Mechanical Ventilation Exam 2 questions with complete solutions., Exams of Nursing

Download Mechanical Ventilation Exam 2 questions with complete solutions. and more Exams Nursing in PDF only on Docsity! Mechanical Ventilation Exam 2 questions with complete solutions In which of the following situations is volume-controlled ventilation sometimes used? - ANSWER: ✔✔I. When a precise PaCO2 has to be maintained (some closed-head injuries). II. When more even distribution of ventilation is required Spontaneous breath modes include all of the following except: - ANSWER: ✔✔continuous mandatory ventilation assist-control. What is the primary physiological effect of positive end-expiratory pressure (PEEP)? - ANSWER: ✔✔Increase the functional residual capacity (FRC). Useful in treating Refractory Hypoxemia. (when a low Pa02 doesn't respond to high Fi02 Which of the following is an advantage of intermittent mandatory ventilation (IMV) over continuous mandatory ventilation (CMV)? - ANSWER: ✔✔IMV results in lower pleural pressures for a given VE. Compared to using pressure as the trigger variable, what is the major advantage of flow-triggering? - ANSWER: ✔✔Decreased work of breathing Which of the following modes is commonly selected for patients with neuromuscular disorders? - ANSWER: ✔✔VC-IMV While observing a patient receiving ventilatory support, you notice that some delivered breaths are begun or ended by the machine, whereas others are begun and ended by the patient. Which of the following modes of ventilatory support is in force? - ANSWER: ✔✔Intermittent mandatory ventilation (IMV) If the pressure waveform of a ventilator remains the same when a patient's lung mechanics change, then what is the ventilator? - ANSWER: ✔✔Pressure controller What parameter serves as the baseline variable on all modern ventilators? - ANSWER: ✔✔Pressure Mean airway pressure is highest with what waveform? - ANSWER: ✔✔Rectangular pressure During pressure-targeted ventilation, which of the following settings determine VT? - ANSWER: ✔✔I. Pressure difference II. Inspiratory time III. Time constant Flow serves as a limit variable whenever a ventilator controls what? - ANSWER: ✔✔Flow primary parameters used to alter the breath size in pressure controlled? - ANSWER: ✔✔Positive inspiratory pressure (PIP) & positive end-expiratory pressure (PEEP) What is the mode of ventilatory support in which patient's inspiratory efforts are augmented with a set amount of positive airway pressure? - ANSWER: ✔✔Pressure support ventilation (PSV) A patient is receiving continuous mandatory ventilation in the control mode at a rate of 15/min. The inspiratory time is 0.8 second. What is the expiratory time? - ANSWER: ✔✔3.2 seconds What is the application of pressure above atmospheric at the airway throughout expiration during mechanical ventilation? - ANSWER: ✔✔Positive end-expiratory pressure (PEEP) During volume control ventilation, the clinician has control over which of the following? - ANSWER: ✔✔II. Volume waveform III. Flow waveform During volume-targeted ventilation, which of the following settings determine the machine-delivered minute volume? - ANSWER: ✔✔I. Volume III. Rate A patient is receiving continuous mandatory ventilation through a constant flow generator in the control mode at a rate of 20/min with a VT of 750 mL. The inspiratory time is 1 second. What is the flow? - ANSWER: ✔✔45 L/min Which of the following can be used by a ventilator as a conditional variable? - ANSWER: ✔✔I. Volume II. Pressure III. Flow IV. Time Calculate the average tidal volume for a patient who has a minute ventilation of 10 L/min with a respiratory rate (RR) of 12 breaths/min. - ANSWER: ✔✔833 ml 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? - ANSWER: ✔✔descending ramp 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 lb. 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? - ANSWER: ✔✔10 cm H2O Calculate the expiratory time (TE) when the ventilator frequency is set to 25 breaths/min and the inspiratory time (TI) is 0.75 second. - ANSWER: ✔✔1.65 secs Calculate the tubing compliance (CT) when the measured volume is 150 mL and the static pressure is 53 cm H2O. a. 0.003 mL/cm H2O b. 0.35 cm H2O/mL c. 2.8 mL/cm H2O d. 7.95cm H2O/mL - ANSWER: ✔✔2.8 mL/cm H2O Calculate tubing compliance (CT) by dividing measured volume by measured static pressure. Slow flow rates will cause which of the following to occur? a. Poor gas exchange b. Increase peak pressures c. Shorten expiratory time d. Decrease mean airway pressure - ANSWER: ✔✔shorten expiratory time 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? a. 64% b. 74% c. 85% d. 95% - ANSWER: ✔✔C. 85% 90*0.5/53 = 45/53 = .849 The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges? a. 40 and 55 mm Hg b. 50 and 60 mm Hg c. 60 and 100 mm Hg d. 100 and 120 mm Hg - ANSWER: ✔✔60 and 100 mm Hg What is the range for setting flow triggering? a. 1 to 10 L/min b. 10 to 15 L/min c. 12 to 16 L/min d. 20 to 30 L/min - ANSWER: ✔✔1 to 10 L/min Following successful cardiac resuscitation, a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (FIO2) settings? a. 0.5 b. 0.6 c. 0.8 d. 1 - ANSWER: ✔✔1 aka 100% 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? a. Decrease the CPAP to 3 cm H2O. b. Increase the CPAP to 8 cm H2O. c. Increase pressure support to 10 cm H2O. d. Change the flow trigger setting to 1 L/min. - ANSWER: ✔✔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? a. 2 cm H2O b. 6 cm H2O c. 8 cm H2O d. 10 cm H2O - ANSWER: ✔✔10 cmH20 A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity? a. 10 mg H2O/L at 35° C to 37° C b. 20 mg H2O/L at 31° C to 35° C c. 30 mg H2O/L at 31° C to 35° C d. 47 mg H2O/L at 35° C to 37° C - ANSWER: ✔✔30 mg H2O/L at 31° C to 35° C In which situation should the heat moisture exchanger (HME) be replaced with a heated humidification system? a. With all tracheostomy tubes b. After 3 days of ventilation c. After 24 hours of ventilation d. Thick secretions not cleared by suctioning - ANSWER: ✔✔Thick secretions not cleared by suctioning 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? - ANSWER: ✔✔verifying the physicians orders How long after beginning mechanical ventilation on a patient should an arterial blood gas sample be drawn? - ANSWER: ✔✔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? a. Sedate the patient. b. Switch to (PC-CMV). c. Decrease set rate to 8 bpm. d. Switch to (VC-SIMV). - ANSWER: ✔✔Switch to (VC-SIMV). An increasing PIP may indicate which of the following? a. Decreasing lung compliance b. Decreasing airway resistance c. Leak in the ventilator circuit d. Increasing dynamic compliance - ANSWER: ✔✔Decreasing lung compliance 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 is most likely indicates which of the following? a. Decrease in dynamic compliance B. Increase in airway resistance C. Decrease in static compliance D. Increase in elastic recoil of alveolar walls. - ANSWER: ✔✔Increase in airway resistance 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? A. Administer a bronchodilator B. Insert a chest tube C. Increase extrinsic PEEP D. Suction airway secretions - ANSWER: ✔✔Suction airway secretions Following initiation of VC-CMV ventilation, the patient's average peak inspiratory pressure (PIP) is 23 cmH2O. The high pressure limit alarm should be set at which of the following? A. 28 cmH2O B. 33 cmH2O C. 38 cmH2O D. 42 cmH20 - ANSWER: ✔✔33 cmH2O A 46-year-old male patient is 2 days post-op for surgery to repair an 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 bibaslar infiltrates. The most likely cause of this patient's clinical presentation is which of the following? A. Asthma B. Pneumonia C. Pneumothorax D. Pleaural effusion - ANSWER: ✔✔Pneumonia Identify the plateau pressure (Pplateau) for the pressure controlled continuous mandatory ventilation (PC-CMV) breaths in the figure. A. Point A (the beginning of inspiration)* B. Point B (rise)* C. Point C (peak)* D. Point D (point just prior to descent)* - ANSWER: ✔✔Point D To reduce the risk of tracheal damage associated with overinflated tube cuffs, intracuff pressures should not exceed what range of pressure? A. 10-15 mm Hg B. 15-20 mm Hg C. 20-25 mm Hg D. 25-30 mm Hg - ANSWER: ✔✔20-25 mm Hg 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? - ANSWER: ✔✔pneumothorax 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/min, 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? - ANSWER: ✔✔plueral effusion 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? - ANSWER: ✔✔release air from cuff The normal airway resistance range is which of the following? - ANSWER: ✔✔.6-2.4 An increase in the peak inspiratory flow rate would increase which of the following? a. VT b. TCT c. Exp time d. Insp time - ANSWER: ✔✔expiratory time Peep setting for pulmonary edema/ CHF on vent - ANSWER: ✔✔5-10cmH20 Pplat setting on vent - ANSWER: ✔✔<30 PaO2 setting for COPD on vent - ANSWER: ✔✔55-75mmHg PaO2 setting for asthma on vent - ANSWER: ✔✔60-100 Best flow wavelength for COPD on vent - ANSWER: ✔✔descending Best flow wavelength for asthma on vent - ANSWER: ✔✔descending Best flow wavelength for neuromuscular disease on vent - ANSWER: ✔✔descending or rectangle (constant) Best flow wavelength for pulmonary edema/CHF on vent - ANSWER: ✔✔descending or rectangle (constant) Best mode of ventilation for COPD on vent - ANSWER: ✔✔PC-CMV Best mode of ventilation for asthma on vent - ANSWER: ✔✔PC-CMV Best mode of ventilation for neuromuscular disease on vent - ANSWER: ✔✔volume Ti setting on vent for asthma - ANSWER: ✔✔≤1 second PaCo2 setting for asthma on vent - ANSWER: ✔✔Permissive Hypercapnia 45-80 (with a norm pH range ≥7.2) Inspiratory Flow setting for asthma on vent - ANSWER: ✔✔80-100 Inspiratory Flow setting for neuromuscular disease on vent - ANSWER: ✔✔>60 With a closed head injury, what is PaCo2 setting on vent and why? - ANSWER: ✔✔25-30 because increased CO2 will cause ICP to elevate so we want to hyperventilate Vt for closed head injury on vent - ANSWER: ✔✔8-12 We want to hyperventilate if ICP is bad normal blood pressure - ANSWER: ✔✔120/80 mmHg Normal CVP range - ANSWER: ✔✔2-6 mmHg normal pulmonary artery pressure - ANSWER: ✔✔25/8mmHg What is MLT? - ANSWER: ✔✔After full inflation of the occluding cuff of an endotracheal or tracheostomy tube, the withdrawal of a small volume of air or saline solution so that a slight leak is heard at the end of (positive pressure) inspiration, to avoid tracheal trauma resulting from overinflation. What can High cuff pressure indicate? - ANSWER: ✔✔overinflated cuff too small ETT displacement of tube For every ___ added to circuit, ______ Vt by ______ - ANSWER: ✔✔6 in; decrease; 50-70mL Normal Capnography Reading - ANSWER: ✔✔35-43 mmHg Deadspace to tidal volume ratio (VD/VT) - ANSWER: ✔✔PaCO2-PECO2/PaCO2 Normal: .2-.4 (up to 60% for ventilator patients) Airway Resistance (Raw) - ANSWER: ✔✔(Peak Inspiratory Pressure - Plateau Pressure) / flow PIP-Plat/flow To determine pressure gradient - ANSWER: ✔✔PIP - PEEP An increase in peak inspiratory flow rate increases what? - ANSWER: ✔✔expiratory time pressure triggering settings - ANSWER: ✔✔-1 to -2 cmH20 To fix autopeep - ANSWER: ✔✔v VT (v VT=vTI=^Te) v rate add more peep change mode (IMV) to allow spontaneous breaths Temp alarm - ANSWER: ✔✔low 30 high 38 rainout - ANSWER: ✔✔when PT temp is less than gas leaving the humidifier. as room temp decreases, this increases dull percussion note - ANSWER: ✔✔PNA, plueral effusion Hyperresonant percussion note - ANSWER: ✔✔COPD, pneumothorax, asthma, emphysema