Ch. 16 - 17
問題一覧
1
The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?
VC-CMV with PEEP
2
High tidal volumes and/or high levels of PEEP cause which of the following?
Increased right ventricular afterload
3
Normovolemic patients experience decreases in cardiac output above what level of PEEP?
15 cm H2O
4
A patient with which of the following is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?
ARDS (stiff lungs)
5
The harmful cardiovascular effects of PPV are influenced most by which of the following pressures?
Mean airway pressure
6
Which of the following ventilator parameters would result in the highest mean airway pressure?
PIP = 30cm H2O; PEEP = 15 cm H2O; TI = 0.5 sec; TCT = 5 sec
7
Physiological dead space may be increased in apneic patients receiving volume control ventilation by which of the following?
Inspiratory time <0.5 sec
8
During spontaneous breathing, the fall in intrapleural pressure that draws air into the lungs during inspiration also draws blood into the major thoracic vessels. This phenomenon increases which of the following?
Right ventricular preload
9
Calculate the cerebral perfusion pressure when the mean arterial blood pressure is 120 mm Hg and the ICP is 14 mm Hg.
106 mm Hg
10
Urinary output is severely reduced when the renal arterial pressure decreases below what level?
75 mmHg
11
Positive pressure ventilation has which of the following effects on the kidneys?
Redistributes blood flow in the kidneys.
12
Mechanical ventilation has an effect on the hormone ______ , which causes a decrease in urinary output.
arginine vasopressin
13
Positive pressure ventilation increases splanchnic resistance, decreases splanchnic venous outflow, and may contribute to gastric mucosal ischemia. This last change contributes to which of the following?
Gastric ulcers
14
The conditions that must exist to cause the interventricular septum to move to the left during positive pressure ventilation include which of the following?
Mean airway pressure >15 cm H2O
15
The most likely cause of uneven ventilation includes which of the following?
High inspiratory flow rates
16
An otherwise healthy 19-year-old male is currently intubated and being mechanically ventilated after a motorcycle accident in which he sustained a closed head injury and multiple rib fractures. Before the patient is taken to the operating room for cranial surgery, the respiratory therapist notices that he has jugular vein distention. The most likely cause of this problem is which of the following?
Increased intracranial pressure
17
Malnutrition during mechanical ventilation can cause which of the following?
Decreased spontaneous ventilation
18
Biotrauma is caused directly by which of the following?
Overdistention of alveoli
19
Alveolar tissue and pulmonary capillary injury is caused by which of the following?
Shear stress
20
Shear stress injury and loss of surfactant from the resulting unstable lung units result in a loss of surfactant. This type of pulmonary trauma is known as ____.
atelectrauma
21
Ventilator-induced lung injury (VILI) is associated with which of the following?
Biotrauma
22
The RT performs a patient-ventilator system check on a 24-year-old, 5-foot, 10-inch male patient who has been intubated because of a drug overdose. The RT notices what appears to be swelling around the patient’s upper anterior chest and neck area. Palpation elicits a tissue paper feeling. The ventilator settings are: VC-CMV, rate 12/min with no patient assist, VT 900 mL, PEEP 5 cm H2O, FIO2 0.4, TI 1.2 sec. The most appropriate action for the RT to take is which of the following?
Decrease the set tidal volume.
23
The RT responds to the high pressure, high respiratory rate, low exhaled volume, and low exhaled minute volume alarms of a mechanically ventilated patient in the ICU. Upon entering the room, the RT notices that the patient, who is still attached to the ventilator, appears diaphoretic, tachypneic, tachycardic, and hypertensive. Breath sounds are absent on the left and distant on the right. The patient’s trachea is deviated to the left, and jugular vein distention is present. The endotracheal tube is 24 cm at the teeth. Immediate action should include which of the following?
Insert a 14-gauage needle into the second intercostal space right midclavicular line.
24
Lung injury is more likely to occur with which of the following with normal lung tissue?
PA = 29 cmH2O; Pp l= 10 cmH2O
25
What is the minimum transpulmonary pressure that has been associated with lung injury in animals?
30 cm H2O
26
Shear stress is most likely to affect a patient with which of the following?
PA = 35 cmH2O ;Ppl = 12 cmH2O
27
Healthy areas of lung tissue in a patient with ARDS can be protected from lung injury caused by overdistention by which of the following?
Using the prone position.
28
Overdistention of the lungs causes the release of which inflammatory mediators?
Tumor necrosis factor
29
Inappropriate ventilator settings can cause the release of inflammatory mediators within _____.
1 to 3 hours
30
In what areas of the lung are ventilation and perfusion best matched during spontaneous ventilation in the supine position?
Dependent posterior lung areas
31
In a mechanically ventilated patient who is receiving lorazepam and succinylcholine, the diaphragm moves in which of the following ways?
D
32
Preservation of spontaneous breathing during mechanical ventilation favors the distribution of gas to which areas of the lung?
Lung periphery
33
Which of the following mechanically ventilated patients shows clinical signs of hypoventilation?
A patient who is anxious and hypertensive and has elevated T waves on the ECG.
34
Which of the following mechanically ventilated patients shows clinical signs of hyperventilation?
A patient who has cool skin and also shows paroxysmal tachycardia on the ECG.
35
Prolonged ventilator-induced hyperventilation can lead to which of the following?
Hypokalemia
36
The RT assesses the flow-time scalar from an apneic patient mechanically ventilated in the VC-CMV mode. The most appropriate action for this patient is to do which of the following?
Reduce the set ventilator rate.
37
What is the minimum range of time constants necessary for the lungs to empty 98% of the inspired volume?
3 to 4
38
The acceptable lower limit of PaO2 for a mechanically ventilated patient with ARDS is which of the following?
60 mmHg
39
Calculate the static compliance for a patient who has the following: auto PEEP = 8 cm H2O, set PEEP=12 cmH2O, VT = 425mL, PIP = 45 cmH2O, and Pplateau = 36 cmH2O.
27 mL/cm H2O
40
The combination of ______ and ______ increases the risk of absorption atelectasis.
low tidal volumes, FIO2 >0.7
41
A patient with a size 8 ET tube has a spontaneous minute ventilation of 20 L/min. Use the figure below to find the imposed WOB through the ET tube.
22 J/min
42
Assessment of a mechanically ventilated patient reveals use of accessory muscles and a respiratory rate of 26 breaths/min. The mode is CPAP with 5 cm H2O and an FIO2 of 0.4. The most appropriate action is which of the following?
Add pressure support to the CPAP.
43
A patient with asthma is being ventilated in PSV, 5 cm H2O, with CPAP of 5 cm H2O. The patient has chest wall retractions on most breaths and appears to have an increased WOB. The following graphic occurred the entire time the respiratory therapist was assessing the patient. What does this graphic demonstrate?
Trigger asynchrony
44
When setting up a patient on volume ventilation with constant flow, the initial flow setting
should be _____.
80 L/min
45
The pressure-time scalar of a patient with COPD who is receiving PSV shows positive deflection toward the end of inspiration. The most appropriate way to alleviate this is to do which of the following?
Increase the flow cycle percentage.
46
Nutritional supplement should always be delivered by the most natural route possible.
True
47
Which of the following increases the risk for a patient developing auto-PEEP?
1. COPD
2. Low minute ventilation
3. Over the age of 60
4. Increased airway resistance
1,3,4
ch. 2
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Darya Rose · 5問 · 1年前test 1
test 1
5問 • 1年前問題一覧
1
The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?
VC-CMV with PEEP
2
High tidal volumes and/or high levels of PEEP cause which of the following?
Increased right ventricular afterload
3
Normovolemic patients experience decreases in cardiac output above what level of PEEP?
15 cm H2O
4
A patient with which of the following is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?
ARDS (stiff lungs)
5
The harmful cardiovascular effects of PPV are influenced most by which of the following pressures?
Mean airway pressure
6
Which of the following ventilator parameters would result in the highest mean airway pressure?
PIP = 30cm H2O; PEEP = 15 cm H2O; TI = 0.5 sec; TCT = 5 sec
7
Physiological dead space may be increased in apneic patients receiving volume control ventilation by which of the following?
Inspiratory time <0.5 sec
8
During spontaneous breathing, the fall in intrapleural pressure that draws air into the lungs during inspiration also draws blood into the major thoracic vessels. This phenomenon increases which of the following?
Right ventricular preload
9
Calculate the cerebral perfusion pressure when the mean arterial blood pressure is 120 mm Hg and the ICP is 14 mm Hg.
106 mm Hg
10
Urinary output is severely reduced when the renal arterial pressure decreases below what level?
75 mmHg
11
Positive pressure ventilation has which of the following effects on the kidneys?
Redistributes blood flow in the kidneys.
12
Mechanical ventilation has an effect on the hormone ______ , which causes a decrease in urinary output.
arginine vasopressin
13
Positive pressure ventilation increases splanchnic resistance, decreases splanchnic venous outflow, and may contribute to gastric mucosal ischemia. This last change contributes to which of the following?
Gastric ulcers
14
The conditions that must exist to cause the interventricular septum to move to the left during positive pressure ventilation include which of the following?
Mean airway pressure >15 cm H2O
15
The most likely cause of uneven ventilation includes which of the following?
High inspiratory flow rates
16
An otherwise healthy 19-year-old male is currently intubated and being mechanically ventilated after a motorcycle accident in which he sustained a closed head injury and multiple rib fractures. Before the patient is taken to the operating room for cranial surgery, the respiratory therapist notices that he has jugular vein distention. The most likely cause of this problem is which of the following?
Increased intracranial pressure
17
Malnutrition during mechanical ventilation can cause which of the following?
Decreased spontaneous ventilation
18
Biotrauma is caused directly by which of the following?
Overdistention of alveoli
19
Alveolar tissue and pulmonary capillary injury is caused by which of the following?
Shear stress
20
Shear stress injury and loss of surfactant from the resulting unstable lung units result in a loss of surfactant. This type of pulmonary trauma is known as ____.
atelectrauma
21
Ventilator-induced lung injury (VILI) is associated with which of the following?
Biotrauma
22
The RT performs a patient-ventilator system check on a 24-year-old, 5-foot, 10-inch male patient who has been intubated because of a drug overdose. The RT notices what appears to be swelling around the patient’s upper anterior chest and neck area. Palpation elicits a tissue paper feeling. The ventilator settings are: VC-CMV, rate 12/min with no patient assist, VT 900 mL, PEEP 5 cm H2O, FIO2 0.4, TI 1.2 sec. The most appropriate action for the RT to take is which of the following?
Decrease the set tidal volume.
23
The RT responds to the high pressure, high respiratory rate, low exhaled volume, and low exhaled minute volume alarms of a mechanically ventilated patient in the ICU. Upon entering the room, the RT notices that the patient, who is still attached to the ventilator, appears diaphoretic, tachypneic, tachycardic, and hypertensive. Breath sounds are absent on the left and distant on the right. The patient’s trachea is deviated to the left, and jugular vein distention is present. The endotracheal tube is 24 cm at the teeth. Immediate action should include which of the following?
Insert a 14-gauage needle into the second intercostal space right midclavicular line.
24
Lung injury is more likely to occur with which of the following with normal lung tissue?
PA = 29 cmH2O; Pp l= 10 cmH2O
25
What is the minimum transpulmonary pressure that has been associated with lung injury in animals?
30 cm H2O
26
Shear stress is most likely to affect a patient with which of the following?
PA = 35 cmH2O ;Ppl = 12 cmH2O
27
Healthy areas of lung tissue in a patient with ARDS can be protected from lung injury caused by overdistention by which of the following?
Using the prone position.
28
Overdistention of the lungs causes the release of which inflammatory mediators?
Tumor necrosis factor
29
Inappropriate ventilator settings can cause the release of inflammatory mediators within _____.
1 to 3 hours
30
In what areas of the lung are ventilation and perfusion best matched during spontaneous ventilation in the supine position?
Dependent posterior lung areas
31
In a mechanically ventilated patient who is receiving lorazepam and succinylcholine, the diaphragm moves in which of the following ways?
D
32
Preservation of spontaneous breathing during mechanical ventilation favors the distribution of gas to which areas of the lung?
Lung periphery
33
Which of the following mechanically ventilated patients shows clinical signs of hypoventilation?
A patient who is anxious and hypertensive and has elevated T waves on the ECG.
34
Which of the following mechanically ventilated patients shows clinical signs of hyperventilation?
A patient who has cool skin and also shows paroxysmal tachycardia on the ECG.
35
Prolonged ventilator-induced hyperventilation can lead to which of the following?
Hypokalemia
36
The RT assesses the flow-time scalar from an apneic patient mechanically ventilated in the VC-CMV mode. The most appropriate action for this patient is to do which of the following?
Reduce the set ventilator rate.
37
What is the minimum range of time constants necessary for the lungs to empty 98% of the inspired volume?
3 to 4
38
The acceptable lower limit of PaO2 for a mechanically ventilated patient with ARDS is which of the following?
60 mmHg
39
Calculate the static compliance for a patient who has the following: auto PEEP = 8 cm H2O, set PEEP=12 cmH2O, VT = 425mL, PIP = 45 cmH2O, and Pplateau = 36 cmH2O.
27 mL/cm H2O
40
The combination of ______ and ______ increases the risk of absorption atelectasis.
low tidal volumes, FIO2 >0.7
41
A patient with a size 8 ET tube has a spontaneous minute ventilation of 20 L/min. Use the figure below to find the imposed WOB through the ET tube.
22 J/min
42
Assessment of a mechanically ventilated patient reveals use of accessory muscles and a respiratory rate of 26 breaths/min. The mode is CPAP with 5 cm H2O and an FIO2 of 0.4. The most appropriate action is which of the following?
Add pressure support to the CPAP.
43
A patient with asthma is being ventilated in PSV, 5 cm H2O, with CPAP of 5 cm H2O. The patient has chest wall retractions on most breaths and appears to have an increased WOB. The following graphic occurred the entire time the respiratory therapist was assessing the patient. What does this graphic demonstrate?
Trigger asynchrony
44
When setting up a patient on volume ventilation with constant flow, the initial flow setting
should be _____.
80 L/min
45
The pressure-time scalar of a patient with COPD who is receiving PSV shows positive deflection toward the end of inspiration. The most appropriate way to alleviate this is to do which of the following?
Increase the flow cycle percentage.
46
Nutritional supplement should always be delivered by the most natural route possible.
True
47
Which of the following increases the risk for a patient developing auto-PEEP?
1. COPD
2. Low minute ventilation
3. Over the age of 60
4. Increased airway resistance
1,3,4