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1. Which one of the following is a common problem encountered when using adult nasal CPAP to treat sleep apnea?
A. inadequate volume delivery
B. double vision (diplopia)
C. inflammation of the sinuses
D. decreased apnea-hypopnea index
2. A doctor orders A/C pressure control for a 50 kg postoperative female patient. Which of the following settings would you choose for this patient?
A. pressure limit/PIP = 30 cm H2O; rate = 12/min; inspiratory time = 2 seconds
B. pressure limit/PIP = 40 cm H2O; rate = 20/min; inspiratory time = 1 second
C. pressure limit/PIP = 25 cm H2O; rate = 15/min; inspiratory time = 1 second
D. pressure limit/PIP = 30 cm H2O; rate = 30/min; inspiratory time = 1 second
3. On a patient receiving volume control AC ventilation, you observe the following flow-volume loop. Which of the following actions would you consider most appropriate?
a. recommend administering a bronchodilator
b. assess the patient’s need for suctioning
c. measure the endotracheal tube cuff pressure
d. switch to pressure control ventilation
4. An 80 kg (176 lb) male patient with a history of chronic CO2 retention is admitted in respiratory failure. You begin volume control ventilation with a tidal volume of 700 mL and a mandatory rate of 12/min. After 20 minutes, an ABG indicates a PaCO2 of 35 mm Hg. The doctor requests that you raise the patient’s PaCO2 to 50 mm Hg. Which of the following new settings would you select to achieve this goal?
Rate/min VT (mL)
A. 10 700
B. 10 600
C. 14 500
D. 16 700
5. In establishing initial ventilatory support settings, the most important consideration is the:
A. patient’s size and clinical condition
B. type of ventilatory support device used
C. quality and amount of nursing supervision
D. amount of spontaneous ventilatory effort
6. Disadvantages of noninvasive ventilation include which one of the following?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP
7. Which of the following patients is the best candidate for high-frequency oscillation ventilation (HFOV)?
A. an adult with refractory hypoxemia
B. a child with severe hypercapnia
C. an adult with status asthmaticus
D. a neonate with refractory hypoxemia
8. To prevent hypoxemia during suctioning an intubated patient receiving invasive ventilatory support, you should do which of the following?
A. silence the pressure alarm prior to suctioning
B. set the vacuum pressure to 100–120 mm Hg
C. provide 100% O2 for 30-60 sec before suctioning
D. maintain the FIO2 and raise PEEP before suctioning
9. In addition to overcoming hypoxemia, oxygen therapy can have which of the following additional benefits?
A. preventing atelectasis
B. decreasing the work of breathing
C. increasing the rate of breathing
D. protecting cells from damage
10. You are getting ready to suction an orally intubated patient receiving SIMV. To prevent hypoxemia during suctioning you should do which of the following?
A. silence all alarms prior to suctioning
B. set vacuum pressure to 100-120 mm Hg before procedure
C. administer 100% O2 for 30-60 seconds before suctioning
D. maintain the set FIO2 and increase PEEP prior to suctioning
11. A patient with a smaller than normal trach tube is placed on volume control SIMV at a rate of 8/min. Over the last hour, you note the patient increasing use of her accessory muscles during spontaneous breaths, accompanied by some abdominal paradox. Which of the following would be the best way to overcome this problem?
A. decrease the SIMV rate to 5/minute
B. switch to pressure control SIMV
C. add or increase pressure support
D. switch to a sine wave flow pattern
12. A ventilator is set at a rate of 15/min and an l:E ratio of 1:3. The length of inspiration is:
A. 1.0 sec
B. 1.5 sec
C. 2.0 sec
D. 2.5 sec
13. A doctor orders a changeover to CPAP for a patient receiving bi-level positive airway pressure (BiPAP) via a device with separate IPAP and EPAP controls. To effect this change you would:
A. set IPAP less than EPAP
B. set IPAP greater than EPAP
C. set EPAP = 0 cm H2O
D. set IPAP equal to EPAP
14. When a patient is receiving positive-pressure ventilation, you should strive to keep the alveolar (plateau) airway pressure below:
A. 20 cm H2O
B. 30 cm H2O
C. 40 cm H2O
D. 50 cm H2O
15. You set up a 47 year old post cardiac surgery patient on volume control A/C ventilation at a base rate of 12/min. After the patient is stabilized, you note the following on the ventilator’s graphic display. Which of the following changes would you make?
A. switch to SIMV at 6-8 breaths/min
B. increase the base rate to 15/minute
C. increase the inspiratory flow
D. switch to pressure control ventilation
16. In the volume control assist/control (VC, A/C) mode of ventilatory support, adjustment of the inspiratory flow allows you to manipulate which of the following parameters of ventilation?
17. Which of the following is an advantage of intermittent mandatory ventilation (SIMV) over assist/control ventilation (A/C)?
A. SIMV prevents hyperventilation
B. SIMV increases pleural pressures
C. SIMV increases the need for sedation
D. SIMV allows graded levels of support
18. A physician orders intubation and mechanical ventilation in the volume control assist/control mode (VC,A/C) for a 190 lb adult male patient with normal lungs. Which of the following ventilatory parameters would be most appropriate for this patient?
Rate/min VT (mL)
A 12 700
B 18 1300
C 8 900
D 20 400
19. You observe the following graphics display on a patient receiving volume controlled A/C ventilation. The most significant problem is:
A. a leak in the patient-ventilator system
B. inadequate inspiratory flow setting
C. improper sensitivity setting
D. presence of auto-PEEP/air-trapping
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20. While performing a patient-ventilator check, you note the following settings and parameters:
Exhaled tidal volume 650 mL
Peak inspiratory pressure 33 cm H2O
High pressure limit 60 cm H2O
Low pressure alarm 20 cm H2O
Low tidal volume alarm 500 mL
Which of the following change would you make?
A. decrease the high pressure limit to 45-50 cm H2O
B. increase the set tidal volume to 800 mL
C. decrease the low pressure alarm to 5 cm H2O
D. increase the low tidal volume alarm to 600 mL
21. The most common problem encountered in applying assist-control mode ventilation is:
B. need for neuromuscular paralysis
D. increased work of breathing
22. While caring for a patient receiving volume-controlled ventilation you note a sudden drop in the peak inspiratory pressure. Causes of this change could include which of the following?
23. On a patient receiving volume controlled A/C ventilation, you note an increase in I:E ratio from 1:3 to 1:2. This could be do to a change in:
24. A patient is stabilized with adequate oxygenation and ventilation on volume control ventilation (VC) with the following settings: rate = 15/min, tidal volume = 550 mL, peak inspiratory pressure (PIP) = 45 cm H2O, plateau pressure = 30 H2O and PEEP = 10 cm H2O. The doctor orders a changeover to pressure control ventilation (PC). Which of the following settings would you initially use to implement PC in this patient?
A. pressure limit/PIP = 30 cm H2O; rate = 15/min; PEEP = 10 cm H2O
B. pressure limit/PIP = 45 cm H2O; rate = 12/min; PEEP = 10 cm H2O
C. pressure limit/PIP = 15 cm H2O; rate = 15/min; PEEP = 20 cm H2O
D. pressure limit/PIP = 20 cm H2O; rate = 20/min; PEEP = 10 cm H2O
25. To prevent hypoxemia when suctioning an adult patient, you should initially do which of the following?
A. preoxygenate the patient with an 50% oxygen
B. preoxygenate the patient with an 100% oxygen
C. give the patient a bronchodilator treatment
D. have the patient hyperventilate for two minutes
26. In the management of a patient with brain trauma, therapeutic hyperventilation should be used:
A. only during the initial 24 hours of management
B. prophylactically to prevent an increase in ICP
C. in urgent situations such as brain herniation
D. to help wean the patient off ventilatory support
27. If the I:E ratio alarm during volume control A/C ventilation is activated on each breath, which of the following controls may be adjusted to remedy the problem?
Volume Rate PEEP Flow
A. Yes Yes Yes No
B. Yes No Yes Yes
C. No Yes Yes Yes
D. Yes Yes No Yes
28. Which of the following are acceptable changes in patient status during a spontaneous breathing trial for weaning from mechanical ventilation?
A. heart rate rises from 103 to 118/min
B. SpO2 falls from 90% to 80%
C. scalene muscle activity increases
D. systolic BP falls from 110 to 75 mm Hg
29. The addition of pressure support to spontaneous breaths during SIMV would be of benefit to patients with:
30. In order to improve gas distribution, a physician requests that the inspiratory flow be lowered on a patient receiving volume control A/C ventilation (VC, A/C). What consequences might this action have?
31. Which of the following is an indication for positive-end expiratory pressure (PEEP)?
A. to provide graded levels of ventilatory support
B. to decrease physiologic deadspace
C. to decrease hypoxemia due to shunting
D. to increase the efficiency of ventilation
32. A postoperative 75-kg (168-lb) patient is receiving mechanical ventilation with the following settings. What should you do to correct the patient’s blood gas values?
A. increase the peak flow
B. administer bicarbonate
C. decrease the FIO2 to 0.35
D. decrease the VT
33. A patient is being ventilated in the volume-control mode when suddenly the high pressure alarm begins to sound. The most likely corrective action would be to:
A. increase the pressure limit
B. deflate the endotracheal tube cuff
C. increase the flow
D. suction the airway
34. A physician orders oxygen via nasal cannula at 4 L/min for an otherwise healthy post-operative patient who has a SpO2 of 80% on room air. After 30 minutes on the nasal O2, the patient’s SpO2 is 87%. What action would be appropriate at this time?
A. increase the oxygen liter flow and reassess the patient
B. intubate the patient and institute mechanical ventilation
C. decrease the oxygen liter flow and reassess the patient
D. institute continuous positive airway pressure by mask
35. Which of the following procedures would be most helpful in preventing atelectasis in a cooperative postoperative patient?
A. albuterol (Proventil) via SVN four times daily
B. inspiratory resistance exercises three times daily
C. incentive spirometry maneuver 10x per hour
D. pursed-lip breathing as needed (PRN)
36. Which of the following is the appropriate load to establish for patients receiving inspiratory muscle training?
A. at least 33% of the predicted inspiratory capacity (IC)
B. at least 10–15 ml/kg of predicted body weight (PBW)
C. at least 30% of the maximum inspiratory pressure (MIP/NIF)
D. at least –25 cm H2O, as measured by a calibrated manometer
37. You are asked to assess a 16-year-old patient with a severe head cold on 4 L/min of oxygen via nasal cannula. The patient is alert and awake and is complaining that he can’t breathe through his nose. His pulse oximeter reads 84% saturation. What action should you take?
A. decrease the O2 flow until the patient is more comfortable
B. increase the O2 flow until the SpO2 equals or exceeds 90%
C. change to a simple mask at 5–7 L/min
D. recommend an arterial blood gas before considering any changes
38. Data for a 50 kg. (110 lb.) COPD patient on ventilatory support are:
Mode Vol Crtl SIMV
VT 400 mL
PaCO2 60 torr
HCO3 35 mEq/L
PaO2 60 torr
PEEP 5 cm H2O
Which of the following changes would you make?
A. increase the SIMV rate
B. increase the FIO2
C. increase the VT
D. maintain settings
39. Which of the following categories of patients are good candidates for negative pressure ventilation?
A. patients with acute obstructive disorders of the upper airway
B. patients suffering acute exacerbations of chronic lung disease
C. patients with end-stage chronic obstructive pulmonary disease
D. patients with chronic neuromuscular disorders and normal airways
40. You are assessing an intubated patient receiving oxygen by T-piece via an air-entrainment nebulizer set at 0.40 with an input flow of 8 L/min O2.You observe no mist at the T-tube during inspiration. Which of the following actions is appropriate?
A. suction the patient via the endotracheal tube
B. change the nebulizer entrainment setting to 50%
C. increase the oxygen input flow to 12 L/min
D. drain the water from the aerosol delivery tubing
41. A doctor has ordered an FIO2 of 0.40 to be delivered to a patient who is breathing spontaneously and has a peak inspiratory flow of 42 L/min. Which of the following would best meet this objective?
A. standard nasal cannula set at 8 L/min
B. air-entrainment nebulizer/aerosol mask at 40% and 8 L/min
C. simple O2 mask at 10 L/min with the blender set at 40%
D. 40% air-entrainment mask set at 12 L/min
42. A physician orders intubation and mechanical ventilation in the SIMV volume control mode for a 140 lb adult male patient with a history of COPD. Which of the following parameters would be best for this patient?
Rate/min VT (mL)
A 8 500
B 10 1400
C 16 900
D 12 1100
43. Which of the following factors determine the tidal volume delivered during pressure support ventilation (PSV)?
A. Yes Yes No
B. Yes No Yes
C. No Yes Yes
D. Yes Yes Yes
44. You are trying to wean an alert intubated patient off full ventilatory support using an “on ventilator” CPAP protocol with 40% O2. Early in the initial effort his respiratory rate increases from 24 to 30/min and you start to observe some use of his accessory muscles of respiration. Which of the following would be your first action?
A. restore the patient to full ventilatory support
B. apply 5-10 cm H2O pressure support
C. increase the FIO2 to 0.50
D. extubate the patient and re-evaluate
45. When monitoring a patient during a spontaneous breathing trial (SBT), which of the following observations would cause you to stop the trial and return the patient to ventilatory support?
A. decrease in O2 saturation from 91% to 82%
B. increase in respiratory rate from 18 to 28/min
C. increase in arterial PCO2 from 45 to 53 torr
D. increase in heart rate from 98/min to 115/min
46. Which of the following ventilator graphics displays would be the best choice to assess the work of breathing associated with patient triggering?
A. volume vs. time display
B. flow vs. volume display
C. flow vs. time display
D. pressure vs. volume display
47. To initiate weaning, a patient was changed from volume control A/C ventilation to pressure support. After 30 minutes on pressure support, the high respiratory rate alarm sounds, with the patient breathing at a rate of 25 to 30 per minute. What change should you make to the ventilator settings?
A. increase the pressure support level
B. increase the high pressure alarm to 50 cm H2O
C. increase the high rate alarm to 30–35
D. switch the patient back to volume control A/C
48. An adult patient receiving ventilatory support via high frequency jet ventilation (HFJV) has a PaO2 of 52 mm Hg with an FIO2 of 0.40. Which of the following control setting changes could be used to improve this patient’s oxygenation?
A. No Yes Yes
B. Yes Yes No
C. Yes No Yes
D. Yes Yes Yes
49. A ventilator operating in the volume controlled A/C mode incorporates an inspiratory time limit control as a safety backup to its normal cycling. If the time needed to deliver the volume increases to the preset limit:
A. additional time will be provided to complete inspiration
B. volume will decrease to make up for the extra inspiratory time
C. the ventilator will automatically cycle to end inspiration
D. the ventilator will alarm and go into the inoperative mode
50. Which of the following is true regarding synchronous intermittent mandatory ventilation (SIMV)?
A. machine breaths cannot be pressure controlled
B. asynchrony is prevented during machine breaths
C. only partial ventilatory support can be provided
D. patient normally contributes to minute ventilation
51. A motorcycle accident victim keeps removing a 28% Venturi mask, complaining that the device causes his beard to itch and is ‘noisy.’ His SpO2 is 92%. What action should you take?
A. change to a 24% Venturi mask
B. change to a simple mask at 2 L/min
C. change to a nasal cannula at 2 L/min
D. change to a nasal cannula at 4 L/min
52. At the bedside of a patient receiving volume control ventilation, you suddenly observe the simultaneous sounding of the high pressure and low volume alarms. Which of following is the most likely cause of this problem?
A. a leak in the ET tube cuff
B. a mucous plug in the ET tube
C. ventilator circuit disconnection
D. development of pulmonary edema
53. Which of the following adult patients receiving ventilatory support is the best candidate for weaning?
54. A doctor requests that you begin noninvasive positive pressure ventilation (NPPV) on a COPD patient in hypercapnic respiratory failure. Which of the following setting would you choose
A. IPAP 20 cm H2O; EPAP 5 cm H2O; assist-control mode
B. IPAP 30 cm H2O; EPAP 5 cm H2O; assist (spontaneous only) mode
C. IPAP 20 cm H2O; EPAP 0 cm H2O; assist-control mode
D. IPAP 10 cm H2O; EPAP 10 cm H2O; assist (spontaneous only) mode
55. An asthmatic patient is struggling to initiate inspiration on an ICU ventilator operating in the assist-control mode. Which of the following ventilator settings would you first check to determine the cause of this problem?
A. the pressure limit
B. the sensitivity
C. the tidal volume
D. the PEEP control
56. Which of the following parameters would you set to establish the minute volume for a patient being ventilated in the volume control assist/control mode (VC, A/C)?
A. No Yes Yes No
B. Yes Yes No Yes
C. Yes Yes Yes Yes
D. Yes No Yes Yes
57. Even after extensive adjustments and coaching, a patient receiving noninvasive positive pressure ventilation (NPPV) via a nasal mask has excessive mouth leakage. Which of the following would you initially try to resolve this problem?
A. oronasal mask
B. nasal pillows
C. chin strap
D. lip seal
58. Venous return is LEAST impaired by which of the following modes of mechanical ventilation?
A. A/C with a mandatory rate of 10/min, 5 cm H2O PEEP
B. SIMV with a mandatory rate of 6/min, no PEEP
C. SIMV with a mandatory rate of 12/min, 5 cm H2O PEEP
D. A/C with a mandatory rate of 15/min, no PEEP
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