A patient is being mechanically ventilated at an FiO2 of 100%. As a precautionary measure, you would monitor and limit its use to ___________ as lung damage can occur with prolonged exposure.
- 6-12 hours
- 12-24 hours
- 24-48 hours
- 48-72 hours
For adult patients during HFOV, the power is initially set at _____ and rapidly increased to achieve chest wiggle. Chest wiggle is defined as visible vibration from __________________.
- 4; shoulder to belly area
- 4; shoulder to mid-thigh area
- 6; shoulder to belly area
- 6; shoulder to mid-thigh area
While monitoring the ventilator, you notice that the pressure gauge goes from 0 cm H2O and then goes up and stays at 8 cm H2O throughout the expiratory phase. Since PEEP is not in use, this observation is called:
- air leak
An intubated patient is being treated with a broad-spectrum antibiotic. The physician would like to do a C&S sputum test. Since the patient’s cough is not strong enough to expectorate the retained secretions, you would collect the sputum sample in a _________________.
- laryngeal mask airway
- esophageal obturator
- suction catheter
- Lukens trap
Alveolar hyperventilation is usually accompanied by a PaCO2 reading of _____________
and this may be managed by ________________ the mechanical VT or RR.
- > 45 mm Hg; increasing
- > 45 mm Hg; decreasing
- < 35 mm Hg; increasing
- < 35 mm Hg; decreasing
Upon entering Mr. Pendleton’s room you notice that the high pressure alarm has been triggered since your last visit. It is no longer alarming. You should consider which of the following as the most likely cause?
- Mucus plug
You are reviewing the chart of a patient who has been admitted to the ICU for severe malnutrition and dehydration. Which of the following urine output measurements may be used to determine if the patient has a fluid deficit?
- Urinary output below 20 mL/hour
- Urinary output
- Urinary output
- All of the above
A patient is being mechanically ventilated. Among other settings, PEEP-10 cm H2O and FiO2-70% are used. After determining the patient has met the weaning criteria, you would begin the weaning process by decreasing the:
- FiO2 gradually to 40%
- FiO2 gradually while simultaneously increasing the PEEP
- PEEP gradually to 3 cm H2O
- PEEP gradually while simultaneously increasing the FiO2
A medical resident asks you to explain the difference between CPAP and PEEP. You would describe that CPAP provides an end-expiratory pressure to patients who are:
- on pressure control mode
- breathing spontaneously with mechanical breaths
- on SIMV mode
- breathing spontaneously without mechanical breaths
Airway resistance imposed by the ventilator circuit and ETT can be minimized or overcome during spontaneous breathing by:
- adding deadspace
- increasing inspiratory flow
- using PSV
- All of the above
Among the conditions below, auto-PEEP is most likely caused by _______________ while on the ventilator.
- air trapping
- excessive inspiratory flow
- insufficient tidal volume
- low frequency
Mrs. McFarland, a patient with a history of COPD, has been admitted for elective surgery. Her preoperative ABGs on room air would most likely show:
- pH = 7.16, PaCO2 = 34 mm Hg, PaO2 = 64 mm Hg
- pH = 7.45, PaCO2 = 44 mm Hg, PaO2 = 65 mm Hg
- pH = 7.37, PaCO2 = 54 mm Hg, PaO2 = 60 mm Hg
- pH = 7.48, PaCO2 = 54 mm Hg, PaO2 = 58 mm Hg
The initial frequency during HFOV is set at _______ Hz and may be ___________ if using amplitude alone fails to control the PaCO2.
- 5-6; decreased
- 5-6; increased
- 10-15; decreased
- 10-15; increased
Inverse ratio ventilation (IRV) is accomplished mainly by:
- decreasing the VT
- increasing the inspiratory flow rate
- extending the inspiratory time
- decreasing the PIP
In HFOV, the mean airway pressure (mPaw) is affected by the ___________ and the initial mPaw should start at __________ the mPaw obtained during conventional mechanical ventilation.
- power setting; 5 cm H2O
- power setting; 15 cm H2O
- frequency; 5 cm H2O
- frequency; 15 cm H2O
The physician asks you to assess a patient for excessive extracellular fluid. Among other signs, you would evaluate all of the following conditions except:
- bounding pulse
- increased cardiac output
- pulmonary edema
Permissive hypercapnia is a strategy in which the ________ value is allowed to go beyond its normal limit and it is used to ____________________:
- PaO2; reduce intracranial pressure in patients with head injuries
- PaO2; reduce O2 toxicity
- PaCO2; minimize ventilator-related lung injuries
- PaCO2; compensate for metabolic alkalosis
Mr. Jones, a patient who has been mechanically ventilated for 3 weeks, is now on a high calorie diet. Which of the following can be a potential problem associated with overfeeding during mechanical ventilation?
- Decreased O2 consumption
- Decreased work of breathing
- Increased CO2 production
- Increased fixed acid
In HFOV, the power setting controls the amplitude of oscillation and thus the:
- oxygenation level
- tidal volume
- A and B only
Dr. Kao asks you to estimate a patient’s resting energy expenditure (REE) using the Harris Benedict equation. You would gather the following set of information:
- age, height, & weight
- height & weight
- sex, height, & weight
- sex, age, height, & weight
The incidence of VAP may be reduced by employing all of the following procedures except:
- proper handwashing
- more frequent ventilator circuit change
- early microbiological exam and use of appropriate antibiotherapy
- closed suction system
When an MDI is administered inline to a mechanically ventilated patient with a HME,
- MDI may not be used inline with a ventilator circuit
- the MDI must be placed between the patient and the HME
- the MDI must be placed between the ventilator and the HME
- the HME must be removed
The degree of ventilation is best assessed by measuring the patient’s:
In high frequency oscillatory ventilation (HFOV), hypoventilation may be managed by ___________ the amplitude or by ____________ frequency.
- increasing; increasing
- increasing; decreasing
- decreasing; increasing
- decreasing; decreasing
In patients with normal cardiopulmonary status, increasing the ________ is the treatment of choice in improving the patient’s oxygenation.
In mechanical ventilation, the most common approach to improving minute ventilation is to increase the _________________. However it should not exceed __________ as auto-PEEP may occur.
- respiratory rate; 10/min
- respiratory rate; 20/min
- tidal volume; 600 mL
- tidal volume; 800 mL
The major cation in the intracellular fluid (ICF) is:
An order has been written for initiating MV at a VT setting of 3 mL/kg. You would contact the physician and explain to her that the VT setting would be too _________ and it may lead to _______________.
- high; barotrauma
- high; alveolar hyperventilatio
- low; atelectasis
- low; bronchospasm
You are reviewing ABG results of a 30-year-old, postoperative patient who has been on assist/control (a/c) ventilation and is currently awake and breathing spontaneously. The results are as follows: pH = 7.53, PaCO2 = 30 mm Hg, PaO2 = 102 mm Hg, HCO3 = 24 mEq/L, a/c rate = 12/min, total rate = 18/min, tidal volume = 800 ml, FiO2 = 30%. Based on the information provided, you would make which of the following changes to the ventilator setting?
- Change to SIMV mode
- Decrease a/c rate to 10/min
- Decrease FiO2 to 25%
- Increase the tidal volume to 850 ml
In humans, water makes up approximately _______ of the total body weight.
Mr. Johns is being mechanically ventilated with these settings: Mode = SIMV, rate = 12/min, tidal volume = 600 mL, FiO2 = 50%, PEEP = 0 cm H2O. Auto-PEEP of 6 cm H2O is observed consistently. You would change the:
- frequency to 14/min
- mode to assist control
- PEEP to 5 cm H2O
- tidal volume to 700 mL
Upon entering the ICU, you are alerted by a series of low pressure alarms from the ventilator. You would check the patient and ventilator for all of the following conditions except:
- circuit disconnection
- airway obstruction
- ETT cuff leak
- loose humidifier connection
Auto-PEEP may be reduced or eliminated by all of the following methods except:
- increasing the expiratory time
- reducing the VT
- reducing the frequency
- reducing the inspiratory flow
The ABG report of Mr. Orin, a patient on mechanical ventilation, is as follows: pH = 7.50, PaCO2 = 32 mm Hg, PaO2 = 83 mm Hg. The physician asks you to make appropriate changes to the settings on the ventilator. Which of the following controls would have the leastimpact in correcting the patient’s condition as indicated by the ABG results?
- PS level
The total rate of a mechanically ventilated patient is 10/min. At this rate, the ABG reveals a PaCO2 of 60 mm Hg. Assuming the VT and deadspace reamin constant, calculate the RR necessary to achieve a PaCO2 of 40 mm Hg.
All of the following statements are true regarding mechanical tidal volume except:
- increasing the tidal volume is the most common approach to improving minute ventilation.
- tidal volume should be set according to the patient’s ideal body weight.
- increasing the tidal volume should be considered when the patient’s ventilatory rate exceeds an ideal breathing pattern.
- insufficient tidal volume increases the risk of atelectasis and hypercapnia.
The most common trigger for apnea alrams is:
- loose humidifier fittin
- cuff leak
The following electrolytes are collected from a patient with severe sepsis who has been on a mechanical ventilator for two weeks. Which of the following electrolytes is out of its normal range?
- Sodium = 138 mEq/L
- Potassium = 1.5 mEq/L
- Chloride = 105 mEq/L
- Bicarbonate = 25 mEq/L
The degree of ventilation may be increased by increasing all of the following ventilator parameters except:
The major cation in the extracellular fluid compartment is __________ and it plays an important role in ____________ balance.
- sodium; fluid
- potassium; fluid
- calcium; acid-base
- magnesium; acid-base
Low VT strategy is done to reduce the risk of ______________ and the tagret volume is reached when _________________.
- atelectasis; PIP is
- atelectasis; plateau pressure is
- barotraumas; PIP is
- barotraumas; plateau pressure is
The PaCO2 of Ms. Hart, a 40-year-old mechanically ventilated dependent patient with normal cardiopulmonary status, is 60 mm Hg. This value indicates _____________ and should be managed by ______________ the mechanical VT or RR.
- hyperventilation; increasing
- hyperventilation; decreasing
- hypoventilation; increasing
- hypoventilation; decreasing