Ch. 7-8

70問 • 1年前

問題一覧

What fractional inspired oxygen (FIO2) setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (PaO2) of 53 mm Hg while receiving 50% oxygen and the desired PaO2 is 90 mm Hg?

85%

A patient’s baseline arterial blood gas (ABG) reveals a partial pressure of oxygen (PaO2) of 78 mm Hg while receiving 35% supplemental oxygen. What should the ventilator fractional inspired oxygen (FIO2) be set at to obtain a target PaO2 of 95mm Hg?

43%

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (PaO2) of 45 mm Hg. The patient is being intubated and the ventilator set up. What is the appropriate fractional inspired oxygen (FIO2) to achieve a PaO2 of 60 mm Hg?

0.8

The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges?

60 and 100 mm Hg

Following successful cardiac resuscitation, a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (FIO2) settings?

What is the range for setting flow triggering?

1 to 10 L/min

A patient is intubated due to an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The patient is now breathing with pressure support ventilation 5 cm H2O and continuous positive airway pressure (CPAP) 5 cm H2O. The patient is unable to flow trigger every inspiration. Unintended positive-end-expiratory pressure (auto-PEEP) is measured at 10 cm H2O. The most appropriate action is to take is which of the following?

Increase the CPAP to 8 cm H2O.

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H2O of unintended positive-end-expiratory pressure (auto-PEEP) and a pressure trigger setting of 2 cm H2O?

10 cm H2O

A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity?

30 mg H2O/L at 31° C to 35° C

Calculate the humidity deficit when a heat moisture exchanger (HME) provided 14 mg/L of water to the set tidal volume.

30 mg/L of water

In which situation should the heat moisture exchanger (HME) be replaced with a heated humidification system?

Thick secretions not cleared by suctioning

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV), a patient’s average peak inspiratory pressure (PIP) is 26 cm H2O following suctioning. The appropriate settings for the low and high pressure alarms are which of the following?

Low pressure = 20 cm H2O, high pressure = 36 cm H2O

A patient is being ventilated with pressure controlled-synchronized intermittent mandatory ventilation (PC-SIMV) of 12 breaths/minute. The apnea alarm time setting should be which of the following?

10 seconds

The ventilator volume is set at 575 mL. The low exhaled tidal volume (VT) alarm should be set at which of the following?

500 mL

A patient set up on pressure support ventilation (PSV) has an average minute volume of 5.8 L. What should the low exhaled minute volume alarm be set at?

5 L

The mechanical ventilator event that is considered potentially life-threatening or a level 2 event is which of the following?

Humidifier malfunction

The respiratory therapist in the intensive care unit (ICU) responds to a patient’s room because the ventilator is alarming. The most appropriate immediate action is which of the following?

Ensure the patient is being ventilated.

Identify the patient that could benefit from sigh breaths.

70 kg ideal body weight (IBW) patient on 400 mL with Pplateau = 25 cm H2O

All of the following are appropriate situations for the use of sigh or deep breaths except which?

During continuous positive airway pressure (CPAP) with spontaneous breathing

How much pressure and time is necessary during a lung recruitment maneuver?

35 to 45 cm H2O for 40 to 60 seconds

Essential capabilities of an adult intensive care unit (ICU) ventilator include all of the following except:

Flow rates up to 250 L/min.

A 70-year-old, 61-inch-tall, female patient was admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD). After 12 hours of oxygen therapy, bronchodilator therapy, and intravenous corticosteroids, the patient began to show signs of clinical deterioration. Her chest x-ray revealed an enlarged heart and bilateral infiltrates. Her arterial blood gas shows acute on chronic respiratory failure. It is decided that this patient requires intubation and mechanical ventilation. The most appropriate ventilator settings for this patient include which of the following?

VC-CMV rate 12, VT 400 mL, FIO2 40%, PEEP 3 cm H2O

Methods to minimize air trapping in mechanically ventilated patients include which of the following?

Increasing inspiratory flow

A chronic obstructive pulmonary disease (COPD) patient with an ideal body weight of 65 kg is brought to the emergency department. The patient is short of breath and using accessory muscles. Aerosolized bronchodilators are administered. The arterial blood gas reveals the following: pH 7.31, partial pressure of carbon dioxide (PaCO2) 72 mm Hg, partial pressure of oxygen (PaO2) 88 mm Hg, oxygen saturation (SaO2) 90%, bicarbonate (HCO3-) 32 mEq/L on nasal cannula 2 L/min. The respiratory therapist should recommend which of the following at this time?

Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (Bilevel PAP) rate 8 bpm, inspiratory positive airway pressure (IPAP) 10 cm H2O, expiratory positive airway pressure (EPAP) 2 cm H2O

Sigh breaths could be beneficial during which of the following situations?

Pressure-supported ventilation with tidal volume (VT) = 4-6 mL/kg

A 45-year-old, 73-inch-tall, 200 lb male patient is admitted to the emergency department with an exacerbation of myasthenia gravis. The respiratory therapist assesses the patient and finds the patient’s maximum inspiratory pressure is 15 cm H2O and his vital capacity is 1200 mL. It is decided that the patient requires ventilatory support. The most appropriate ventilator settings for this patient are which of the following?

Volume-controlled synchronized intermittent mandatory ventilation (VC-SIMV), f= 12 breaths/min, tidal volume (VT) = 725 mL, PS 5 cm H2O, PEEP 5 cm H2O, FIO2 24%

A 36-year-old female patient with a history of asthma is admitted to the ICU from the emergency department. Her respirations are 30, very labored, with accessory muscle use and bilateral inspiratory and expiratory wheezing. There is bilateral hyperresonance during chest percussion. A blood gas taken in the ICU after 1 hour of continuous aerosolized albuterol (15 mg) reveals: pH 7.38, partial pressure of carbon dioxide (PaCO2) 42mm Hg, partial pressure of oxygen (PaO2) 53 mm Hg, oxygen saturation (SaO2) 88%, bicarbonate (HCO3-) 25 mEq/L with nasal cannula 6 L/min. The patient is 5’5” and weighs 135 lbs. The most appropriate action at this time is which of the following?

Intubate, use pressure-controlled continuous mandatory ventilation (PC-CMV), f = 8, peak inspiratory pressure (PIP) 28 cm H2O, TI 0.75 sec, positive-end-expiratory pressure (PEEP) 3 cm H2O, FIO2 100%

Patients with acute severe asthma requiring mechanical ventilation are difficult to manage because of which of the following?

Uneven alveolar hyperexpansion

During mechanical ventilation, a patient with a closed head injury develops the Cushing response. This may be immediately managed by using which of the following?

Iatrogenic hyperventilation

A male patient who is 5’10” and weighs 190 lbs arrives at the hospital having suffered a closed head injury in a motor vehicle accident. The patient is unconscious and a computer tomogram of the head reveals an intracranial bleed. The patient receives an intracranial pressure (ICP) monitor following neurosurgery. Initial ventilator settings should include which of the following?

Volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 15 bpm, tidal volume (VT) 750 mL, positive-end-expiratory pressure (PEEP) 5 cm H2O, fractional inspired oxygen (FIO2) 100%

An 18-year-old, 5’6” and 125 lb female patient was admitted to the hospital 2 days ago for spinal meningitis. She developed sepsis and suffered hypercapnic respiratory failure. The patient was intubated and placed on volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequency (f) 12 bpm, tidal volume (VT) 600 mL, positive-end- expiratory pressure (PEEP) 5 cm H2O, fractional inspired oxygen (FIO2) 40%. Twenty-four hours later, the patient’s oxygen requirements have dramatically increased and her lung compliance has dramatically dropped, while her chest x-ray showed development of bilateral fluffy infiltrates. The most appropriate actions to take include which of the following?

Decrease VT to 250 mL, increase f to 15 bpm, increase PEEP to 15 cm H2O.

While initially ventilating a patient with acute respiratory distress syndrome (ARDS), the extrinsic positive-end-expiratory pressure (PEEPE) should be maintained using which of the following methods?

Open lung approach

The statement that is true concerning the use of permissive hypercapnia in the management of patients with acute respiratory distress syndrome (ARDS) includes which of the following?

Tromethamine (THAM) may be used to keep the pH above 7.2.

The application of positive pressure for patients with left ventricular failure is beneficial because of which of the following?

Decreases preload to the heart

A 72-year-old male patient (height 6’2”, weight 95 kg) with a history of congestive heart failure (CHF) presents to the emergency department complaining of shortness of breath and inability to lie down to sleep. Physical assessment reveals a very anxious patient with a pulse of 140, respirations 32 and labored with diaphoresis. Breath sounds are decreased with bibasilar coarse crackles. The patient has a productive cough of pink frothy secretions. The patient is placed on a nonrebreather mask and the resulting arterial blood gases (ABG) shows: pH 7.25, partial pressure of carbon dioxide (PaCO2) 55 mm Hg, partial pressure of oxygen (PaO2) 54 mm Hg, oxygen saturation (SaO2) 86%, bicarbonate (HCO3 -) 24 mEq/L. The most appropriate immediate action to take includes which of the following?

Noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiLevel PAP), inspiratory positive airway pressure (IPAP) 15 cm H2O, expiratory positive airway pressure (EPAP) 5 cm H2O, FIO2 60%

The first step in the assessment and documentation of patient-ventilator interaction following the placement of a patient on a mechanical ventilator is which of the following?

Verifying physician’s orders

The operational verification procedure (OVP) involves checking the ventilator circuit for leaks. Ventilator settings that could be used to perform this procedure include which of the following?

VT = 500 mL, Flow rate = 20 L/min, High pressure limit = maximum, Inspiratory pause = 2 seconds

How often should the fractional inspired oxygen (FIO2) of an adult be measured with an oxygen analyzer?

Every patient-ventilator system check

How long after beginning mechanical ventilation on a patient should an arterial blood gas sample be drawn?

15 minutes

A female patient who is 5’7” tall and weighs 68 kg is being mechanically ventilated with volume-controlled continuous mandatory ventilation (VC-CMV), set rate 12, patient trigger rate 25 bpm, tidal volume (VT) 500 mL, set flow rate 60 L/min, fractional inspired oxygen (FIO2) 40%, positive-end-expiratory pressure (PEEP) 5 cm H2O. The patient is currently in distress using accessory muscles of inspiration. A patient-ventilator system check is performed by the respiratory therapist. The flow-time waveform shows a failure of the expiratory flow to return to zero before the next breath is triggered. The most appropriate action for the respiratory therapist to take includes which of the following?

Switch to volume-controlled synchronized intermittent mandatory ventilation (VC-SIMV).

Calculate the volume delivered to the patient when the tubing compliance (CT) is 2.5 mL/cm H2O, the tidal volume (VT) at the exhalation port is 550 mL, and the peak inspiratory pressure (PIP) is 28 cm H2O.

480 mL

A 6’2” male patient is being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode with a set tidal volume (VT) of 650 mL. There is 40 mL of mechanical dead space. Calculate the final alveolar ventilation.

432 mL

An increasing PIP may indicate which of the following?

Decreasing lung compliance

A pathophysiologic condition that causes an increase in peal inspiratory pressure (PIP) while transairway pressure (PTA) remains the same is which of the following?

Acute respiratory distress syndrome (ARDS)

During the course of several patient-ventilator system checks a respiratory therapist notices that the patient’s peak inspiratory pressure (PIP) is rising, while the plateau pressure (Pplateau) has remained the same. This most likely indicates which of the following?

Increase in airway resistance

The data on the following ventilator flow sheet for a patient being ventilated in the volume- controlled continuous mandatory ventilation (VC-CMV) mode demonstrates which of the following?

Lung compliance is decreasing.

A patient’s transairway pressure (PTA) is rising while the plateau pressure (Pplateau) remains unchanged. The treatment plan that could correct this problem includes which of the following? 1. Administer a bronchodilator. 2. Insert a chest tube. 3. Increase extrinsic positive-end-expiratory pressure (PEEPE) 4. Suction airway secretions.

1, 4

The respiratory therapist is evaluating the following ventilator flow sheet. The recommendation that is most appropriate in this situation is which of the following?

Increase extrinsic positive-end-expiratory pressure (PEEPE).

Following initiation of volume-controlled continuous mandatory ventilation (VC-CMV) ventilation, the patient’s average peak inspiratory pressure (PIP) is 23 cm H2O. The high pressure limit alarm should be set at which of the following?

33 cm H2O

Identify the plateau pressure (Pplateau) for the pressure-controlled continuous mandatory ventilation (PC-CMV) breaths in the figure.

Point D

The volume-time curve is demonstrating which of the following?

System leak

The respiratory therapist observes the volume-time curve shown in the figure. What action should the respiratory therapist take at this time?

Detach the ventilator and manually resuscitate.

A 31-year-old woman is admitted to the emergency department following a motor vehicle accident. The paramedics brought her into the ER in respiratory distress. She was intubated in the field and started on mechanical ventilation as soon as she arrived. Breath sounds were clear on the left and absent on the right. Percussion revealed resonance on the left and hyperresonance on the right. The patient’s trachea was shifted to the left. The most likely cause of this patient’s clinical presentation is which of the following?

Pneumothorax

A 46-year-old male patient is 2 days post-op for surgery to repair and aortic aneurysm. He is currently receiving mechanical ventilation. Auscultation of the anterior and posterior chest reveals bilateral late inspiratory crackles. Percussion is dull in both lower lobes. A STAT radiograph reveals bibasilar infiltrates. The most likely cause of this patient’s clinical presentation is which of the following?

Pneumonia

The respiratory therapist is performing a physical assessment of a patient receiving pressure support ventilation. The patient is short of breath, has a respiratory rate of 28 breaths per minute, a dull percussion note over the right base that becomes resonant over the right upper lobe, and resonance over the left lung. Chest movement on the right side is decreased. The STAT chest x-ray reveals a blunting of the right costophrenic angle. The pulmonary disorder that is causing this clinical presentation is which of the following?

Pleural effusion

To reduce the risk of tracheal damage associated with overinflated tube cuffs, intracuff pressures should not exceed what range of pressures?

20 – 25 mm Hg

The respiratory therapist is monitoring the cuff pressure of a tracheostomy tube inserted in a patient who is receiving mechanical ventilation. The cuff pressure is measured at 41 cm H2O. The respiratory therapist should immediately do which of the following?

Release some of the air from the cuff.

A 49-kg female patient intubated with a size 7 mm ID endotracheal tube is being mechanically ventilated in the volume-controlled continuous mandatory ventilation (VC- CMV) mode. During patient rounds, both the low pressure and low volume alarms are sounding persistently on the ventilator. Upon observation of the patient, the respiratory therapist hears murmuring from the patient, with audible sounds during inspiration. The cause of this condition is which of the following?

Endotracheal tube (ET) cuff leak

An 87-kg male patient, orally intubated with a size 7.5 mm inner diameter (ID) endotracheal tube, is being mechanically ventilated in the pressure-controlled continuous mandatory ventilation (PC-CMV) mode. During patient rounds, both the low pressure and low volume alarms are sounding persistently on the ventilator. Upon observation of the patient, the respiratory therapist hears murmuring from the patient, with audible sounds during inspiration. The respiratory therapist notes the position of the endotracheal tube is 21 cm at the gum line, measures the cuff pressure, and adds 3 mL of air to the cuff. To make an appropriate seal, it requires 44 cm H2O. The respiratory therapist should do which of the following?

Change to a larger size endotracheal tube.

During intracuff measurement with a three-way stopcock, manometer, and syringe, the amount of cuff volume/pressure lost in the connecting tube should be minimized by which of the following?

Pressurizing the manometer to 25 mm Hg prior to use

The flow sheet below, for a patient on pressure-controlled continuous mandatory ventilation (PC-CMV), demonstrates which of the following?

Dynamic compliance is decreasing.

The normal airway resistance range is which of the following?

0.6 to 2.4 cm H2O/L/sec

A patient’s transairway pressure (PTA) is rising while the plateau pressure (Pplateau) remains unchanged. The treatment plan that could correct this problem includes which of the following? 1. Administer a bronchodilator. 2. Insert a chest tube. 3. Measure unintended positive-end-expiratory pressure (auto-PEEP). 4. Suction airway secretions.

1, 4

In a patient receiving mechanical ventilation with a constant tidal volume, an airway resistance increase is indicated by which of the following?

Increased peak inspiratory pressure (PIP) and transairway pressure (PTA)

The pressure at which large numbers of alveoli are recruited in a patient with acute respiratory distress syndrome (ARDS) is located on the static pressure-volume curve at which of the following?

Lower inflection point

The pressure at which large numbers of alveoli become overinflated in a patient with acute respiratory distress syndrome (ARDS) is located on the static pressure-volume curve at which of the following?

Upper inflection point

The static pressure-volume curve shown in the figure indicates the presence of which of the following?

Bronchospasm

To help prevent inflated alveoli from collapsing and reexpanding with each breath, the positive-end-expiratory pressure (PEEP) level should be set at which point on the deflation part of the loop?

Above the lower inflection point

The flow sheet below, for a patient on pressure-controlled continuous mandatory ventilation (PC-CMV), demonstrates which of the following?

Airway resistance is decreasing.

The low pressure and low tidal volume alarm is sounding on a mechanically ventilated patient. Measurement of the cuff pressure reveals 18 cm H2O. What action should be taken?

Add air until a slight leak is heard while auscultating the larynx, then measure pressure.

ch. 2

Darya Rose · 83問 · 2年前

ch. 2