問題一覧
1
Respiratory failure due to inadequate ventilation is known as which of the following?
Hypercapnic
2
The underlying physiological process leading to pure hypercapnic respiratory failure is which of the following?
Alveolar hypoventilation
3
A patient with an opiate drug overdose is unconscious and has the following arterial blood gas results on room air:
pH 7.20; partial pressure of carbon dioxide (PaCO2) 88 mm Hg; partial pressure of oxygen (PaO2) 42 mm Hg; bicarbonate (HCO3) 25 mEq/L. Which of the following best describes this patient’s condition?
Acute hypercapnic respiratory failure
4
Acute hypercapnic respiratory failure may be caused by which of the following?
Respiratory muscle fatigue
5
Hypercapnic respiratory failure due to increased work of breathing will be caused by which of the following?
Asthma exacerbation
6
A postoperative patient complaining of dyspnea is found to have tachypnea and tachycardia, and is somewhat confused. Breath sounds reveal end inspiratory crackles in both lung bases. An arterial blood gas is drawn and reveals the following: pH 7.49; partial pressure of carbon dioxide (PaCO2) 33 mm Hg; partial pressure of oxygen (PaO2) 51 mm Hg; arterial oxygen saturation (SaO2) 87%; bicarbonate (HCO3-) 25 mEq/L while on a 30% air entrainment mask. The most appropriate respiratory therapy intervention includes which of the following?
Initiate continuous positive airway pressure (CPAP) by mask.
7
A patient with inadequate oxygenation of the brain may display which of the following conditions?
1. Confusion
2. Excitement
3. Somnolence
4. Compliance
1, 3
8
A 28-year-old man is admitted to the emergency department with suspected drug overdose. The patient is obtunded and slightly cyanotic. The arterial blood gas results obtained while the patient was breathing room air were: pH 7.24; partial pressure of carbon dioxide (PaCO2) 58 mm Hg; partial pressure of oxygen (PaO2) 52 mm Hg; bicarbonate (HCO3-) 24 mEq/L. The most appropriate interpretation of these results is which of the following?
Hypercapnic respiratory failure
9
The respiratory assessment of a 44-year-old female patient diagnosed with myasthenia gravis shows: vital capacity 475 mL, maximum inspiratory pressure (MIP) -18 cm H2O. The patient is 5 feet 6 inches tall and weighs 188 lbs. The most recent arterial blood gas on a 2L/min nasal cannula is pH 7.32, partial pressure of carbon dioxide (PaCO2) 49 mm Hg, partial pressure of oxygen (PaO2) 77 mm Hg, arterial oxygen saturation (SaO2) 95%, bicarbonate (HCO3) 24 mEq/L.The most appropriate recommendation for this patient is which of the following?
Intubation and mechanical ventilation
10
Which of the following values are indicative of acute respiratory failure and the need for ventilatory support?
1. Maximum inspiratory pressure (MIP) = – 25 cm H2O
2. Dead space to tidal volume ration (VD/VT) = 0.4
3. Vital capacity (VC) = 8 mL/kg IBW
4. pH = 7.20
3, 4
11
A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath. Physical assessment reveals: pulse 102, blood pressure 138/80, respiratory rate 25 with accessory muscle use, and breath sounds are decreased with bilateral inspiratory and expiratory wheezing with a prolonged expiratory phase. The peak expiratory flow rate is 100 L/min. The immediate action by the respiratory therapist should include which of the following?
Administer continuous bronchodilator therapy.
12
A 64-year-old female patient having an acute exacerbation of chronic obstructive pulmonary disease (COPD) was admitted to the hospital yesterday. During rounds today the respiratory therapist finds the patient to be difficult to arouse and has the following physical findings: heart rate 102, respiratory rate 23 shallow and slightly labored, breath sounds are bilaterally decreased with rhonchi in both bases. The patient has a frequent, but weak cough. The respiratory therapist draws an arterial blood gas with the following results on a 2 L/min nasal cannula: pH 7.52, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2) 45 mm Hg, arterial oxygen saturation (SaO2) 86%, bicarbonate (HCO3-) 24 m Eq/L. The most appropriate action is which of the following?
Increase the nasal cannula to 4 L/min.
13
A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented. His physical examination reveals: heart rate (HR) 120 and regular, blood pressure (BP) 146/88, temperature 38° C, respiratory rate (RR) 28 shallow and labored. Breath sounds are decreased throughout with fine late crackles on inspiration, chest expansion is decreased in both bases. The patient is not coughing. The arterial blood gas (ABG) on room air is: pH 7.52, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2 ) 42 mm Hg, Hb-O2 80%, bicarbonate (HCO3-) 24 mEq/L. This patient is retired after working in a steel factory for 38 years and he has a 50 pack-year history of smoking. The most appropriate action for the respiratory therapist to take is which of the following?
Administer oxygen via a high flow nasal cannula.
14
A 28-year-old female was admitted last night for weakness and what appears to be ascending muscle paralysis. The patient is alert and oriented. Physical findings reveal: pulse 96, regular; blood pressure (BP) 134/83; temperature 37° C; respiratory rate (RR) 24 shallow with bilateral decrease in air entry, and no adventitious breath sounds. The patient’s arterial blood gas (ABG) results on room air are: pH 7.46; partial pressure of carbon dioxide (PaCO2) 39 mmHg; partial pressure of oxygen (PaO2) 80 mmHg; Sat 97%; bicarbonate (HCO3-) 26 mEq/L on room air. The most appropriate suggestion that the respiratory therapist should make for this patient includes which of the following?
Vital capacity every two hours
15
An 80-year-old female with a diagnosis of pneumonia was admitted to the hospital 2 days ago from a nursing home. The patient is responsive only to painful stimuli. She has a peripheral IV and a feeding tube in place. Physical examination reveals: pulse 98 bpm, respiratory rate 24 and shallow, blood pressure 100/48, and temperature 39.2° C. Auscultation reveals decreased breath sounds with crackles in the bases. The patient has an occasional weak, nonproductive cough. Arterial blood gas on NC 4 L/min is pH 7.42, partial pressure of carbon dioxide (PaCO2) 38 mmHg, partial pressure of oxygen (PaO2) 40 mm Hg, arterial oxygen saturation (SaO2) 76%, bicarbonate (HCO3-) 24 mEq/L. A portable chest x- ray shows patchy basilar infiltrates in both lungs. The most appropriate action to take at this time is which of the following?
Change the nasal cannula to a nonrebreather mask.
16
The first arterial blood gas for an asthma patient in the emergency department reveals: pH 7.49; partial pressure of carbon dioxide (PCO2) 30; partial pressure of oxygen (PO2) 82; oxygen saturation (SO2) 95%; bicarbonate (HCO3-) 24 on a nasal cannula 3 L/min. The patient’s peak expiratory flow rate was 165 L/min, respiratory rate was 16, and pulse 106. After continuous aerosolized albuterol over the last hour patient’scurrent arterial blood gas results are as follows: pH 7.34; PCO2 45; PO2 49; SO2 79%; HCO3- 25 on a high flow nasal cannula 15 L/min. The patient’s peak expiratory flow rate is 95 L/min, respiratory rate 35, pulse 128, and the patient is diaphoretic. The respiratory therapist should suggest which of the following at this time?
Intubate and initiate mechanical ventilation.
17
A patient seen in the emergency department exhibits paralysis of the lower extremities that is getting progressively worse. Vital capacity is 6 mL/kg, maximum inspiratory pressure (MIP) is -17 cm H2O, and oxygen saturation measured by pulse oximeter (SpO2) is 89%. Arterial blood gases (ABGs) are pending. The physician suspects Guillain-Barré syndrome. The most appropriate action at this time is which of the following?
Intubate and mechanically ventilate.
18
Which of the following values are indicative of acute respiratory failure and the need for ventilatory support?
1. Maximum inspiratory pressure (MIP) = -38 cm H2O
2. Vital capacity (VC) = 650 mL for a 70 kg male
3. Alveolar-to-arterial partial pressure of oxygen [P(A-a)O2] = 150 on 100% oxygen
4. Maximum expiratory pressure (MEP) = 25 cm H2O
2, 4
19
The disorders that cause respiratory failure due to increased work of breathing include which of the following?
1. Myasthenia gravis
2. Cardiogenic pulmonary edema
3. Interstitial pulmonary fibrosis
4. Amyotrophic lateral sclerosis
2, 3
20
A 52-year-old male with a medical history of congestive heart failure and hypertension arrives in the emergency department because of an acute onset of dyspnea. The patient has pink frothy secretions at the mouth. A rapid physical assessment reveals a pulse of 128, respiratory rate 28 breaths/min and labored, and blood pressure 82/56 mm Hg. Bilateral coarse crackles are heard in the lung bases. Arterial blood gas results on a 12 L/min nonrebreather mask are: pH 7.32, partial pressure of carbon dioxide (PaCO2) 49 mm Hg, partial pressure of oxygen (PaO2) 50 mm Hg, arterial oxygen saturation (SaO2) 74%. The most appropriate immediate action for this patient is which of the following?
Intubation and mechanical ventilation
21
A 45-year-old woman arrives in the emergency department after ingesting an unknown quantity of pain medication and alcohol. She was found unconscious in her apartment by her friend. She is currently unresponsive to verbal stimuli. Vital signs reveal: pulse 56/min, respiratory rate 10 and shallow, BP 90/50. Her arterial blood gas on room air reveals: pH 7.21, partial pressure of carbon dioxide (PaCO2) 64 mm Hg, partial pressure of oxygen (PaO2) 52 mm Hg, bicarbonate (HCO3-) 24 mEq/L. The appropriate treatment for this patient includes which of the following?
1. Naloxone hydrochloride (Narcan)
2. Nasal cannula 4 L/min
3. Nonrebreathing mask
4. Intubation and ventilatory support
1, 4
22
A 59-year-old patient is in severe respiratory distress in the emergency department. The patient is being treated for congestive heart failure and pulmonary edema. Vital signs are pulse 98/min, respiratory rate 23/min, and BP 138/98. The patient’s arterial blood gas results on a nonrebreather mask are as follows: pH 7.35, partial pressure of carbon dioxide (PaCO2) 45 mm Hg, partial pressure of oxygen (PaO2) 49 mm Hg, arterial oxygen saturation (SaO2) 79%, and bicarbonate (HCO3-) 24 mEq/L. The respiratory therapy that is most appropriate at this time is which of the following?
Mask continuous positive airway pressure (CPAP) with 100% oxygen
23
Which of the following patients is showing the signs of acute respiratory distress?
One in the high Fowler position, diaphoretic, anxious and unable to complete a sentence
24
A 68-year-old female admitted for congestive heart failure is in respiratory distress and is being seen by the hospital’s medical emergency team in her regular room. The patient is in obvious respiratory distress and is immediately placed on a nonrebreathing mask. Physical assessment reveals: pulse 138 and thready; respiratory rate 30, shallow and labored; temperature 37° C; blood pressure 110/68. Breath sounds are bilaterally decreased with coarse crackles on inspiration. EKG shows normal sinus rhythm with widened cardiac output (QT) interval and an occasional irregular beat. No coughing is noted. The arterial blood gas on the nonrebreathing mask is: pH 7.34; PCO2 46 mm Hg; partial pressure of oxygen in the arteries (PO2) is 52 mm Hg; oxygen saturation is 86%; bicarbonate (HCO -) is
3 24 mEq/L. The patient is diaphoretic. The most appropriate ventilator mode to manage this patient initially is which of the following?
Noninvasive Positive Pressure Ventilation (NPPV)
25
A patient has recently been diagnosed with obstructive sleep apnea. The most appropriate treatment includes which of the following?
Continuous Positive Airway Pressure (CPAP)
26
Which of the following is the minimum ventilator rate that is considered full ventilatory support?
8 breaths/minute
27
Partial ventilatory support can be provided by which of the following ventilator modes?
1. Pressure Controlled Continuous Mandatory Ventilation (PC-CMV) set rate 8 breaths/minute
2. Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) set rate 4 breaths/minute
3. Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) set rate 10 breaths/minute
4. VC- MMV set Ve8 L/minute
2, 4
28
Of the following breath descriptions, which one is considered spontaneous?
Patient triggered, patient cycled, baseline pressure +5 cm H2O
29
What type of breath occurs when the ventilator controls the timing, tidal volume, or inspiratory pressure?
Mandatory
30
A home care patient diagnosed with central sleep apnea would benefit from which of the following modes of ventilation?
Noninvasive Positive Pressure Ventilation (NPPV)
31
During volume control ventilation a patient’s airway resistance increases. This change will cause which of the following to occur?
Increase in peak airway pressure
32
A 28-year-old male has arrived in the emergency department following a motor vehicle accident. He has a Glasgow Coma Score of 14. Chest x-ray reveals 5 ribs broken anteriorly in 2 areas each. Physical assessment reveals paradoxical movement of the chest. Breath sounds are diminished and the trachea is midline. Arterial blood gas on nonrebreathing mask is: pH 7.53, partial pressure of carbon dioxide (PaCO2) is 25 mm Hg, partial pressure of oxygen (PaO2) is 59 mm Hg, arterial oxygen saturation (SaO2) 93%, bicarbonate (HCO3 -) 23 mEq/L. The respiratory therapist should recommend which of the following for this patient?
Mask Continuous Positive Airway Pressure (CPAP) with supplemental oxygen
33
An assisted breath in the pressure-controlled continuous mandatory ventilation (PC-CMV) mode can be described by which of the following?
Patient triggered, pressure limited, time cycled
34
The ventilator mode that allows the patient to breathe spontaneously between operator selected time-triggered volume or pressure-targeted breaths is which of the following?
Synchronized Intermittent Mandatory Ventilation (SIMV)
35
A hemodynamically unstable patient being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode is triggering inspiration at a rate of 25 breaths/minute and has the following arterial blood gas results: pH 7.50, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2) 98 mm Hg, arterial oxygen saturation (SaO2)100%, bicarbonate (HCO3-) 24 mEq/L. The respiratory therapist should peform which of the following?
Change the mode to Volume-Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV).
36
The pressure-time scalar shown in the figure represents which of the following?
Pressure-Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) with Positive-End-Expiratory Pressure (PEEP)
37
Full ventilatory support is provided by which of the following modes?
Pressure-Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) rate 12 with pressure support (PS)
38
The ventilator mode that would be most appropriate to iatrogenically induce hyperventilation to manage a closed head injury patient with severely elevated intracranial pressure (ICP) is which of the following?
Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV)
39
If flow or sensitivity is set incorrectly, which of the following is most likely to occur during the continuous mandatory ventilation (CMV) mode?
Ventilator dysynchrony
40
When a patient does not breathe spontaneously while in the airway pressure release ventilation (APRV) mode, the pressure-time scalar looks like that of which of the following?
Pressure-Controlled Inverse Ratio Ventilation (PCIRV)
41
A breath that is triggered, limited, and cycled by the mechanical ventilator is which of the following?
Mandatory breath
42
A breath that is patient triggered, pressure targeted, and time cycled is which of the following?
Assisted breath
43
Which mode of ventilation is shown in the pressure-time scalar in the figure?
Volume-Controlled Continuous Mandatory Ventilation (VC-CMV)
44
Which mode of ventilation is shown in the pressure-time scalar in the figure?
Volume-Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) with pressure support (PS)
45
A patient triggered, pressure limited, flow cycled breath describes which of the following?
Pressure-support breath
46
When a patient is to be switched from continuous mandatory ventilation (CMV) to synchronized intermittent mandatory ventilation (SIMV) to facilitate weaning from mechanical ventilation, which of the following could be used in addition to SIMV to assist this process?
Pressure Support (PS)
47
Every breath from the ventilator is time or patient triggered, pressure limited, and time cycled. This describes which of the following ventilator modes?
Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV)
48
If lung compliance decreases while a patient is receiving mechanical ventilation with pressure-controlled continuous mandatory ventilation (PC-CMV) which of the following would occur?
Tidal volume decreases
49
A patient arrives in the emergency department following a motor vehicle accident in which the patient sustained a deceleration chest injury. The patient was intubated in the field for airway protection. Physical assessment reveals that the patient is spontaneously breathing at a rate of 16 breaths per minute and breath sounds reveal bibasilar fine crackles at end inspiration. A second arterial blood gas was drawn while the patient was receiving 100% oxygen from an air entrainment large volume nebulizer.
Continuous Positive Airway Pressure (CPAP) with supplemental oxygen
50
A patient with Acute Respiratory Distress Syndrome (ARDS) has developed a pneumothorax from elevating peak and plateau pressures. The patient is currently being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode with a set rate of 12 bpm. However, the patient is triggering the ventilator at a rate of 25 bpm. The arterial blood gas reveals ventilator induced hyperventilation with corrected hypoxemia. The most appropriate recommendation to manage this patient on the ventilator is which of the following?
Switch the mode to pressure-controlled synchronized mandatory ventilation (PC-SIMV)
51
A patient, who is nasally intubated, due to facial surgery, has been successful on her spontaneous breathing trial. She currently has moderate hypoxemia, despite a fractional inspired oxygen (FIO2) of 40% and positive-end-expiratory pressure (PEEP) of 5 cm H2O while on volume-controlled continuous mandatory ventilation (VC-CMV). The most appropriate ventilator mode for this patient is which of the following?
Synchronized Intermittent Mandatory Ventilation (SIMV) with Pressure Support Ventilation (PSV) and Positive-End-Expiratory Pressure (PEEP)
52
A dual control mode provides pressure-limited ventilation with volume delivery targeted for every breath. If the desired volume is not met the ventilator will volume cycle. This describes which of the following ventilator modes?
Pressure Augmentation (Paug)
53
The ventilator mode that delivers pressure breaths that are patient- or time-triggered, volume targeted, time cycled, and where the pressure is automatically adjusted to maintain delivery of the targeted volume is which of the following?
Pressure Regulated Volume Control (PRVC)
54
The ventilator mode where every breath is patient triggered, pressure targeted, flow cycled with a volume target is which of the following?
Volume Support Ventilation (VSV)
55
A leak around a patient’s ET tube cuff during pressure support ventilation (PSV) will cause which of the following to occur?
Time cycle
56
Calculate the tubing compliance (CT) when the measured volume is 100 mL and the static pressure is 65 cm H2O.
1.5 mL/cm H2O
57
Calculate the tubing compliance (CT) when the measured volume is 150 mL and the static pressure is 53 cm H2O.
2.8 mL/cm H2O
58
When initially setting up a ventilator the plateau pressure (PPlateau) is measured at 47 cm H2O with a set volume of 100 mL. After applying the ventilator to the patient, the average peak pressure reached during volume delivery is 28 cm H2O. How much volume is lost in the ventilator tubing?
60 mL
59
When initially setting up a ventilator, the plateau pressure (PPlateau) is measured at 68 cm H2O with a set volume of 200 mL. After applying the ventilator to the patient, the average peak pressure reached during volume delivery is 22 cm H2O. How much volume is lost in the ventilator tubing?
64.7 mL
60
Calculate the volume lost if the tubing compression factor is 2.5 mL/cm H2O and the pressure change during ventilation is 32 cm H2O.
80 mL
61
Calculate the average tidal volume for a patient who has a minute ventilation of 10 L/min with a respiratory rate (RR) of 12 bpm.
833 mL
62
Calculate the inspiratory time (TI) when a ventilator is set at a tidal volume (VT) of 800 mL and a constant flow rate of 40 L/min.
1.2 seconds
63
Calculate the inspiratory time (TI) when a ventilator is set at a tidal volume (VT) of 500 mL and a constant flow rate of 30 L/min.
1 second
64
Calculate the inspiratory to expiratory (I:E) ratio for a ventilator that is set to deliver 850 mL at a frequency of 15 bpm with a flow rate of 45 L/min.
1:2.5
65
Calculate the inspiratory to expiratory (I:E) ratio when the inspiratory time is 0.5 seconds and the respiratory rate is 30 bpm.
1:3
66
Calculate the expiratory time (TE) when the ventilator frequency is set to 25 bpm and the inspiratory time (TI) is 0.75 second.
1.65 seconds
67
What is the flow rate necessary to deliver a tidal volume (VT) of 600 mL, with a constant waveform, at a respiratory rate of 15 breaths/min with an I:E of 1:4?
45 L/min
68
Setting flow rates high will cause which of the following to occur?
Increase peak pressures
69
Slow flow rates will cause which of the following to occur?
Shorten expiratory time
70
The flow wave form pattern that provides the shortest inspiratory time (TI) of all the available flow patterns with an equivalent peak flow rate setting is which of the following?
Rectangular
71
The flow wave form pattern that is created during pressure targeted ventilation is which of the following?
Descending Ramp
72
The flow wave form pattern that will decrease peak pressure but at the same time may increase mean airway pressure is which of the following?
Descending Ramp
73
A patient having an acute, severe asthma exacerbation is intubated and set up on volume- controlled continuous mandatory ventilation (VC-CMV). To ensure volume delivery at the lowest peak pressure while providing for better air distribution, which flow wave form should be used?
Descending Ramp
74
The most appropriate tidal volume setting for a 6’3” male ventilator patient with normal lungs is which of the following?
500 mL
75
A 5’10” male patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV). The tidal volume and ventilator rate settings that should be recommended for this patient are which of the following?
VT = 525 mL, rate = 14bpm
76
A 5’2” female patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV). The tidal volume (VT) and ventilator rate settings that should be recommended for this patient are which of the following?
VT = 364 mL,rate = 14 bpm
77
A 26-year-old, 6’6”, 250 lb male patient, is still under the effects of anesthesia following knee surgery. His body temperature is 37° C. He has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following?
9.7 L/min
78
A 47-year-old, 5’6”, 112 lb female patient, is still under the effects of anesthesia following a hysterectomy. Her body temperature is 37° C. She has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following?
6.1 L/min
79
A 39-year-old, 5’4”, 138 lb female patient requires intubation and mechanical ventilation. Her body temperature is 39° C. She has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following?
6.8 L/min
80
A patient has a body temperature of 40° C. How should the initial minute ventilation setting be adjusted?
Increase it by 30%
81
The pattern that has been shown to improve the distribution of gas in the lungs for an intubated patient on volume-controlled continuous mandatory ventilation (VC-CMV) is which of the following?
Descending ramp
82
A 47-year-old, 6’1” male patient is admitted to the hospital due to trauma from a motor vehicle accident. Forty-eight hours post admission, the patient is suffering from respiratory distress with severe hypoxemia and is intubated. A chest x-ray, done prior to intubation , reveals a ground glass appearance bilaterally. The physician requests the volume-controlled continuous mandatory ventilation (VC-CMV) mode for this patient. The initial settings for the ventilator should be which of the following?
VT = 450 mL, rate = 18 bpm, PEEP = 8 cm H2O
83
A 65-year-old, 73-inch-tall, 195 lb male patient was admitted 2 days ago for renal failure. The patient has a history of Chronic Obstructive Pulmonary Disease (COPD) and has a pulse of 122 bpm, BP 153/88, and temperature 37° C. The patient is intubated for acute-on- chronic respiratory failure with hypoxemia. The physician requests volume-controlled continuous mandatory ventilation (VC-CMV). The initial settings for the ventilator should be which of the following?
VT = 700 mL, rate = 12 bpm, PEEP = 3 cm H2O
84
A 57-year-old, 5’3”, 165 lb female patient arrives in the open heart unit following coronary artery bypass surgery. The patient has a history of diabetes and no history of pulmonary disease. The most appropriate initial volume-controlled continuous mandatory ventilation (VC-CMV) settings are which of the following?
VT = 360 mL, rate = 15 bpm, PEEP = 5 cm H2O
85
With which flow waveform pattern will the mean airway pressure be the highest?
Descending ramp
86
A mechanically ventilated patient is going to be placed on pressure support ventilation following an acceptable spontaneous weaning trial. The patient is a 5’9” male who weighs 185 lbs. During volume-controlled continuous mandatory ventilation (VC-CMV) his average peak inspiratory pressure (PIP) was about 26 cm H2O and the plateau pressure (PPlateau) was 16 cm H2O. What initial pressure support level should be set?
10 cm H2O
87
An intubated patient with Chronic Obstructive Pulmonary Disease (COPD) is breathing on pressure support ventilation (PSV) 13 cm H2O with positive-end-expiratory pressure (PEEP) 5 cm H2O and a flow cycle setting of 25%. The pressure-time scalar shown in the figure is evaluated by the respiratory therapist. What action should the respiratory therapist take at this time?
The flow cycle setting should be increased to allow more time for exhalation.
88
When changing the control variable from volume-control (VC) to pressure control (PC), the initial inspiratory pressure should be set based on which of the following methods?
Plateau pressure measurement taken during VC ventilation
89
A 63-year-old, 5’11”, 185 lb male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted to the hospital due to liver failure. Over the course of the 48 hours he has developed respiratory distress. The respiratory therapist performs a physical assessment and finds the following: heart rate 135 bpm, respiratory rate 28 with accessory muscle use. Breath sounds are decreased bilaterally with coarse crackles in the right base. A chest x-ray from 24 hours ago shows bilateral lower lobe infiltrates. The patient has a nonproductive cough. The respiratory therapist draws an arterial blood gas which reveals: pH 7.31; partial pressure of carbon dioxide (PaCO2) 57 mm Hg; partial pressure of oxygen (PaO2) 58 mm Hg; arterial oxygen saturation (SaO2) 87%; bicarbonate (HCO3-) 27 mEq/L while receiving oxygen via nasal cannula 3 L/min. The respiratory therapist should recommend which of the following for this patient?
Use BiPAP with IPAP 10 cm H2O, EPAP 5cm H2O, bleed in 4 L/min oxygen.
90
The mode of ventilation that provides pressure-limited, time-cycled breaths that use a set tidal volume as a feedback control is which of the following?
Pressure Regulated Volume Control (PRVC)
91
The mode of pressure ventilation that is patient- or time-triggered and flow-cycled is which of the following?
Bileval Positive Airway Pressure (Bilevel PAP)
92
A patient receiving mechanical ventilation via pressure regulated volume control (PRVC) has a set target volume of 500 mL with an upper pressure limit setting of 35 cm H2O. During the respiratory therapist’s first patient ventilator system check, 25 cm H2O was needed to deliver the set volume. Several hours later the pressure to deliver the set volume is 15 cm H2O. The respiratory therapist should do which of the following?
The upper pressure limit should be reduced.
ch. 2
ch. 2
Darya Rose · 83問 · 2年前ch. 2
ch. 2
83問 • 2年前ch. 3
ch. 3
Darya Rose · 88問 · 2年前ch. 3
ch. 3
88問 • 2年前ch 41
ch 41
Darya Rose · 78問 · 2年前ch 41
ch 41
78問 • 2年前ch 42
ch 42
Darya Rose · 96問 · 2年前ch 42
ch 42
96問 • 2年前ch 4
ch 4
Darya Rose · 86問 · 2年前ch 4
ch 4
86問 • 2年前ch. 6
ch. 6
Darya Rose · 93問 · 2年前ch. 6
ch. 6
93問 • 2年前ch. 39
ch. 39
Darya Rose · 111問 · 2年前ch. 39
ch. 39
111問 • 2年前ch. 5
ch. 5
Darya Rose · 95問 · 2年前ch. 5
ch. 5
95問 • 2年前ch. 5
ch. 5
Darya Rose · 41問 · 2年前ch. 5
ch. 5
41問 • 2年前ch. 7
ch. 7
Darya Rose · 22問 · 2年前ch. 7
ch. 7
22問 • 2年前ch. 6
ch. 6
Darya Rose · 93問 · 2年前ch. 6
ch. 6
93問 • 2年前ch. 36 & 40
ch. 36 & 40
Darya Rose · 186問 · 2年前ch. 36 & 40
ch. 36 & 40
186問 • 2年前ch. 7
ch. 7
Darya Rose · 96問 · 2年前ch. 7
ch. 7
96問 • 2年前ch. 44
ch. 44
Darya Rose · 94問 · 2年前ch. 44
ch. 44
94問 • 2年前ch. 8
ch. 8
Darya Rose · 86問 · 2年前ch. 8
ch. 8
86問 • 2年前ch. 43
ch. 43
Darya Rose · 65問 · 2年前ch. 43
ch. 43
65問 • 2年前ch. 9
ch. 9
Darya Rose · 100問 · 2年前ch. 9
ch. 9
100問 • 2年前ch. 19 / 14
ch. 19 / 14
Darya Rose · 53問 · 2年前ch. 19 / 14
ch. 19 / 14
53問 • 2年前ch. 10
ch. 10
Darya Rose · 90問 · 2年前ch. 10
ch. 10
90問 • 2年前ch. 21
ch. 21
Darya Rose · 47問 · 2年前ch. 21
ch. 21
47問 • 2年前問題一覧
1
Respiratory failure due to inadequate ventilation is known as which of the following?
Hypercapnic
2
The underlying physiological process leading to pure hypercapnic respiratory failure is which of the following?
Alveolar hypoventilation
3
A patient with an opiate drug overdose is unconscious and has the following arterial blood gas results on room air:
pH 7.20; partial pressure of carbon dioxide (PaCO2) 88 mm Hg; partial pressure of oxygen (PaO2) 42 mm Hg; bicarbonate (HCO3) 25 mEq/L. Which of the following best describes this patient’s condition?
Acute hypercapnic respiratory failure
4
Acute hypercapnic respiratory failure may be caused by which of the following?
Respiratory muscle fatigue
5
Hypercapnic respiratory failure due to increased work of breathing will be caused by which of the following?
Asthma exacerbation
6
A postoperative patient complaining of dyspnea is found to have tachypnea and tachycardia, and is somewhat confused. Breath sounds reveal end inspiratory crackles in both lung bases. An arterial blood gas is drawn and reveals the following: pH 7.49; partial pressure of carbon dioxide (PaCO2) 33 mm Hg; partial pressure of oxygen (PaO2) 51 mm Hg; arterial oxygen saturation (SaO2) 87%; bicarbonate (HCO3-) 25 mEq/L while on a 30% air entrainment mask. The most appropriate respiratory therapy intervention includes which of the following?
Initiate continuous positive airway pressure (CPAP) by mask.
7
A patient with inadequate oxygenation of the brain may display which of the following conditions?
1. Confusion
2. Excitement
3. Somnolence
4. Compliance
1, 3
8
A 28-year-old man is admitted to the emergency department with suspected drug overdose. The patient is obtunded and slightly cyanotic. The arterial blood gas results obtained while the patient was breathing room air were: pH 7.24; partial pressure of carbon dioxide (PaCO2) 58 mm Hg; partial pressure of oxygen (PaO2) 52 mm Hg; bicarbonate (HCO3-) 24 mEq/L. The most appropriate interpretation of these results is which of the following?
Hypercapnic respiratory failure
9
The respiratory assessment of a 44-year-old female patient diagnosed with myasthenia gravis shows: vital capacity 475 mL, maximum inspiratory pressure (MIP) -18 cm H2O. The patient is 5 feet 6 inches tall and weighs 188 lbs. The most recent arterial blood gas on a 2L/min nasal cannula is pH 7.32, partial pressure of carbon dioxide (PaCO2) 49 mm Hg, partial pressure of oxygen (PaO2) 77 mm Hg, arterial oxygen saturation (SaO2) 95%, bicarbonate (HCO3) 24 mEq/L.The most appropriate recommendation for this patient is which of the following?
Intubation and mechanical ventilation
10
Which of the following values are indicative of acute respiratory failure and the need for ventilatory support?
1. Maximum inspiratory pressure (MIP) = – 25 cm H2O
2. Dead space to tidal volume ration (VD/VT) = 0.4
3. Vital capacity (VC) = 8 mL/kg IBW
4. pH = 7.20
3, 4
11
A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath. Physical assessment reveals: pulse 102, blood pressure 138/80, respiratory rate 25 with accessory muscle use, and breath sounds are decreased with bilateral inspiratory and expiratory wheezing with a prolonged expiratory phase. The peak expiratory flow rate is 100 L/min. The immediate action by the respiratory therapist should include which of the following?
Administer continuous bronchodilator therapy.
12
A 64-year-old female patient having an acute exacerbation of chronic obstructive pulmonary disease (COPD) was admitted to the hospital yesterday. During rounds today the respiratory therapist finds the patient to be difficult to arouse and has the following physical findings: heart rate 102, respiratory rate 23 shallow and slightly labored, breath sounds are bilaterally decreased with rhonchi in both bases. The patient has a frequent, but weak cough. The respiratory therapist draws an arterial blood gas with the following results on a 2 L/min nasal cannula: pH 7.52, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2) 45 mm Hg, arterial oxygen saturation (SaO2) 86%, bicarbonate (HCO3-) 24 m Eq/L. The most appropriate action is which of the following?
Increase the nasal cannula to 4 L/min.
13
A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented. His physical examination reveals: heart rate (HR) 120 and regular, blood pressure (BP) 146/88, temperature 38° C, respiratory rate (RR) 28 shallow and labored. Breath sounds are decreased throughout with fine late crackles on inspiration, chest expansion is decreased in both bases. The patient is not coughing. The arterial blood gas (ABG) on room air is: pH 7.52, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2 ) 42 mm Hg, Hb-O2 80%, bicarbonate (HCO3-) 24 mEq/L. This patient is retired after working in a steel factory for 38 years and he has a 50 pack-year history of smoking. The most appropriate action for the respiratory therapist to take is which of the following?
Administer oxygen via a high flow nasal cannula.
14
A 28-year-old female was admitted last night for weakness and what appears to be ascending muscle paralysis. The patient is alert and oriented. Physical findings reveal: pulse 96, regular; blood pressure (BP) 134/83; temperature 37° C; respiratory rate (RR) 24 shallow with bilateral decrease in air entry, and no adventitious breath sounds. The patient’s arterial blood gas (ABG) results on room air are: pH 7.46; partial pressure of carbon dioxide (PaCO2) 39 mmHg; partial pressure of oxygen (PaO2) 80 mmHg; Sat 97%; bicarbonate (HCO3-) 26 mEq/L on room air. The most appropriate suggestion that the respiratory therapist should make for this patient includes which of the following?
Vital capacity every two hours
15
An 80-year-old female with a diagnosis of pneumonia was admitted to the hospital 2 days ago from a nursing home. The patient is responsive only to painful stimuli. She has a peripheral IV and a feeding tube in place. Physical examination reveals: pulse 98 bpm, respiratory rate 24 and shallow, blood pressure 100/48, and temperature 39.2° C. Auscultation reveals decreased breath sounds with crackles in the bases. The patient has an occasional weak, nonproductive cough. Arterial blood gas on NC 4 L/min is pH 7.42, partial pressure of carbon dioxide (PaCO2) 38 mmHg, partial pressure of oxygen (PaO2) 40 mm Hg, arterial oxygen saturation (SaO2) 76%, bicarbonate (HCO3-) 24 mEq/L. A portable chest x- ray shows patchy basilar infiltrates in both lungs. The most appropriate action to take at this time is which of the following?
Change the nasal cannula to a nonrebreather mask.
16
The first arterial blood gas for an asthma patient in the emergency department reveals: pH 7.49; partial pressure of carbon dioxide (PCO2) 30; partial pressure of oxygen (PO2) 82; oxygen saturation (SO2) 95%; bicarbonate (HCO3-) 24 on a nasal cannula 3 L/min. The patient’s peak expiratory flow rate was 165 L/min, respiratory rate was 16, and pulse 106. After continuous aerosolized albuterol over the last hour patient’scurrent arterial blood gas results are as follows: pH 7.34; PCO2 45; PO2 49; SO2 79%; HCO3- 25 on a high flow nasal cannula 15 L/min. The patient’s peak expiratory flow rate is 95 L/min, respiratory rate 35, pulse 128, and the patient is diaphoretic. The respiratory therapist should suggest which of the following at this time?
Intubate and initiate mechanical ventilation.
17
A patient seen in the emergency department exhibits paralysis of the lower extremities that is getting progressively worse. Vital capacity is 6 mL/kg, maximum inspiratory pressure (MIP) is -17 cm H2O, and oxygen saturation measured by pulse oximeter (SpO2) is 89%. Arterial blood gases (ABGs) are pending. The physician suspects Guillain-Barré syndrome. The most appropriate action at this time is which of the following?
Intubate and mechanically ventilate.
18
Which of the following values are indicative of acute respiratory failure and the need for ventilatory support?
1. Maximum inspiratory pressure (MIP) = -38 cm H2O
2. Vital capacity (VC) = 650 mL for a 70 kg male
3. Alveolar-to-arterial partial pressure of oxygen [P(A-a)O2] = 150 on 100% oxygen
4. Maximum expiratory pressure (MEP) = 25 cm H2O
2, 4
19
The disorders that cause respiratory failure due to increased work of breathing include which of the following?
1. Myasthenia gravis
2. Cardiogenic pulmonary edema
3. Interstitial pulmonary fibrosis
4. Amyotrophic lateral sclerosis
2, 3
20
A 52-year-old male with a medical history of congestive heart failure and hypertension arrives in the emergency department because of an acute onset of dyspnea. The patient has pink frothy secretions at the mouth. A rapid physical assessment reveals a pulse of 128, respiratory rate 28 breaths/min and labored, and blood pressure 82/56 mm Hg. Bilateral coarse crackles are heard in the lung bases. Arterial blood gas results on a 12 L/min nonrebreather mask are: pH 7.32, partial pressure of carbon dioxide (PaCO2) 49 mm Hg, partial pressure of oxygen (PaO2) 50 mm Hg, arterial oxygen saturation (SaO2) 74%. The most appropriate immediate action for this patient is which of the following?
Intubation and mechanical ventilation
21
A 45-year-old woman arrives in the emergency department after ingesting an unknown quantity of pain medication and alcohol. She was found unconscious in her apartment by her friend. She is currently unresponsive to verbal stimuli. Vital signs reveal: pulse 56/min, respiratory rate 10 and shallow, BP 90/50. Her arterial blood gas on room air reveals: pH 7.21, partial pressure of carbon dioxide (PaCO2) 64 mm Hg, partial pressure of oxygen (PaO2) 52 mm Hg, bicarbonate (HCO3-) 24 mEq/L. The appropriate treatment for this patient includes which of the following?
1. Naloxone hydrochloride (Narcan)
2. Nasal cannula 4 L/min
3. Nonrebreathing mask
4. Intubation and ventilatory support
1, 4
22
A 59-year-old patient is in severe respiratory distress in the emergency department. The patient is being treated for congestive heart failure and pulmonary edema. Vital signs are pulse 98/min, respiratory rate 23/min, and BP 138/98. The patient’s arterial blood gas results on a nonrebreather mask are as follows: pH 7.35, partial pressure of carbon dioxide (PaCO2) 45 mm Hg, partial pressure of oxygen (PaO2) 49 mm Hg, arterial oxygen saturation (SaO2) 79%, and bicarbonate (HCO3-) 24 mEq/L. The respiratory therapy that is most appropriate at this time is which of the following?
Mask continuous positive airway pressure (CPAP) with 100% oxygen
23
Which of the following patients is showing the signs of acute respiratory distress?
One in the high Fowler position, diaphoretic, anxious and unable to complete a sentence
24
A 68-year-old female admitted for congestive heart failure is in respiratory distress and is being seen by the hospital’s medical emergency team in her regular room. The patient is in obvious respiratory distress and is immediately placed on a nonrebreathing mask. Physical assessment reveals: pulse 138 and thready; respiratory rate 30, shallow and labored; temperature 37° C; blood pressure 110/68. Breath sounds are bilaterally decreased with coarse crackles on inspiration. EKG shows normal sinus rhythm with widened cardiac output (QT) interval and an occasional irregular beat. No coughing is noted. The arterial blood gas on the nonrebreathing mask is: pH 7.34; PCO2 46 mm Hg; partial pressure of oxygen in the arteries (PO2) is 52 mm Hg; oxygen saturation is 86%; bicarbonate (HCO -) is
3 24 mEq/L. The patient is diaphoretic. The most appropriate ventilator mode to manage this patient initially is which of the following?
Noninvasive Positive Pressure Ventilation (NPPV)
25
A patient has recently been diagnosed with obstructive sleep apnea. The most appropriate treatment includes which of the following?
Continuous Positive Airway Pressure (CPAP)
26
Which of the following is the minimum ventilator rate that is considered full ventilatory support?
8 breaths/minute
27
Partial ventilatory support can be provided by which of the following ventilator modes?
1. Pressure Controlled Continuous Mandatory Ventilation (PC-CMV) set rate 8 breaths/minute
2. Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) set rate 4 breaths/minute
3. Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) set rate 10 breaths/minute
4. VC- MMV set Ve8 L/minute
2, 4
28
Of the following breath descriptions, which one is considered spontaneous?
Patient triggered, patient cycled, baseline pressure +5 cm H2O
29
What type of breath occurs when the ventilator controls the timing, tidal volume, or inspiratory pressure?
Mandatory
30
A home care patient diagnosed with central sleep apnea would benefit from which of the following modes of ventilation?
Noninvasive Positive Pressure Ventilation (NPPV)
31
During volume control ventilation a patient’s airway resistance increases. This change will cause which of the following to occur?
Increase in peak airway pressure
32
A 28-year-old male has arrived in the emergency department following a motor vehicle accident. He has a Glasgow Coma Score of 14. Chest x-ray reveals 5 ribs broken anteriorly in 2 areas each. Physical assessment reveals paradoxical movement of the chest. Breath sounds are diminished and the trachea is midline. Arterial blood gas on nonrebreathing mask is: pH 7.53, partial pressure of carbon dioxide (PaCO2) is 25 mm Hg, partial pressure of oxygen (PaO2) is 59 mm Hg, arterial oxygen saturation (SaO2) 93%, bicarbonate (HCO3 -) 23 mEq/L. The respiratory therapist should recommend which of the following for this patient?
Mask Continuous Positive Airway Pressure (CPAP) with supplemental oxygen
33
An assisted breath in the pressure-controlled continuous mandatory ventilation (PC-CMV) mode can be described by which of the following?
Patient triggered, pressure limited, time cycled
34
The ventilator mode that allows the patient to breathe spontaneously between operator selected time-triggered volume or pressure-targeted breaths is which of the following?
Synchronized Intermittent Mandatory Ventilation (SIMV)
35
A hemodynamically unstable patient being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode is triggering inspiration at a rate of 25 breaths/minute and has the following arterial blood gas results: pH 7.50, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2) 98 mm Hg, arterial oxygen saturation (SaO2)100%, bicarbonate (HCO3-) 24 mEq/L. The respiratory therapist should peform which of the following?
Change the mode to Volume-Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV).
36
The pressure-time scalar shown in the figure represents which of the following?
Pressure-Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) with Positive-End-Expiratory Pressure (PEEP)
37
Full ventilatory support is provided by which of the following modes?
Pressure-Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) rate 12 with pressure support (PS)
38
The ventilator mode that would be most appropriate to iatrogenically induce hyperventilation to manage a closed head injury patient with severely elevated intracranial pressure (ICP) is which of the following?
Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV)
39
If flow or sensitivity is set incorrectly, which of the following is most likely to occur during the continuous mandatory ventilation (CMV) mode?
Ventilator dysynchrony
40
When a patient does not breathe spontaneously while in the airway pressure release ventilation (APRV) mode, the pressure-time scalar looks like that of which of the following?
Pressure-Controlled Inverse Ratio Ventilation (PCIRV)
41
A breath that is triggered, limited, and cycled by the mechanical ventilator is which of the following?
Mandatory breath
42
A breath that is patient triggered, pressure targeted, and time cycled is which of the following?
Assisted breath
43
Which mode of ventilation is shown in the pressure-time scalar in the figure?
Volume-Controlled Continuous Mandatory Ventilation (VC-CMV)
44
Which mode of ventilation is shown in the pressure-time scalar in the figure?
Volume-Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) with pressure support (PS)
45
A patient triggered, pressure limited, flow cycled breath describes which of the following?
Pressure-support breath
46
When a patient is to be switched from continuous mandatory ventilation (CMV) to synchronized intermittent mandatory ventilation (SIMV) to facilitate weaning from mechanical ventilation, which of the following could be used in addition to SIMV to assist this process?
Pressure Support (PS)
47
Every breath from the ventilator is time or patient triggered, pressure limited, and time cycled. This describes which of the following ventilator modes?
Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV)
48
If lung compliance decreases while a patient is receiving mechanical ventilation with pressure-controlled continuous mandatory ventilation (PC-CMV) which of the following would occur?
Tidal volume decreases
49
A patient arrives in the emergency department following a motor vehicle accident in which the patient sustained a deceleration chest injury. The patient was intubated in the field for airway protection. Physical assessment reveals that the patient is spontaneously breathing at a rate of 16 breaths per minute and breath sounds reveal bibasilar fine crackles at end inspiration. A second arterial blood gas was drawn while the patient was receiving 100% oxygen from an air entrainment large volume nebulizer.
Continuous Positive Airway Pressure (CPAP) with supplemental oxygen
50
A patient with Acute Respiratory Distress Syndrome (ARDS) has developed a pneumothorax from elevating peak and plateau pressures. The patient is currently being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode with a set rate of 12 bpm. However, the patient is triggering the ventilator at a rate of 25 bpm. The arterial blood gas reveals ventilator induced hyperventilation with corrected hypoxemia. The most appropriate recommendation to manage this patient on the ventilator is which of the following?
Switch the mode to pressure-controlled synchronized mandatory ventilation (PC-SIMV)
51
A patient, who is nasally intubated, due to facial surgery, has been successful on her spontaneous breathing trial. She currently has moderate hypoxemia, despite a fractional inspired oxygen (FIO2) of 40% and positive-end-expiratory pressure (PEEP) of 5 cm H2O while on volume-controlled continuous mandatory ventilation (VC-CMV). The most appropriate ventilator mode for this patient is which of the following?
Synchronized Intermittent Mandatory Ventilation (SIMV) with Pressure Support Ventilation (PSV) and Positive-End-Expiratory Pressure (PEEP)
52
A dual control mode provides pressure-limited ventilation with volume delivery targeted for every breath. If the desired volume is not met the ventilator will volume cycle. This describes which of the following ventilator modes?
Pressure Augmentation (Paug)
53
The ventilator mode that delivers pressure breaths that are patient- or time-triggered, volume targeted, time cycled, and where the pressure is automatically adjusted to maintain delivery of the targeted volume is which of the following?
Pressure Regulated Volume Control (PRVC)
54
The ventilator mode where every breath is patient triggered, pressure targeted, flow cycled with a volume target is which of the following?
Volume Support Ventilation (VSV)
55
A leak around a patient’s ET tube cuff during pressure support ventilation (PSV) will cause which of the following to occur?
Time cycle
56
Calculate the tubing compliance (CT) when the measured volume is 100 mL and the static pressure is 65 cm H2O.
1.5 mL/cm H2O
57
Calculate the tubing compliance (CT) when the measured volume is 150 mL and the static pressure is 53 cm H2O.
2.8 mL/cm H2O
58
When initially setting up a ventilator the plateau pressure (PPlateau) is measured at 47 cm H2O with a set volume of 100 mL. After applying the ventilator to the patient, the average peak pressure reached during volume delivery is 28 cm H2O. How much volume is lost in the ventilator tubing?
60 mL
59
When initially setting up a ventilator, the plateau pressure (PPlateau) is measured at 68 cm H2O with a set volume of 200 mL. After applying the ventilator to the patient, the average peak pressure reached during volume delivery is 22 cm H2O. How much volume is lost in the ventilator tubing?
64.7 mL
60
Calculate the volume lost if the tubing compression factor is 2.5 mL/cm H2O and the pressure change during ventilation is 32 cm H2O.
80 mL
61
Calculate the average tidal volume for a patient who has a minute ventilation of 10 L/min with a respiratory rate (RR) of 12 bpm.
833 mL
62
Calculate the inspiratory time (TI) when a ventilator is set at a tidal volume (VT) of 800 mL and a constant flow rate of 40 L/min.
1.2 seconds
63
Calculate the inspiratory time (TI) when a ventilator is set at a tidal volume (VT) of 500 mL and a constant flow rate of 30 L/min.
1 second
64
Calculate the inspiratory to expiratory (I:E) ratio for a ventilator that is set to deliver 850 mL at a frequency of 15 bpm with a flow rate of 45 L/min.
1:2.5
65
Calculate the inspiratory to expiratory (I:E) ratio when the inspiratory time is 0.5 seconds and the respiratory rate is 30 bpm.
1:3
66
Calculate the expiratory time (TE) when the ventilator frequency is set to 25 bpm and the inspiratory time (TI) is 0.75 second.
1.65 seconds
67
What is the flow rate necessary to deliver a tidal volume (VT) of 600 mL, with a constant waveform, at a respiratory rate of 15 breaths/min with an I:E of 1:4?
45 L/min
68
Setting flow rates high will cause which of the following to occur?
Increase peak pressures
69
Slow flow rates will cause which of the following to occur?
Shorten expiratory time
70
The flow wave form pattern that provides the shortest inspiratory time (TI) of all the available flow patterns with an equivalent peak flow rate setting is which of the following?
Rectangular
71
The flow wave form pattern that is created during pressure targeted ventilation is which of the following?
Descending Ramp
72
The flow wave form pattern that will decrease peak pressure but at the same time may increase mean airway pressure is which of the following?
Descending Ramp
73
A patient having an acute, severe asthma exacerbation is intubated and set up on volume- controlled continuous mandatory ventilation (VC-CMV). To ensure volume delivery at the lowest peak pressure while providing for better air distribution, which flow wave form should be used?
Descending Ramp
74
The most appropriate tidal volume setting for a 6’3” male ventilator patient with normal lungs is which of the following?
500 mL
75
A 5’10” male patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV). The tidal volume and ventilator rate settings that should be recommended for this patient are which of the following?
VT = 525 mL, rate = 14bpm
76
A 5’2” female patient with normal lungs has been intubated and requires mechanical ventilation with volume-controlled continuous mandatory ventilation (VC-CMV). The tidal volume (VT) and ventilator rate settings that should be recommended for this patient are which of the following?
VT = 364 mL,rate = 14 bpm
77
A 26-year-old, 6’6”, 250 lb male patient, is still under the effects of anesthesia following knee surgery. His body temperature is 37° C. He has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following?
9.7 L/min
78
A 47-year-old, 5’6”, 112 lb female patient, is still under the effects of anesthesia following a hysterectomy. Her body temperature is 37° C. She has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following?
6.1 L/min
79
A 39-year-old, 5’4”, 138 lb female patient requires intubation and mechanical ventilation. Her body temperature is 39° C. She has no history of lung disease. The appropriate initial minute ventilation for this patient is which of the following?
6.8 L/min
80
A patient has a body temperature of 40° C. How should the initial minute ventilation setting be adjusted?
Increase it by 30%
81
The pattern that has been shown to improve the distribution of gas in the lungs for an intubated patient on volume-controlled continuous mandatory ventilation (VC-CMV) is which of the following?
Descending ramp
82
A 47-year-old, 6’1” male patient is admitted to the hospital due to trauma from a motor vehicle accident. Forty-eight hours post admission, the patient is suffering from respiratory distress with severe hypoxemia and is intubated. A chest x-ray, done prior to intubation , reveals a ground glass appearance bilaterally. The physician requests the volume-controlled continuous mandatory ventilation (VC-CMV) mode for this patient. The initial settings for the ventilator should be which of the following?
VT = 450 mL, rate = 18 bpm, PEEP = 8 cm H2O
83
A 65-year-old, 73-inch-tall, 195 lb male patient was admitted 2 days ago for renal failure. The patient has a history of Chronic Obstructive Pulmonary Disease (COPD) and has a pulse of 122 bpm, BP 153/88, and temperature 37° C. The patient is intubated for acute-on- chronic respiratory failure with hypoxemia. The physician requests volume-controlled continuous mandatory ventilation (VC-CMV). The initial settings for the ventilator should be which of the following?
VT = 700 mL, rate = 12 bpm, PEEP = 3 cm H2O
84
A 57-year-old, 5’3”, 165 lb female patient arrives in the open heart unit following coronary artery bypass surgery. The patient has a history of diabetes and no history of pulmonary disease. The most appropriate initial volume-controlled continuous mandatory ventilation (VC-CMV) settings are which of the following?
VT = 360 mL, rate = 15 bpm, PEEP = 5 cm H2O
85
With which flow waveform pattern will the mean airway pressure be the highest?
Descending ramp
86
A mechanically ventilated patient is going to be placed on pressure support ventilation following an acceptable spontaneous weaning trial. The patient is a 5’9” male who weighs 185 lbs. During volume-controlled continuous mandatory ventilation (VC-CMV) his average peak inspiratory pressure (PIP) was about 26 cm H2O and the plateau pressure (PPlateau) was 16 cm H2O. What initial pressure support level should be set?
10 cm H2O
87
An intubated patient with Chronic Obstructive Pulmonary Disease (COPD) is breathing on pressure support ventilation (PSV) 13 cm H2O with positive-end-expiratory pressure (PEEP) 5 cm H2O and a flow cycle setting of 25%. The pressure-time scalar shown in the figure is evaluated by the respiratory therapist. What action should the respiratory therapist take at this time?
The flow cycle setting should be increased to allow more time for exhalation.
88
When changing the control variable from volume-control (VC) to pressure control (PC), the initial inspiratory pressure should be set based on which of the following methods?
Plateau pressure measurement taken during VC ventilation
89
A 63-year-old, 5’11”, 185 lb male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted to the hospital due to liver failure. Over the course of the 48 hours he has developed respiratory distress. The respiratory therapist performs a physical assessment and finds the following: heart rate 135 bpm, respiratory rate 28 with accessory muscle use. Breath sounds are decreased bilaterally with coarse crackles in the right base. A chest x-ray from 24 hours ago shows bilateral lower lobe infiltrates. The patient has a nonproductive cough. The respiratory therapist draws an arterial blood gas which reveals: pH 7.31; partial pressure of carbon dioxide (PaCO2) 57 mm Hg; partial pressure of oxygen (PaO2) 58 mm Hg; arterial oxygen saturation (SaO2) 87%; bicarbonate (HCO3-) 27 mEq/L while receiving oxygen via nasal cannula 3 L/min. The respiratory therapist should recommend which of the following for this patient?
Use BiPAP with IPAP 10 cm H2O, EPAP 5cm H2O, bleed in 4 L/min oxygen.
90
The mode of ventilation that provides pressure-limited, time-cycled breaths that use a set tidal volume as a feedback control is which of the following?
Pressure Regulated Volume Control (PRVC)
91
The mode of pressure ventilation that is patient- or time-triggered and flow-cycled is which of the following?
Bileval Positive Airway Pressure (Bilevel PAP)
92
A patient receiving mechanical ventilation via pressure regulated volume control (PRVC) has a set target volume of 500 mL with an upper pressure limit setting of 35 cm H2O. During the respiratory therapist’s first patient ventilator system check, 25 cm H2O was needed to deliver the set volume. Several hours later the pressure to deliver the set volume is 15 cm H2O. The respiratory therapist should do which of the following?
The upper pressure limit should be reduced.