled)
  26. If the transducer is lower than than tip of the catheter during PA monitoring:

    A) the waveform will be dampened
    B) catheter fling will appear on the waveform
    C) an overwedged waveform will appear
    D) the readings will be falsely high
    B) catheter fling will appear on the waveform
    (this multiple choice question has been scrambled)
  27. The dicrotic notch on the PA waveform may disappear in all of the following conditions except:

    A) measurements obtained from a femoral artery
    B) systemic vasoconstriction
    C) pulmonary vasodilation
    D) pulmonary stenosis
    A) measurements obtained from a femoral artery
    (this multiple choice question has been scrambled)
  28. LV stoke work is decreased by increases in which of the following:

    A) Mean PAP
    B) systemic vasodilation
    C) HR
    D) Ventricular end-diastolic pressure
    C) HR
    (this multiple choice question has been scrambled)
  29. Pulmonary hypertension will have which of the following effects?

    A) decreased preload of the right side of the heart
    B) increased afterload of the right side of the heart
    C) increased afterload of the left side of the heart
    D) no effect on myocardial function
    B) increased afterload of the right side of the heart
    (this multiple choice question has been scrambled)
  30. If a patient had a CO of 5.6 L/min and a BSA of 2.1 m2, what is the patient's CI?

    A) 2.67 L/min/m2
    B) 3.50 L/min/m2
    C) 7.70 L/min/m2
    D) 11.76 L/min/m2
    A) 2.67 L/min/m2
    (this multiple choice question has been scrambled)
  31. Which of the following is true regarding the effects of mechanical ventilation on hemodynamic measurements?

    A) applied PEEP should be discontinued when making PAOP measurements
    B) PC-IRV use is associated with increased CI & DO2
    C) PAOP should be measured at the end of a quiet inspiration
    D) lower mean inspiratory pressures present with PSV minimizes the effects of positive intrathoracic pressure
    D) lower mean inspiratory pressures present with PSV minimizes the effects of positive intrathoracic pressure
    (this multiple choice question has been scrambled)
  32. Which of the following could be used to estimated LV end-diastolic pressure?

    A) PA systolic pressure & RV systolic pressure
    B) PAOP, PA diastolic pressure, PA systolic pressure & RV systolic pressure
    C) PAOP & PA diastolic pressure
    D) PA diastolic pressure & PA systolic pressure
    C) PAOP & PA diastolic pressure
    (this multiple choice question has been scrambled)
  33. A patient on PC-SIMV with no PEEP has the following ventilatory parameters and ABG's: set pressure = 20 cm H2O; Vt = 400 ml; set rate = 8 bpm; spontaneous rate = 25 bpm; spontaneous Vt = 225; FiO2 = 0.4.  pH = 7.28; pCO2 = 58 mm Hg; pO2 = 89 mm Hg. THe patient is at IBW of 140 lbs (64 kg). Estimate the patient's total alveolar ventilation (assuming that the dead space changes associated with the ETT and The VDmech balance each other)
    • Mandatory VA = 8 x (600-140) = 3.68 L
    • Sponteneous VA = 25 x (225-140) = 2.13 L
    • Total VA= 3.68 + 2.13 = 5.81 L
  34. A patient on PC-SIMV with no PEEP has the following ventilatory parameters and ABG's: set pressure = 20 cm H2O; Vt = 400 ml; set rate = 8 bpm; spontaneous rate = 25 bpm; spontaneous Vt = 225; FiO2 = 0.4.  pH = 7.28; pCO2 = 58 mm Hg; pO2 = 89 mm Hg. THe patient is at IBW of 140 lbs (64 kg). Calculate the patient's Cs (assuming that flow drops to zero before end inspiration).
    Cs = 600/20 = 30 ml/cm H20
  35. A patient on PC-SIMV with no PEEP has the following ventilatory parameters and ABG's: set pressure = 20 cm H2O; Vt = 400 ml; set rate = 8 bpm; spontaneous rate = 25 bpm; spontaneous Vt = 225; FiO2 = 0.4.  pH = 7.28; pCO2 = 58 mm Hg; pO2 = 89 mm Hg. THe patient is at IBW of 140 lbs (64 kg). Based on ABG results, how do you interpret these data and what changes are appropriate?
    The patient has a respiratory acidosis. In addition, his spontaneous breathing rate is hgh and his spontaneous Vt is low, indicating a high WOB. His Pset is within safe limits. The CO2 can be reduced by increasing the pressure to increase the Vt or by increasing the set rate. Increasing the Pset to 29 cm H2O theoretically would increase his Vt to 860ml (about 14 ml/kg) and reduce the pCO2 to 40 mm Hg. This is a high Vt, although the Pset is still safe. On the other hand, increasing the rate to 12 bpm would also reduce the pCO2 to 40mm Hg. In addition, using PSV to overcome the WOB required to move air through the resistance of the ETT would reduce the patient's spontaneous WOB. PSV could also be used to reduce the PaCO2, instead of changing the mandatory rate or volume.
  36. A 67 YO man with COPD is being mechanically ventilated with the following settings: Vt = 435 ml (6 ml/kg); f = 6 bpm on SIMV; FiO2 = 0.24. He has a spontaneous rate of 25 bpm and a spontaneous Vt of 200ml. PIP = 30 cm H2O and Pplat = 22 cm H2O. The following ABG's are obtained: pH = 7.25; pCO2 = 89; pO2 = 55 and HCO3 = 38 mEq/L. The patient has a normal pCO2 of 55 mm Hg. What changes would you recommend?
    Increase the mandatory rate to 9 bpm to return the patient to a pCO2 closer to his normal value. Add PSV of about 8 cm H2O for spontaneous breaths to reduce spontaneous WOB.
  37. A 45 YO man with Pickwickian Syndrome who is 5'4" and weighs 340 lbs (155 kg) is placed on mechanical ventilation following hip replacement surgery. The initial parameters are as follows: Vt = 1250 ml; f = 10 bpm; PIP = 58 cm H2O and Pplat = 45 cm H2O. ABG's show pH = 7.41; pCO2 = 39 mm Hg; pO2 = 120; HCO3 = 24 and FiO2 = 0.3. What would you recommend?
    IBW for this patient is 106 + 6(4) = 130 lbs or 59 kg. The set Vt is too high and has been based on actual weight, not ideal. PIP and Pplat are high because of the large Vt. Reduce the volume to 500 to 600 ml. The current VE of 12.5 L results in a normal acid base status. With Pplat at 45 cm H2O for a volume of 1.25 L, Cs is about 28 ml/cm H20. A Vt of 0.6 L should produce a safer Pplat. The rate could be adjusted to 16 to 18 bpm, which would provide an adequate VE.
  38. A 22 YO comatose apneic man with a closed head injury is being mechanically ventilated. He is also being treated medically for high ICP. Vt = 600 ml (7.5 ml/kg); mode = VC-CMV; f = 14 bpm; no spontaneous efforts; PaCO2 = 40 mm Hg; pH = 7.39; PaO2 = 80 mm Hg on FiO2 = 0.25. Which of the following changes would you make?

    A) increase Vt to 1000 ml (~12.5 ml/kg)
    B) increase f to 18 bpm
    C) make no change at this time
    D) switch to the SIMV mode
    C) make no change at this time
    (this multiple choice question has been scrambled)
  39. A 35 YO woman with a size 9 ETT requires suctioning. What would an appropriately sized suction catheter be?
    14 Fr

    • 9 x 3 = 27
    • 27/2= 13.5
  40. A 35 YO woman with a size 9 ETT requires suctioning. How long should the catheter be?
    about 22 cm
  41. A 35 YO woman with a size 9 ETT requires suctioning. What is an appropriate suction pressure?
    -100 to -120 mm Hg
  42. Closed suction catheters may be more appropriate than using open suctioning because of which of the following:

    A) the catheter adds no weight to the ventilator circuit
    B) they are less expensive
    C) they reduce the risk of infection
    D) there is no risk of the catheter migrating into the ETT
    C) they reduce the risk of infection
    (this multiple choice question has been scrambled)
  43. The procedure of instilling NSS into the ETT before suctioning is known to do which of the following:

    A) require a physician's order
    B) effectively thin secretions
    C) pose no risk to the patient
    D) increase an elderly person's sensation of dyspnea
    D) increase an elderly person's sensation of dyspnea
    (this multiple choice question has been scrambled)
  44. Silent aspiration and VAP can occur with cuffed ETTs as a result of which of the following:

    A) injury to the mucosa during insertion and manipulation of the tube following insertion and interference with the normal cough reflex
    B) injury to the mucosea during insertion and manpulation of the tube following insertion and interference with the normal cough reflex and aspiration of contaminated secretions that pool above the cuff
    C) injury to the mucosa during insertion and manipulation of the tube following insertion and interference with the normal cough reflex and rupture of the cuff
    D) injury to the mucosa during insertion and manipulation of the tube following insertion and rupture of the cuff
    B) injury to the mucosea during insertion and manpulation of the tube following insertion and interference with the normal cough reflex and aspiration of contaminated secretions that pool above the cuff
  45. Which of the following is true regarding the special ETT that provides continuous aspiration of subglottic secretions?

    A) a pressure of 20 mm Hg is applied continuously to the suction lumen
    B) it is no more expensive than a standard ETT
    C) it is most effective in patients requiring intubation for less than 1 to 2 days
    D) the suction port is located just below the cuff on the dorsal side of the tube
    B) it is no more expensive than a standard ETT
    (this multiple choice question has been scrambled)
  46. A 15 YO patient with severe acute asthma is being mechanically ventilated. Which of the following methods will deliver the largest quantity of a beta-agonist to the respiratory tract?

    A) dry poweder capsule
    B) pMDI with spacer
    C) SVN (although a pMDI is more efficient, a SVN delivers more medication)
    D) pMDI
    C) SVN (although a pMDI is more efficient, a SVN delivers more medication)
    (this multiple choice question has been scrambled)
  47. When delivering medication by pMDI to a ventilated patient, the best placement for the device in the ventilator circuit is which of the following?

    A) on the inspiratory limb near the Y connector
    B) on the inspiratory limb attached to the Y connector using a spacer
    C) between the Y connector and the ETT using an elbow connector
    D) less than 30 cm from the Y connector on the inspiratory side of the circuit with spacer
    D) less than 30 cm from the Y connector on the inspiratory side of the circuit with spacer
    (this multiple choice question has been scrambled)
  48. Which of the following statements is not true when using an externally powdered SVN placed in the ventilatory circuit?

    A) use of an expiratory filter may protect the expiratory valve and expiratory monitors from medication deposition
    B) the added flow will alter monitoring of exhaled Vt and VE
    C) the HME does not have to be removed from the circuit when using an SVN
    D) patient inspiratory efforts may not be sufficient to trigger inspiratory flow from the ventilator
    C) the HME does not have to be removed from the circuit when using an SVN
    (this multiple choice question has been scrambled)
  49. The use of atropine in patients who will be having a fiberoptic bronchoscopy is for what purpose?

    A) drying the airways
    B) reducing the respiratory rate and VE
    C) calming the patient
    D) helping the patient sleep
    A) drying the airways
    (this multiple choice question has been scrambled)
  50. During fiberoptic bronchoscopy of mechanically ventilated patients, the therapist can anticipate what types of changes in ventilator function?

    A) high minute volume alarm
    B) increase in peak pressure
    C) increase in volume delivery
    D) high rate alarm
    B) increase in peak pressure
    (this multiple choice question has been scrambled)
  51. Postural drainage positions recommended for mechanically ventilated patients include all but which of the following?

    A) 45 degree rotation prone with R side up
    B) 45 degree rotation prone with L side up
    C) supine
    D) seated
    D) seated
    (this multiple choice question has been scrambled)
  52. A 38 YO woamn with ARDS is on 15 cm H2o of PEEP and an FiO2 of 0.85. Ventilation is acceptable, but PaO2 is only 54 mm Hg. What might the therapist recommend for improving the oxygenation?

    A) set the FiO2 to 0.5
    B) recommend an increase in VE
    C) change the patient to the prone position
    D) set the PEEP to 10 cm H2O
    C) change the patient to the prone position
    (this multiple choice question has been scrambled)
  53. The improvement in ventilation/perfusion matching and oxygenation seen with prone positioning has been associated with which of the following factors?

    A) relieving the weight of the heart, great vessels and part of the abdominal contents from the lungs
    B) clearance of secretions from the airways
    C) improvement of chest wall compliance in the prone position
    D) increase in perfusion to the nondependent portion of the lungs when the patient is positioned face down
    A) relieving the weight of the heart, great vessels and part of the abdominal contents from the lungs
    (this multiple choice question has been scrambled)
  54. A patient on mechanical ventilation is suctioned for large amounts of foul-smelling green sputum. The patient has a temperature and an elevated white blood cell count. The most like cause of this problem is:

    A) an allergic reaction to acetylcysteine
    B) a pseudomonas infection
    C) an overheated humidifier
    D) cardiogenic pulmonary edema
    B) a pseudomonas infection
    (this multiple choice question has been scrambled)
  55. Patient centered mechanical ventilation involves which of the following?

    A) looking at the patient first and not the machine when an alarm is activated
    B) asking the patient about his or her level of comfort and dyspnea when making ventilator changes
    C) involving the family in ventilator changes
    D) involving all members of the health care team in patient management
    B) asking the patient about his or her level of comfort and dyspnea when making ventilator changes
    (this multiple choice question has been scrambled)
  56. Which of the following must be performed during patient transport to reduce the risk of complications?

    A) all of the answers are correct
    B) maintain acceptable hemodynamic stability during transport
    C) monitor the patient's cardiopulmonary status during transport
    D) provide adeqaute oxygenation and ventilation during transport either by manual bag, portable ventilator or ICU ventilator
    A) all of the answers are correct
    (this multiple choice question has been scrambled)
  57. A 25 YO woman is recovering from severe pneumonia and has been receiving mechanical ventilation for two days. Current FiO2 is 0.6 and the patient's PaO2 is 200 mm Hg. What change is FiO2 would achieve a target PaO2 of 80 mm Hg?

    A) 0.40
    B) 0.25
    C) 0.75
    D) 0.50
    B) 0.25
    (this multiple choice question has been scrambled)
  58. CPAP can only be used for patients who have which of the following characteristics?

    A) are hypovolemic
    B) have central sleep apnea
    C) can breathe spontaneously
    D) have high PaCO2 levels
    C) can breathe spontaneously
    (this multiple choice question has been scrambled)
  59. A PEEP study is being performed on a patient. When the PEEP is increased from 10 cm H2O to 15 cm H2O, cardiac output drops from 4 lpm to 2 lpm. What would be the next most appropriate step?

    A) administer whole blood
    B) decrease the FiO2
    C) decrease the PEEP to 10 cm H2O
    D) make no change at this time
    C) decrease the PEEP to 10 cm H2O
    (this multiple choice question has been scrambled)
  60. During mechanical ventilation with VC-CMV, the PEEP level is set at 10 cm H2O and the PIP is 34 cm H2O. The PEEP is increased to 15 cm H2O and the PIP rises to 40 cm H2O. The rise in PIP indicates which of the following:

    A) a normal occurrence when PEEP is increased
    B) the presence of a pneumothorax
    C) the compliance has changed
    D) a bronchospasm
    A) a normal occurrence when PEEP is increased
    (this multiple choice question has been scrambled)
  61. PEEP therapy is commonly used in which of the following conditions:

    A) ARDS & ALI
    B) ARDS & ALI & for cerebrovascular accidents
    C) Pneumonia on the R side & for cerebrovascular accidents
    D) ARDS
    A) ARDS & ALI
    (this multiple choice question has been scrambled)
  62. A 38 YO man with ARDS is undergoing mechanical ventilation. The results of an ABG are pH 7.38; pCO2 42; pO2 55. The ventilator settings are FiO2 0.9; f 10; Vt 550 ml; PEEP 5 cm H2O. Based on this information, which of the following might be changed to improve this patient's oxygenation status?

    A) oxygen
    B) Vt
    C) f
    D) PEEP
    D) PEEP
    (this multiple choice question has been scrambled)
  63. Research suggests the way to establish an optimum level of PEEP in a patient with ARDS is to do which of the following:

    A) progressively increase PEEP until cardiac output decreases
    B) perform a recruitment/decruitment maneuver to establish the UIPd during deflation (deflection point)
    C) perform an inspiratory P-V curve maneuver
    D) monitor PvO2
    B) perform a recruitment/decruitment maneuver to establish the UIPd during deflation (deflection point)
    (this multiple choice question has been scrambled)
  64. Assessment for optimum PEEP is being determined in a mechanically ventilated patient. PEEP is increased from 5 cm to 10 cm H2O. Volume delivery remains constant at 450 ml. PaO2 increases progressively from 55 to 63 to 78 mm Hg. BP remains fairly constant. Mixed venous pO2 goes from 27 to 26 to 20 mm Hg at 15cm H20 of PEEP. Based on these findings, the most appropriate action is to do which of the following:

    A) use PEEP of 5 cm
    B) use PEEP of 15 cm
    C) increase PEEP to 20 and repeat the study
    D) use PEEP of 10 cm
    D) use PEEP of 10 cm
    (this multiple choice question has been scrambled)
  65. A 70 kg man with bilateral viral pneumonia is on VC-SIMV. His set Vt is 500ml, minimum rate is 15 with no spontaneous breaths, FiO2 0.4, and 5 cm PEEP. THe following ABG's are noted: pH 7.48; pCO2 30 mm Hg; pO2 98 mm Hg. Which of the following is appropriate?

    A) decrease f
    B) increase Vt
    C) increase the FiO2 to 0.5
    D) increase the PEEP to 10 cm
    A) decrease f
    (this multiple choice question has been scrambled)
  66. If you could select only one parameter or value that you wanted to evaluate to establish an optimum PEEP in a patient, what would you select? Why?
    Oxygen transport is an acceptable answer. Another is Cs. More than one answer is possible.
  67. The first parameter to measure following the administration of PEEP is which of the following:

    A) PAOP
    B) PAP
    C) BP
    D) HR
    C) BP
    (this multiple choice question has been scrambled)
  68. A patient on CPAP of 10 cm H2O has f = 36 bpm; pH 7.23; PaCO2 = 54 mm Hg; PaO2 = 75 mm Hg (FiO2 = 0.5). The most appropriate action is to do which of the following:

    A) increase FiO2
    B) begin mechanical ventilation
    C) decrease CPAP to 5cm H2O
    D) increase CPAP to 15
    B) begin mechanical ventilation
    (this multiple choice question has been scrambled)
  69. A patient has a PaO2/FiO2 of 150 and severe sepsis. Compliance is reduced and CXR shows bilateral infiltrates. Which of the following statements are true about this patient?

    A) this type of patient will probably have an improvement in oxygenation with a recruitment maneuver & low Vt and therapeutic PEEP ventilation should be used
    B) the patient has ARDS
    C) The patient has ARDS & this type of patient will probably have improvement in oxygenation with a recruitment maneuver & low Vt and therapeutic PEEP ventilation should be used & protective stratigies should be started ASAP.
    D) the patient has ARDS & protective strategies should be started ASAP
    C) The patient has ARDS & this type of patient will probably have improvement in oxygenation with a recruitment maneuver & low Vt and therapeutic PEEP ventilation should be used & protective stratigies should be started ASAP.
    (this multiple choice question has been scrambled)
  70. T/F  It is better to use the inspiratory limb of an SPV curve for determining LIP and UIP than to use the deflation limb of the curve.
    False
  71. The purpose of setting an adequate PEEP level in ARDS is to:

    A) improve ventilation
    B) increase the perfusion of the lung
    C) prevent alveolar collapse at end exhalation
    D) avoid overdistension of the lung
    C) prevent alveolar collapse at end exhalation
    (this multiple choice question has been scrambled)
  72. A patient with ARDS has an ideal body weight of 53 kg. An acceptable Vt using a protective strategy would be:

    A) 630 ml
    B) 150 ml
    C) 320 ml
    D) 530 ml
    C) 320 ml
    (this multiple choice question has been scrambled)
  73. T/F  During mechanical ventilation of patients with ARDS, it is strongly recommended that the Pplat not exceed 30 cm H2O.
    True
  74. Which of the following indicates that a patient is ready to be weaned from PEEP/CPAP?

    A) PaO2 is 80 mm Hg on 30% O2
    B) PaO2 is 80mm Hg on 30% O2 & the patient is stable and has no active infections & CL is 37ml/cm H20 & the PaO2/FiO2 ratio is 300
    C) PaO2 is 80 mm Hg on 30% O2 & the patient is stable and has no active infections
    D) the patient is stable and has no active infections & PaO2/FiO2 ratio is 300
    B) PaO2 is 80mm Hg on 30% O2 & the patient is stable and has no active infections & CL is 37ml/cm H20 & the PaO2/FiO2 ratio is 300
    (this multiple choice question has been scrambled)
  75. Which of the following can be used to produce IRV on a conventional volume ventilator?

    A) using a long TI & increasing pause time
    B) using long TI
    C) using long TI and increasing Vt
    D) using long TE & increasing Vt & increasing pause time
    A) using a long TI & increasing pause time
    (this multiple choice question has been scrambled)
  76. The inflection point on the deflation curve (deflection point) using the P-V loop for a patient with ARDS is 8 cm H2O. At what value should PEEP be set?

    A) 6 cm H2O
    B) cannot be determined from this information
    C) 10 cm H2O
    D) 8 cm H2O
    C) 10 cm H2O
    (this multiple choice question has been scrambled)
  77. What is the incidence of VAP among ICU patients receiving mechanical ventilation?

    A) 8-28%
    B) 50%
    C) 1-5%
    D) 25-46%
    A) 8-28%
    (this multiple choice question has been scrambled)
  78. Recent clinical studies have identified which of the following bacterial infections has been increasingly shown to be associated with VAP?

    A) haemophilis influenzae
    B) escherichia coli
    C) methicillin resistant staph aureus
    D) legionella pneumophila
    C) methicillin resistant staph aureus
    (this multiple choice question has been scrambled)
  79. Which of the following would be considered host related factors for the developement of VAP?

    A) enhanced gag reflex
    B) malnutrition & shift in the oropharyngeal flora to gram-negative bacilli & gastric alkalization
    C) shift in oropharyngeal flora to gram-negative bacilli & gastric alkalization
    D) malnutrition & shift in the oropharyngeal flora to gram-negative bacilli
    B) malnutrition & shift in the oropharyngeal flora to gram-negative bacilli & gastric alkalization
    (this multiple choice question has been scrambled)
  80. In patients with VAP, the bacterial contaminants are typically less than

    A) 10 to the 4th CFU/ml
    B) 10 to the 6th CFU/ml
    C) 10 to the 8th CFU/ml
    D) 10 to the 12th CFU/ml
    A) 10 to the 4th CFU/ml
    (this multiple choice question has been scrambled)
  81. Which of the following has been implicated in the pathogenesis of VAP?

    A) presence of an ETT & impaired level of consciousness
    B) colonization of the oropharnyx by viridian species of strep &impaired level of consciousness
    C) colonization of the oropharynx by viridian species of strep & presence of an ETT & impaired level of consciousness & reduced airway pH
    D) colonization of the oropharynx by viridian species of strep & presence of an ETT & impaired level of consciousness
    A) presence of an ETT & impaired level of consciousness
    (this multiple choice question has been scrambled)
  82. Clinical diagnosis of VAP is based on which of the following criteria:

    A) FiO2 & total WBC & microscopic analysis of lower airway secretions & CXR
    B) FiO2 & total WBC
    C) total WBC & microscopic analysis of the lower airway secretions & CXR
    D) Total WBC & microscopic analysis of lower airway secretions
    C) total WBC & microscopic analysis of the lower airway secretions & CXR
    (this multiple choice question has been scrambled)
  83. Which of the following would NOT be considered a risk factor for VAP?

    A) home wound care
    B) resdience in an extended care facility
    C) high frequency use of antibiotics in the community
    D) NIV
    D) NIV
    (this multiple choice question has been scrambled)
  84. Which of the following statements is false regarding using sucralfate as a prophylactic agent for the treatment of stress ulcers?

    A) the CDC does not have specific recommendations for the use of sucralfate in stress-bleeding prophylaxis
    B) it does not affect the gastric pH
    C) sucralfate should not be used in patients who are at high risk for GI bleeding
    D) it is the most effective agent to treat stress ulcers in ARDS patients
    D) it is the most effective agent to treat stress ulcers in ARDS patients
    (this multiple choice question has been scrambled)
  85. Which of these nonpharmacologic strategies has not been shown to reduce the incidence of VAP?

    A) nasal rather than oral intubation
    B) maintaining adequate ETT cuff pressure
    C) semi-recumbent positioning of the patient
    D) use of closed suction catheters and sterile suction techniques
    A) nasal rather than oral intubation
    (this multiple choice question has been scrambled)
  86. Which of the following methods do not improve a pateint's immune response to infections?

    A) relying on the use of invasive procedures when possible
    B) maintain nutritional state
    C) avoid agents that impair pulmonary defense (sedative narcotics, anesthetics, aminophylline)
    D) treat disease states that affect host defenses (acidosis, dehydration, hypoxemia)
    A) relying on the use of invasive procedures when possible
    (this multiple choice question has been scrambled)
  87. Which of the following is an appropriate short acting depolarizing agent to use for intubation of a patient?

    A) succinylcholine
    B) fentanyl
    C) vecuronium
    D) pancuronium
    A) succinylcholine
    (this multiple choice question has been scrambled)
  88. A mechanically ventilated patient exhibits severe anxiety and agitation. Talking with the patient does not successfully relieve his symptoms. The nurse is concerned that the patient is being sleep deprived. Which of the following would be an appropriate medication to suggest?

    A) paralyzing agent
    B) opioid
    C) B) sedative
    D) neuromuscular blocking agent
    C) B) sedative
    (this multiple choice question has been scrambled)
  89. A patient in the ICU has a Ramsay score of 6. Which of the following is a patient indication resulting from this score?

    A) patient requires an additional dose of paralyzing agent
    B) patient responds to a painful stimuli
    C) patient is heavily sedated
    D) patient has irreversible brain injury
    C) patient is heavily sedated
    (this multiple choice question has been scrambled)
  90. While performing an assessment of the level of sedation of a patient, the following is observed: patient is asleep; patient has a brisk response to a light glabellar tap or loud auditory stimulus. These criteria would suggest that the patient would rate a score of ___ on the Ramsey scale?

    A) 2
    B) 4
    C) 6
    D) 1
    B) 4
    (this multiple choice question has been scrambled)
  91. A patient with chronic CO2 retention and lung cancer is being treated with morphine for pain. She is very anxious and keeps trying to get out of bed, despite the use of restraints. The nurse gives midazolam (versed) and shortly thereafter notes that the patient's respirations become irregular and short periods of apnea occur. Which of the following is the most appropriate treatment for this patient?

    A) NPPV
    B) caffeine
    C) flumazenil (romazicon)
    D) reduction of morphine administration
    C) flumazenil (romazicon)
    (this multiple choice question has been scrambled)
  92. A patient is receiving mechanical ventilation as a result of an apparent tetanus infection. The patient is having tetanic contractions. What medications would be appropriate for this patient?

    A) analgesics & sedatives
    B) paralytic agents & analgesics
    C) analgesics, sedatives & diuretics
    D) paralytics, analgesics & sedatives
    D) paralytics, analgesics & sedatives
    (this multiple choice question has been scrambled)
  93. A patient receiving morphine postoperatively by a self-actuating morphine pump complains of nausea. Which of the following is an appropriate response?

    A) notify housekeeping
    B) the morphine should be stopped
    C) nausea is not a common side effect when administering morphine, so you should ignore the patient's complaint
    D) contact the nurse & the physician
    D) contact the nurse & the physician
    (this multiple choice question has been scrambled)
  94. Which of the following is a nodepolarizing NMBA?

    A) pancureonium & atacurium & vecurium & succynlcholine
    B) pancuronium & atacurium & vecuronium
    C) vecuronium & succinylcholine
    D) pancuronium & atacurium
    B) pancuronium & atacurium & vecuronium
    (this multiple choice question has been scrambled)
  95. Which of the following is not correctly matched?

    A) propofol, diprivan
    B) diazapam, valium
    C) fentanyl, ativan
    D) midazolam, versed
    C) fentanyl, ativan
    (this multiple choice question has been scrambled)
  96. Describe the technique of TOF monitoring.
    The TOF technique allows the clinician to assess the extent of neuromuscular blockade during pahrmacologically induced paralysis. With this technique, two electrodes are placed on the skin along a nerve path, often near a hand, foot or facial nerve. An electrical current consisting of four impulses is applied to the peripheral nerve over 2 seconds; the muscle contractions (twitches) produced provide information about the level of paralysis.
  97. Which of the following are potential complications of PPV?

    A) reduced CO & decreased BP
    B) reduced urine output & decreased BP & increased ICP
    C) reduced CO & reduced urine output & decreased BP & increased ICP
    D) reduced CO
    C) reduced CO & reduced urine output & decreased BP & increased ICP
    (this multiple choice question has been scrambled)
  98. Four days after being placed on ventilatory support, a postoperative abdominal surgery patient has indications of low urine production and a weight gain of 1 kg. Which od the following might have caused the changes?

    A) kidney failure & fluid loading & lasix administration & PPV
    B) kidney failure
    C) kidney failure, PPV & fluid loading
    D) fluid loading
    C) kidney failure, PPV & fluid loading
    (this multiple choice question has been scrambled)
  99. Paw can be increased by which of the following?

    A) increasing inspiratory gas flow & decreasing the I:E ratio
    B) adding PEEP and adding an inspiratory pause
    C) adding an inspiratory pause & decreasing the I:E ratio
    D) adding PEEP
    B) adding PEEP and adding an inspiratory pause
    (this multiple choice question has been scrambled)
  100. High Vts or high levels of PEEP can result in which of the following?

    A) an increase in resistance to blood flow through the pulmonary circulation
    B) maintenance of normal RV stroke volume in patients with compromised RV function
    C) an increase in RV afterload
    D) a decrease in PAP
    A) an increase in resistance to blood flow through the pulmonary circulation
    (this multiple choice question has been scrambled)
  101. T/F  Reductions in PaO2 can decrease renal blood flow and increase sodium and water retention.
    True
  102. T/F   To reduce the eddects of PPV, the therapist should evaluate the Paw and reduce it as much as possible.
    True
  103. Which of the following should be used with caution in a patient with severe hypovolemia?

    A) administering a plasma volume expander & inverse I:E ratio & short Ti
    B) >5 cm H2O PEEP
    C) > 5 cm H2O PEEP & inverse I:E ratio
    D) inverse I:E ratio
    D) inverse I:E ratio
    (this multiple choice question has been scrambled)
  104. Briefly explain how PPV can affect cerebral blood flow in patients with closed head injury.
    The amount of blood flowing to the brain is determined by the cerebral perfusion pressure (CPP) which is calculated by subtracting the intracranial pressure from the mean system arterial blood pressure (MABP). Because PPV (with or without PEEP) can reduce CO and MABP, it is reasonable to assume the CPP would also decrease furing PPV in these patients.
  105. Which of the following should a therapist measure when assessing the nutritional status of a critically ill patient receiving mechanical ventilation?

    A) actual weight versus predicted body weight
    B) body composition & actual versus predicted body weigh & urinary nitrogen excretion
    C) body composition & actual versus predicted body weight & urinary nitrogen excretion
    D) body composition & arterial pO2
    C) body composition & actual versus predicted body weight & urinary nitrogen excretion
    (this multiple choice question has been scrambled)
  106. T/F  Nutritional supplements should always be delivered by the most natural route possible.
    True
  107. The peak pressure alarm is activated on a patient receiving mechanical ventilatory support. Peak pressures have increased from 25 to 50 cm H2O in the last 30 minutes. While listening to the patient's breath sounds, the therapist notes the absence of breath sounds over the entire right hemothorax. The patient is unconscious and unresponsive. Which of the following actions would assist the therapist in determining the cause of the problem?

    A) increase the pressure limit setting to 60 cm H2O
    B) percuss over the right thorax
    C) deflate the ETT cuff
    D) percuss over the right thorax and recommend a stat CXR
    D) percuss over the right thorax and recommend a stat CXR
    (this multiple choice question has been scrambled)
  108. Further evaluation of the patient showed increased radiolucency over the right and the absence of vascular markings on the right. The trachea is deviated to the left. Neck veins are distended. The patient is cyanotic. What immediate action(s) should the practitioner take at this time?

    A) call a physician stat
    B) increase the pressure limit
    C) increase the pressure limit & increase the ventilator volume
    D) call a physician stat, disconnect the patient from the ventilator and manually ventilate the patient
    D) call a physician stat, disconnect the patient from the ventilator and manually ventilate the patient
    (this multiple choice question has been scrambled)
  109. A patient with ARDS is difficult to oxygenate: FiO2 is 0.8; PEEP is 12 cm H2O and PaO2 is 63 mm Hg. The physician requests that the therapist perform whatever maneuver that might establish an optimum PEEP for this patient.
    The therapist might consider performing a recruitment maneuver that would include recruitment to open the lung, decruitment to establish the deflation point (UIP during derecruitment) and then re-recruiting the lungs. It might be argued that a static pressure-volume curve could establish a LIP, but current research supports the use of the deflation point.
  110. A patient with ARDS requires high PEEP levels. Plateau pressures are approximately 35 cm H2O and PEEP is 16 cm H2O. The patient's abdomen is turgidly overdistended. The therapist is concerned about the high Pplat. Should the therapist reduce the ventilating pressures?
    In patients with high chest wall and abdominal pressures, the restriction of lung movement caused by a rigid thoracic compartment may provide some protection from elevating transpulmonary pressures. The same would be true is a patient were in the prone position. In this situation, the increase in Pplat probably is permissible and will not cause VILI. Another option might be to allow the PaCO2 to increase to maintain a lower Pplat.
  111. VILI is associated with which of the following?

    A) washout or alteration of surfactant & damage to the pulmonary microvasculature
    B) washout of alteration of surfactant & shear stress & damage to the pulmonary microvasculature & possible release of inflammatory mediators from pulmonary cells
    C) washout or alteration of surfactant
    D) possible release of inflammatory mediators from pulmonary cells
    B) washout of alteration of surfactant & shear stress & damage to the pulmonary microvasculature & possible release of inflammatory mediators from pulmonary cells
    (this multiple choice question has been scrambled)
  112. Overdistention injury of the lungs is associated with release of what substances from the lungs into the bloodstream?

    A) mucus
    B) cytokines
    C) surfactant
    D) bacterial endotoxins
    B) cytokines
    (this multiple choice question has been scrambled)
  113. During mechanical ventilation, a patient appears to be "fighting the ventilator," He is anxious, agitated and hypertensive. The patient's skin is hot and moist. The ECG shows peaked T waves and St segment depression. Potassium level is elevated. What further assessment and therapy might be needed for this patient?
    The temptation might be to sedate this patient for anxiety. Another concern might be the patient's heart, considering the ECG changes. Before any medications are administered, the patient must be assessed further. ABG analysis may reveal respitatory acidosis, because all these findings are consistent with that condition.
  114. A patient on PC-CMV has initial ABG findings as follows: pH 7.30; pCO2 60; pO2 101. The therapist should:

    A) very gradually, over several days, increase the minute ventilation to this patient
    B) increase minute ventilation to this patient
    C) decrease pressure setting
    D) change the ventilator mode
    B) increase minute ventilation to this patient
    (this multiple choice question has been scrambled)
  115. During mechanical ventilation, hyperventilation, particularly in patients with COPD, can cause which of the following:

    A) high pH values & air trapping & cardiac arrhthymias
    B) muscle twitching and tetany & air trapping
    C) muscle twitching & tetany& high pH values & air trapping & cardiac arrhythmias
    D) high pH values
    C) muscle twitching & tetany& high pH values & air trapping & cardiac arrhythmias
    (this multiple choice question has been scrambled)
  116. During mechanical ventilation with VC-SIMV, a respiratory rate of 4 bpm and a Vt of 600ml in a patient with a spontaneous rate of 24 bpm between machine breaths. Pressure support is set a 5 cm H2O. SpO2 is 95%. The spontaneous Vt rnages from 175 to 275 ml. The patient is using accessory muscles to breathe. ABG results are within the normal range. The patient's ideal body weight is 70 kg. Which of the following might be appropriate?

    A) increase the Vt on the ventilator
    B) decrease the SIMV rate
    C) increase pressure support to 10 cm H20
    D) increase the FiO2
    C) increase pressure support to 10 cm H20
    (this multiple choice question has been scrambled)
  117. Reducing the WOB can be accomplished by using which of the following:

    A) increased inspiratory flow rates & incresed ventilator sensitivity & putting the patient in an upright position & ensuring the patency of the ETT
    B) increasing the ventilator sensitivity & putting the patient in an upright position
    C) increasing inspiratory flow rates
    D) increasing the ventilator sensitivity & putting the patient in an upright position
    A) increased inspiratory flow rates & incresed ventilator sensitivity & putting the patient in an upright position & ensuring the patency of the ETT
    (this multiple choice question has been scrambled)
  118. A patient with ARDS is on 15 cm H2O of PEEP after a recruitment maneuver. FiO2 is 0.85. Ventilation is good but PaO2 is only 94 mm Hg. What might the therapist do to improve the oxygenation?

    A) recommend an increase in minute ventilation
    B) change the patient to the prone position
    C) reduce the PEEP to 10 cm H2O
    D) set the FiO2 at 0.5 to avoid oxygen toxicity
    B) change the patient to the prone position
    (this multiple choice question has been scrambled)
  119. Mean airway pressure for a patient is 21 cm H20. THe therapist increases MAP to 25 cm H2O by increasing PEEP. Pplat is now 35 cm H2O. This might result in which of the following?

    A) VILI
    B) an increase in CO
    C) a decrease in FRC
    D) an increase in deadspace
    A) VILI
    (this multiple choice question has been scrambled)
  120. A patient will require 10 to 14 days of mechanical ventilation and is orally intubated with a standard ETT. Ventilation and Pplat are adequate of VC-CMV with a volume of 450 ml and a rate of 14 bpm. ABG's are pH 7.40; pCO2 41; pO2 101. What changes might the therapist make?

    A) make no changes
    B) decrease the FiO2
    C) change the ETT to provide CASS
    D) increase Vt
    A) make no changes
    (this multiple choice question has been scrambled)
  121. A 25 YO man receiving mechanical ventilation is rotated form the supine position onto his right side. Immediately after this move, the high pressure alarm on the ventilator activates. On auscultation, the therapist hears breath sounds only over the right lung. The centimeter marking of the ETT is 25 cm. What should the therapist do to correct the situation?
    The breath sounds and the ET marking at the teeth suggest that the tube may have migrated down into the right mainstem bronchus when the patient was moved. The RT should check the chart for the original tube position. The tube must be withdrawn about 3-4 cm and the breath sounds reevaluated. A CXR may be required.
  122. A constant inspiratory glow of 40 lpm is set for a patient receiving VC-CMV. The ventilator I:E ratio indicator shows that I exceeds E. How could this problem be solved without changing the Ve?

    A) increase the inspiratory gas flow setting
    B) lengthen the Ti
    C) increase the f
    D) shorten the expiratory time
    A) increase the inspiratory gas flow setting
    (this multiple choice question has been scrambled)
  123. A patient with COPD is treated with prednisone, theophylline and furosemide. Which of the following is the most important to check regularly?

    A) potassium levels
    B) calcium levels
    C) clotting times
    D) pupillary response
    A) potassium levels
    (this multiple choice question has been scrambled)
  124. A patient on mechanical ventilation is suctioned for large amounts of foul-smelling green sputum. The patient has a temperature of 38 degrees C and a normal white cell count. Which of the following is the most likely cause of this problem?

    A) an asthma exaccerbation
    B) cardiogenic pulmonary edema
    C) an overheated humidifier
    D) a respiratory infection
    D) a respiratory infection
    (this multiple choice question has been scrambled)
  125. The sudden onset of dyspnea can be recognized visually from the physical signs of distress. Describe the typical findings of respiratory distress in a ventilated patient.
    Tachypnea, nasal flarring, diaphoresis, use of accessory muscles, paradoxical movements of the thorax and abdomen, tachycardia, arrhythmia, and hypotension.
  126. What is the first step in managing a mechanically ventilated patient in severe distress. How can you tell if the problem originates with the ventilator or the patient?
    The initial step is to disconnect the patient from the ventilator and carefully manually ventilate the patient. If the distress immediately resolves, the problem originates with the ventilator. If the distress is not resolved, the problem originates with the patient. Continue assessment until the problem is resolved.
  127. A 58 YO man is intubated orally after cardiac arrest. The patient is admitted to the ICU and ventilatory support is provided using volume controlled ventilation in the A/C mode using 100% oxygen. The PIP has been progressively increasing over the past four hours. Auscultation of the patient's chest reveals an absence of breath sounds over the left lung and distant breath sounds over the right lung. The left hemithorax is dull to percussion and the right chest is resonant. The trachea is deviated to the left. No CXR is available. Briefly describe what is causing the problem and how can it be corrected.
    Intubation apparently resulted in the insertion of the ETT into the right mainstem bronchus. After 4 hours of ventilation at a high oxygen concentration, the left lung has collapsed, resulting in the dull percussion over the left lung, the absence of breath sounds and the tracheal shift. The tube must be repositioned, breath sounds reevaluated and a CXR is necessary to confirm the tube placement.
  128. The low pressure and low volume alarms activate on a ventilated patient. Auscultation over the trachea reveals a hiss during the entire mandatory breath cycle. What is the likely problem and how would you correct it?
    The most likely cause is a leak around the tube cuff. Inflate the cuff using MLT or minimum occluding volume and measure the cuff pressure. Listen again over the tracheal area to make sure the cuff is not still leaking. Another possible cause is migration of the ETT upward, above the vocal cords. Check the centimeter markings at the teeth.
  129. While monitoring a patient on mechanical ventilatory support, the therapist hears the high pressure alarm and notes breath sounds are absent over the right lung and diminished over the left lung. Percussion is more tympanic on the right and resonant on the left. The patient's distress is not relieved when the therapist performs manual ventilation with 100% oxygen. What could cause these findings and what should be done?
    Breath sounds suggest the presence of a pneumothorax in the right hemithorax. Contact a physician immediately for placement of a chest tube and continue to manually ventilate the patient with 100% oxygen.
  130. A 70 YO woman with COPD is being mechanically ventilated using volume controlled continuous mandatory ventilation. Although the sensitivity is set at the most sensitive setting, the patient is struggling to breathe (using accessory muscles) and is unable to trigger a machine breath on her own. When breaths are delivered, the ventilator graphics show a concave pressure curve. Expiratory glow does not return to zero before the next mandatory breath is delivered. What is the most likely cause of the problem?
    The graphics demonstrate that auto-PEEP is present (the flow does not return to zero before a mandatory breath begins), that the machine is not responding to the patient effort and that inspiratory flow is set too low for patient demand. If this is unsuccessful, consider using external PEEP to make triggering easier for the patient. Perhaps VC-CMV is not the best mode for this patient. Consider other alternatives, such as changing the flow waveform.
  131. The low pressure and low volume alarm alert on a patient receiving mechanical support. The ventilator graphics indicated that the expired volume is lower than the inspired volume. Which of the following could cause this problem?

    A) disconnection from the ventilator
    B) pneumothorax and disconnection from the ventilator and increased airway resistance
    C) pneumothorac and pulmonary edema and disconnection from the ventilator
    D) pneumothorax
    A) disconnection from the ventilator
    (this multiple choice question has been scrambled)
  132. A 26 YO man who was in an MVA is transferred from a rural hospital to the trauma center. He is 6'3" tall and weights 200 pounds. He suffered trauma to the chest and has a fractured left femur. Currently no pneumothorax or hemothorax is present and he had had no head or neck injuries. The artificial airway is a 7 Fr. oral ETT in the correct position. Cuff pressure is 38 cm H2O to provide the minimum leak technique. Do you think any immediate changes need to be made in the current management of this patient?
    The patient will need further assessment, including VS, pulse ox, ABG's and a chest examination. More information about the ventilator settings is needed. An immediate concern is the high cuff pressure. The tube size is too small for this patient: change to a larger tube.
  133. Difficulty is encountered in the management of a patient with acute pancreatitis and ARDS. In PC-CMV mode, the pressure is set at 30 cm H2O and a Ti of 2 seconds and an I:E ratio of 1:1. The patient is heavily sedated and the rate is set at 15 bpm. PaO2 is maintained at 61 mm Hg on an FiO2 of 0.5 and a PEEP of 15 cm H2O. However, over the past 4 hours, the pH has dropped from 7.31 to 7.22, the PaCO2 has risen from 45 to 53 mm Hg and the PaO2 has dropped to 54 mm Hg and the delivered Vt has steadily decreased. What change in ventilation would you suggest?
    It may be appropriate to do a recruitment maneuver on this patient because the condition is secondary, nonpulmonary ARDS. Resetting PEEP after recruitment may be indicated. Another option is to use permissive hypercapnia. Eliminatre any contraindications to this treatment and assess the patient's tolerance of this technique. The patient may need sedation but may already be sedated as the I:E ration is 1:1.
  134. A therapist is monitoring a patient who is receiving CPAP through a free-standing system. The therapist notes that although a wick-type humidifier is in use no rain-out (condensation) is present in the circuit. Which of the following would be appropriate to do in this situation?

    A) Nothing: this is not unusual and check that the heater is working and evaluate the system to see if water has been added to the humidifier and determine when the system was last changed.
    B) nothing: this is not unusual
    C) check that the heater is working and determine when the system was last changed
    D) nothing: this is not unusual and check that the heater is working and evaluate the system to see if water has been added to the humidifier
    A) Nothing: this is not unusual and check that the heater is working and evaluate the system to see if water has been added to the humidifier and determine when the system was last changed.
    (this multiple choice question has been scrambled)

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