Ch. 18-19

60問 • 1年前

問題一覧

When an alarm is activated on a ventilator, the respiratory therapist’s first priority is to ____.

ensure adequate ventilation and oxygenation.

Removing a patient from a ventilator to ventilate manually can lead to which of the following? 1. Barotrauma 2. Lung derecruitment 3. Increased airway resistance 4. Ventilator-acquired pneumonia

1, 2, 4

A 68-year-old woman was admitted to the ICU with pneumonia and was intubated when she developed progressive hypoxemia. She has been on the ventilator for 5 days and has been tolerating this therapy well. The patient has suddenly become severely agitated and appears to be fighting the ventilator. The ventilator’s high pressure alarm is sounding continuously. The respiratory therapist disconnects the patient from the ventilator and begins manual ventilation with 100% oxygen and PEEP. The resuscitator bag is difficult to squeeze, breath sounds are present on the left with no adventitious sounds and absent on the right side, and percussion reveals hyperresonance over the right side. The most appropriate action to address this situation is which of the following?

Insert a 14-gauge needle in the second intercostal space, midclavicular line, right side.

The respiratory therapist is called to the bedside of a patient mechanically ventilated in the VC-CMV mode because the low pressure, low exhaled tidal volume, and low exhaled minute volume alarms all have activated. This situation could be caused by which of the following?

Rupture of the endotracheal tube cuff.

The initial step in the management of patient-ventilator asynchrony is which of the following?

Ventilate the patient with a manual resuscitator bag.

At 1030 the respiratory therapist is called to the bedside of a patient being mechanically ventilated with VC-IMV. The patient is a 55 kg female who has been intubated with a size 8 endotracheal tube. Currently, the ET tube is located 20 cm at the gum line. During spontaneous breathing, the patient shows lack of coordinated chest wall movement, and the respiratory therapist notes some retraction of the intercostal spaces. The respiratory therapist performs a system check. The current and past few patient-ventilator system checks reveal the following information: The most appropriate action to take in this situation is which of the following?

Administer albuterol via an in-line metered-dose inhaler.

A patient with a past medical history of COPD was placed on a ventilator after upper abdominal surgery for a serious wound infection. Although the patient was medically stable, a tracheostomy was performed 2 weeks later because the patient was unable to be weaned from the ventilator. The patient is on VC-CMV, rate = 12, VT = 700 mL, FIO2 = 40%, PEEP = 5 cm H2O, with an HME. The respiratory therapist notes that the patient is assisting at a rate of 18 and has bilaterally decreased breath sounds in the bases. The respiratory therapist suctions a moderate amount of very thick, tenacious yellow sputum from the tracheostomy tube. What action should the respiratory therapist take?

The HME should be replaced with an active heated humidifier system.

An intubated patient is receiving mechanical ventilation with the following settings: VC- CMV, rate = 18, VT = 850 mL (10 mL/kg), PEEP = 5 cm H2O, flow rate = 40 L/min. The patient is sedated and is not assisting the ventilator. During a patient-ventilator system check, the respiratory therapist observes the following ventilator graphic: The respiratory therapist should do which of the following?

Decrease the rate.

Reduction of preload and afterload is important in the management of which of the following?

Cardiogenic pulmonary edema

An increased arterial-to-end-tidal partial pressure CO2 gradient can help identify which of the following?

Pulmonary embolism

The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the low pressure, low exhaled volume, and low VE alarms active. The ventilator circuit is connected to the patient’s endotracheal tube. This situation could be caused by which of the following?

Migration of the ET tube into the upper airway.

A patient is intubated and set up on VC-CMV. Afterstabilization and suctioning of the ET tube, the peak inspiratory pressure (PIP) is 25 cm H2O. The low pressure and high pressure alarms should be set at ____ cm H2O and _____ cm H2O, respectively.

15, 35

The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the high pressure, low exhaled volume, and low VE alarms active. This situation could be caused by which of the following?

The patient is out of synchrony with the ventilator.

The respiratory therapist is assessing a mechanically ventilated patient for whom the high pressure alarm is active and the flow-volume loop shows the following: The action that could alleviate this problem is which of the following?

Administer a fast-acting bronchodilator and suction the ET tube.

An apnea alarm may be activated by which of the following?

Auto PEEP

The graphics below indicate which of the following conditions?

Inadequate flow setting

The following two graphic loops show which of the following conditions?

Leak in the patient-ventilator circuit

The flow-volume loop below is representative of which of the following conditions?

Intrinsic PEEP

The flow-time curve shows small oscillations after the peak flow rate has been reached. The respiratory therapist can alleviate this by making which of the following ventilator adjustments?

Increase the inspiratory rise time.

The graphic below for a patient receiving mechanical ventilation shows which of the following conditions?

Active exhalation

Use of an externally powered, small-volume nebulizer for aerosol delivery during partial ventilatory support with PSV may cause which of the following? 1. High VT alarm activation 2. Triggering difficulties 3. Low pressure alarm activation 4. Ventilator inoperative alarm

1 and 2

During ventilation with VC-CMV, pleural drainage leaks sometimes can be compensated for by increasing which of the following?

The set tidal volume

A mechanically ventilated patient with COPD is receiving partial ventilatory support with PSV. The respiratory therapist notes a sudden rise at the end of each breath on the pressure- time graphic. What action should the respiratory therapist take at this time?

Lower the flow cycle setting.

The respiratory therapist is performing a patient-ventilator system check on a patient who was in a motor vehicle accident 2 days earlier. The therapist gathers the following information from the flow sheet: Which condition most likely has produced the changes reflected in these data?

Abdominal distention

Negative pressure ventilators cause air to enter the lungs by increasing ______ pressure.

transpulmonary

A patient with acute cardiogenic pulmonary edema (ACPE), as evidenced by pink, frothy secretions, arrives in the emergency department (ED) by ambulance with a nonrebreather mask (NRM) at 15 L/min. An arterial blood gas sample is drawn in the ED while the patient is on the NRM; the values are: pH = 7.50, PaCO2 = 28 mmHg; PaO2 = 43mm Hg; SaO2=84%, HCO3 = 24 mEq/L. After evaluating the situation, the respiratory therapist should suggest which of the following therapies?

Mask CPAP with supplemental oxygen

A patient has acute pulmonary edema from left-sided heart failure and acute hypoxemic respiratory failure that has not responded to conventional pharmacologic and oxygen therapy. As the next line of therapy, the respiratory therapist should recommend which of the following?

Continuous positive airway pressure

One of the physiological goals of NPPV in acute respiratory failure is to improve gas exchange by _______ .

resting the respiratory muscles

The primary goal of NPPV in the acute care setting is to do which of the following?

Avoid invasive ventilation

Patients with chronic hypoventilation disorders need a minimum of _____ hours of NPPV to experience improved quality of life.

4 to 6

NPPV is considered the standard of care for the treatment of which of the following?

COPD exacerbation

A 75-year-old man with a long history of COPD is brought to the emergency department with shortness of breath. He has a persistent, productive cough with green purulent sputum, cyanosis of the lips and extremities, and is uncooperative. His arterial blood gas values on 2 L/min by nasal cannula are: pH = 7.25; PaCO2 = 90 mm Hg; PaO2 = 38 mm Hg; SaO2 = 59%; HCO - = 38 mEq/L. The most appropriate action at this time is which of the following?

Invasive mechanical ventilation

A 61-year-old female was admitted last night with shortness of breath. She currently is alert and oriented, but very anxious. Her latest arterial blood gas values, on a nasal cannula at 3L/min,show:pH=7.39;PaCO2=41mmHg;PaO2=40mmHg;SaO2=74%;HCO- =24 3 mEq/L. Breath sounds are decreased throughout with fine late crackles on inspiration. The current chest x-ray shows an enlarged heart with bilateral vascular congestion. The most appropriate therapy for this patient is _____.

mask CPAP

A patient with acute cardiogenic pulmonary edema is to be placed on CPAP. What should the initial setting be?

10 to 12 cm H2O

A 62-year-old male patient with COPD is being seen in the pulmonary clinic for dyspnea at rest and daytime hypersomnolence. The patient has been hospitalized three times in the past year for COPD exacerbations and once for pneumonia. He currently uses 2 L/min oxygen from a concentrator all the time. The patient reports that he is able to sleep only about 2 hours each night and that he has a headache every morning. Which of the following should be recommended to the physician?

Nocturnal NPPV

A patient who was diagnosed 1 year ago with amyotrophic lateral sclerosis is being seen in his primary care physician’s office. The patient is complaining of fatigue and inability to concentrate at work. The patient’s FVC is 45% of predicted, the PaCO2 is 47 mm Hg, and the MIP is 54 cm H2O. Which of the following should be considered for this patient?

Nocturnal NPPV

To use CPAP successfully, a patient must have which of the following?

Adequate spontaneous ventilation

The variable that ends pressure support breaths from a PTV system is ______.

flow

A patient in the subacute care unit is receiving NPPV with a PTV system, with an IPAP of 10 cm H2O and an EPAP of 2 cm H2O. The patient’s latest arterial blood gas values reveal an increase in the PaCO2. The most appropriate action to take is which of the following?

Increase the EPAP and IPAP.

A home care patient using NPPV complains that when she puts on the NPPV mask at night and turns on the machine, “at first the gas feels like it is punching [her] in the face.” The patient is noncompliant with the NPPV because of this. What action should the respiratory therapist take?

Set the ramp and delay time.

If oxygen is bled into each of the following portable PTVs at the same rate, which of the following combinations will provide the highest oxygen concentration?

Leak port in circuit, oxygen bleed at mask, IPAP 5 cm H2O, EPAP 10 cm H2O

The leading cause of patient discomfort and noncompliance with NPPV is which of the following?

Drying of nasal mucosa

A patient with acute respiratory failure requires NPPV. The patient is very dyspneic. Which of the following patient interfaces is most appropriate?

Oronasal mask

Overtightening of the headgear straps for a nasal mask may lead to which of the following?

Facial skin irritation

Which of the following NPPV settings produces the greatest tidal volume, with all other variables being equal (i.e., airway resistance and lung compliance)?

IPAP = 18 cm H2O; EPAP = 4 cm H2O

A 75-year-old, 5-foot, 7-inch female patient with an exacerbation of COPD is placed on the following NPPV settings: IPAP = 8 cm H2O, EPAP = 4 cm H2O, rate = 12 breaths/min, FIO2 = 0.3. The resulting VT is 255 mL. An arterial blood gas sample is drawn 1 hour later, and the results are: pH = 7.33, PaCO2 = 70 mm Hg, PaO2 = 58 mm Hg, HCO -3= 35 mEq/L. What action should the respiratory therapist take at this time?

Increase the IPAP to 10 cm H2O.

A 68-year-old, 5-foot, 10-inch male patient with acute-on-chronic respiratory failure due to COPD has been placed on NPPV with these settings: IPAP = 8 cm H2O, EPAP = 4 cm H2O, FIO2 = 0.28. The patient’s measured exhaled volume is 350 mL with a spontaneous respiratory rate of 24 breaths/min. The resulting arterial blood gas values are: pH = 7.27, PaCO2 = 77 mm Hg, PaO2 = 64 mm Hg, SaO2 = 88%, HCO - 3= 36 mEq/L. What action should the respiratory therapist take at this time?

Increase the IPAP to 12 cm H2O.

A patient with central sleep apnea uses a nasal mask with NPPV at night. The patient complains of nasal congestion. What action should the respiratory therapist take?

Add a heated humidifier.

Which of the following is the most efficient means of delivering a medicated aerosol during NPPV?

MDI placed in the circuit with the leak port in the mask

What would cause the low pressure, low exhaled tidal volume, and low exhaled minute volume alarms to sound?

blown cuff

Which of the following can set off the apnea alarm?

auto peep

A vented patient had a high HR and RR, with absent BS on right. The high pressure alarm is sounding. What is the cause?

pneumothorax

What can happen if the RT is running a SVN from a room flow meter when the patient is on PSV?

patient may have trouble triggering breaths, high VT, alarm may sound

Which of the following is the essential goal of NIV in ICU?

preventing intubation

Which type of patient should not have a NIV trial?

ARDS who are unstable

The RT notices that there has been a drop in the exhaled Vt of a patient on NIV. The most appropriate action to take is?

adjust the mask

Which of the following are symptoms of chronic hypoventilation?

tiredness, headache in the morning

When on bi-level ventilation, what determines the tidal volume?

difference between the inspiratory and expiratory positive airway pressures

NiV has just been initiated on a patient in respiratory distress with an inspiratory positive airway pressure (IPAP) of 12 cm H2O and an end-expiratory positive airway pressure (EPAP) of 5 cm H2O. Which of the following would indicate clinical improvement of the patient's condition? 1. Decreased respiratory rate 2. Synchronization with the ventilator 3. Decreased inspiratory muscle activity 4. Decreased arterial oxygen saturation (Sa02)

1, 2, 3

A patient who was diagnosed 1 year ago with amyotrophic lateral sclerosis is being seen in his primary care physician's office. The patient is complaining of fatigue and inability to concentrate at work. The patient's FVC is 45% of predicted, the PaCO2 is 47 mm Hg, and the MIP is 54 cm H2O. Which of the following should be considered for this patient?

Nocturnal NIV

ch. 2

Darya Rose · 83問 · 2年前

ch. 2