\

Mechanical Ventilation Chapters 1 – 5 Practice Questions:

1. The body’s mechanism for conducting air in and out of the lungs is known as which of the following?: Spontaneous ventilation

2. Which of the following are involved in external respiration?: Alveoli and pulmonary capillaries

3. All of the following could be the cause of a patient’s peak pressure increasing from 35 to 45 cm H2O except:

a. Bronchospasm

b. Resolving pulmonary edema

c. The patient biting on the endotracheal tube. Secretions in the airway

d. Secretions in the airway

4. The pressure required to maintain alveolar inflation is known as which of the following?

a. Transairway pressure (PTA )

b. Transthoracic pressure (PTT)

c. Transrespiratory pressure (PTR)

d. Transpulmonary pressure (PL)

5. The term used to describe the tendency of a structure to return to its original form after being stretched or acted on by an outside force is which of the following?

a. Elastance

b. Compliance

c. Viscous resistance

d. Distending pressure

6. The condition that causes pulmonary compliance to increase is which of the following?

a. Asthma

b. Kyphoscoliosis

c. Emphysema

d. Acute respiratory distress syndrome (ARDS)

7. Use this figure to compute the static compliance (CS) for an intubated patient with an exhaled tidal volume (VT) of 500 mL.

a. 14 mL/cm H2O

b. 20 mL/cm H2O

c. 33 mL/cm H2O

d. 50 mL/cm H2O

8. The ventilator that functions most physiologically uses which of the following?

a. Open loop

b. Double circuit

c. Positive pressure

d. Negative pressure

9. Plateau pressure (Pplateau) is measured during which phase of the ventilatory cycle?

a. Inspiration

b. End-inspiration

c. Expiration

d. End-expiration

10. Calculate airway resistance (Raw) for a ventilator patient, in cm H2O/L/sec, with the following information: Peak inspiratory pressure (PIP) is 20 cm H2O, plateau pressure (Pplateau) is 15 cm H2O, PEEP is 5 cm H2O, and set flow rate is 50 L/min.

a. 5 Raw

b. 6 Raw

c. 10 Raw

d. 15 Raw

11. Calculate the static compliance (CS), in mL/cm H2O, when PIP is 47 cm H2O, plateau pressure (Pplateau) is 27 cm H2O, baseline pressure is 10 cm H2O, and exhaled tidal volume (VT) is 725 mL.

a. 43 CS

b. 36 CS

c. 20 CS

d. 0.065 CS

12. Air accidentally trapped in the lungs due to mechanical ventilation is known as which of the following?

a. Plateau pressure (Pplateau)

b. Functional residual capacity (FRC)

c. Extrinsic positive end expiratory pressure (extrinsic PEEP)

d. Intrinsic positive end expiratory pressure (intrinsic PEEP)

13. Which of the following statements is (are) true?

I. During inspiration with positive pressure ventilation, intrapleural pressure becomes positive.

II. During inspiration with negative pressure ventilation, intrapleural pressure is negative.

III. During spontaneous ventilation, intrapleural pressure is most negative at the beginning of inspiration

IV. During positive pressure ventilation, intrapleural pressure is about – 15 cmH2)

Answer: I, II, III

14. The respiratory therapist enters modes and parameters into the ventilator with which of the following?

a. Control logic

b. Input power

c. User interface

d. Drive mechanism

15. The function of the exhalation valve is to do which of the following?

a. Adjust the flow going to the patient

b. Close during exhalation to vent patient gas

c. Seal the external circuit during inspiration

d. Determine the volume being delivered

16. In the image, what does “B” represent?

a. Expiratory valve line

b. Exhalation valve

c. Expiratory line

d. Main inspiratory line

17. There are two types of pneumatically powered ventilators: pneumatic and fluidic

A. True

B. False

18. Closed-loop ventilator logic systems are called “unintelligent” because they cannot be programmed to respond to changing conditions.

A. True

B. False

19. Modern ICU ventilators use flow control valves. These valves control or direct gas flow by opening or closing either completely or in small increments. 

A. True

B. False

20. The power source used by the ventilator provides the energy to perform the work of ventilating the patient. Ventilator power sources include:

A. Electrical

B. Pneumatic

C. Dual electrical-pneumatic

D. All of the above

21. Early ventilators such as the tank ventilator and chest cuirass were designed to operate as:

A. Positive pressure ventilators

B. Negative pressure ventilators

C. Constant pressure ventilators

D. Volume-cycled ventilators

22. The equation of motion describes the relationships between which of the following?

a. Pressure and flow during a mechanical breath

b. Pressure and volume during a spontaneous breath

c. Flow and volume during a mechanical or spontaneous breath

d. Flow, volume, and pressure during a spontaneous or mechanical breath

23. How many variables can a ventilator control at one time?

a. One

b. Two

c. Three

d. Four

24. An increase in airway resistance during volume-controlled ventilation will have which of the following effects?

a. Volume increase

b. Flow decrease

c. Pressure increase

d. Rate decrease

25. An increase in airway resistance during pressure-targeted ventilation will have which of the following effects?

a. Volume decrease

b. Flow increase

c. Pressure increase

d. Rate decrease

26. The most commonly used patient-trigger variables include which of the following?: 1. Flow, 2. Time, 3. Pressure, 4. Volume

a. 1 and 3 only

b. 2 and 4 only

c. 1 and 4 only

d. 2 and 3 only

27. A patient who has been sedated and paralyzed by medication is being controlled by the ventilator. The set rate is 15 bpm. How many seconds does it take for inspiration and expiration to occur?

a. 2 seconds

b. 4 seconds

c. 6 seconds

d. 8 seconds

28. The trigger variable in the controlled mode is which of the following?

a. Flow

b. Time

c. Pressure

d. Volume

29. The inspiratory and expiratory flow sensors are reading a base flow of 5 liters per minute (L/min). The flow trigger is set to 2 L/min. The expiratory flow sensor must read what flow to trigger inspiration?

a. 1 L/min

b. 2 L/min

c. 3 L/min

d. 4 L/min

30. The patient trigger that requires the least amount of work of breathing for the patient is which of the following?

a. Time

b. Flow

c. Pressure

d. Volume

31. The limit variable set on a mechanical ventilator will do which of the following?

a. End inspiration

b. Begin inspiration

c. Control the maximum value allowed

d. Control the minimum value allowed

32. The variable that a ventilator uses to end inspiration is known as which of the following?

a. Cycle

b. Limit

c. Trigger

d. Baseline

33. The most common method of terminating inspiration during pressure support ventilation is which of the following?

a. Flow

b. Time

c. Pressure

d. Volume

34. What is the flow-cycle setting for the following pressure supported breath?

D. 50% 

35. Which maneuver will maintain air in the lungs at the end of inspiration, before the exhalation valve opens?

a. Pressure limit

b. Inspiratory hold

c. Expiratory hold

d. Expiratory resistance

36. A ventilator is set to deliver a 600 mL tidal volume. The flow rate is set at 40 L/min and the frequency is set at 10 breaths/min. If the flow rate is doubled and the patient is not assisting, which of the following will occur?

a. The frequency will decrease.

b. The tidal volume will increase.

c. The expiratory time will increase.

d. The inspiratory time will increase.

37. A patient with an opiate drug overdose is unconscious and has the following arterial blood gas results on room air: pH 7.20; partial pressure of carbon dioxide (PaCO2) 88 mm Hg; partial pressure of oxygen (PaO2) 42 mm Hg; bicarbonate (HCO3-) 25 mEq/L. Which of the following best describes this patient’s condition?

a. Chronic hypoxemic respiratory failure

b. Chronic hypercapnic respiratory failure

c. Acute hypoxemic respiratory failure

d. Acute hypercapnic respiratory failure

38. A patient with inadequate oxygenation of the brain may display which of the following conditions?: 1. Confusion, 2. Excitement, 3. Somnolence, 4. Compliance

a. 1 and 2 only

b. 1 and 3 only

c. 2 and 4 only

d. 3 and 4 only

39. Which of the following values are indicative of acute respiratory failure and the need for ventilatory support?: 1. Maximum inspiratory pressure (MIP) = – 25 cm H2O, 2. Dead space to tidal volume ratio (VD/VT) = 0.4, 3. Vital capacity (VC) = 8 mL/kg IBW, 4. pH = 7.20

a. 1 and 2 only

b. 2 and 3 only

c. 3 and 4 only

d. 1 and 4 only

40. A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath. Physical assessment reveals: pulse 102, blood pressure 138/80, respiratory rate 25 with accessory muscle use, and breath sounds are decreased with bilateral inspiratory and expiratory wheezing with a prolonged expiratory phase. The peak expiratory flow rate is 100 L/min. The immediate action by the respiratory therapist should include which of the following?

a. Intubate and mechanically ventilate.

b. Administer oxygen via non-rebreather mask.

c. Administer continuous bronchodilator therapy.

d. Initiate noninvasive positive pressure ventilation.

41. Which of the following patients is showing the signs of acute respiratory distress?

a. One who is in a semi-Fowler position, watching TV, with a 2 L/min nasal cannula

b. One in the high Fowler position, diaphoretic, anxious and unable to complete a sentence

c. One who is leaning forward on a table, using accessory muscles, and pursed-lip breathing

d. One in the high Fowler position, with a 2 L/min nasal cannula, eating breakfast

42. The underlying physiological process leading to pure hypercapnic respiratory failure is which of the following?

a. Ventilation/perfusion mismatch

b. Intrapulmonary shunting

c. Diffusion impairment

d. Alveolar hypoventilation

43. Which of the following are conditions affecting the central nervous system that is associated with reduced drive to breathe?

A. General anesthesia

B. Stroke

C. Narcotics

D. All of the above

44. A patient has recently been diagnosed with obstructive sleep apnea. The most appropriate treatment includes which of the following? 

a. Pressure Support Ventilation (PSV)

b. Noninvasive Positive Pressure Ventilation (NPPV)

c. Continuous Positive Airway Pressure (CPAP)

d. Pressure Controlled Continuous Mandatory Ventilation (PC-CMV)

45. Which of the following is the minimum ventilator rate that is considered full ventilatory support?

a. 4 breaths/minute

b. 6 breaths/minute

c. 8 breaths/minute

d. 10 breaths/minute

46. Partial ventilatory support can be provided by which of the following ventilator modes?: 1. Pressure Controlled Continuous Mandatory Ventilation (PC-CMV) set rate 8 breaths/minute, 2. Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) set rate 4 breaths/minute, 3. Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) set rate 10 breaths/minute, 4. VC- MMV set Ve8 L/minute

a. 1 and 2 only

b. 2 and 3 only

c. 2 and 4 only

d. 3 and 4 only

47. Of the following breath descriptions, which one is considered spontaneous?

a. Flow triggered, pressure limited, flow cycled

b. Time triggered, volume limited, volume cycled

c. Pressure triggered, pressure limited, time cycled

d. Patient triggered, patient cycled, baseline pressure +5 cm H2O

48. What type of breath occurs when the ventilator controls the timing, tidal volume, or inspiratory pressure?

a. Assisted

b. Mandatory

c. Spontaneous

d. Controlled

49. An assisted breath in PC-CMV mode can be described by which of the following?

a. Time triggered, pressure limited, time cycled

b. Patient triggered, pressure limited, time cycled

c. Time triggered, pressure limited, pressure cycled

d. Patient triggered, volume limited, volume cycled

50. Full ventilatory support is provided by which of the following modes?

a. Pressure Support Ventilation (PSV) with Continuous Positive Airway Pressure (CPAP)

b. Volume Support Ventilation (VSV) with Continuous Positive Airway Pressure (CPAP)

c. Volume-Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) rate 6 with pressure support (PS)

d. Pressure-Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) rate 12 with pressure support (PS)

51. When a patient does not breathe spontaneously while in the airway pressure release ventilation (APRV) mode, the pressure-time scalar looks like that of which of the following?

a. Pressure Support Ventilation (PSV)

b. Continuous Positive Airway Pressure (CPAP)

c. Pressure-Controlled Inverse Ratio Ventilation (PCIRV)

d. Volume-Controlled Continuous Mandatory Ventilation (VC-CMV)

52. A breath that is patient triggered, pressure targeted, and time cycled is which of the following?

a. Assisted breath

b. Mandatory breath

c. Spontaneous breath

d. Synchronized breath

53. A patient triggered, pressure limited, flow cycled breath describes which of the following?

a. Spontaneous breath

b. Pressure-support breath

c. Volume-control breath

d. Pressure-control breath

54. The ventilator mode that delivers pressure breaths that are patient- or time-triggered, volume targeted, time cycled, and where the pressure is automatically adjusted to maintain delivery of the targeted volume is which of the following?

a. Volume Support Ventilation (VSV

b. Pressure Augmentation (Paug)

c. MMV

d. Pressure Regulated Volume Control (PRVC)