Mechanical Ventilation Final With NBRC questions and Answers., Exams of Medicine

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Mechanical Ventilation Final With NBRC questions and Answers. closed suction catheters may be more appropriate than using open suctioning because of - \they reduce the risk of infections the procedure of instilling normal saline into the ET before suctioning is known to - \increase an elderly pts sensation of dyspnea silent aspiration and VAP can occur with cuffed Et's as a result of - \injury to the mucosa during insertion and manipulation of the tube following insertion, interference with the normal cough reflex, and aspiration of contaminated secretions that pool above the ET cuff what is true regarding the special ET that provides continuous aspiration of subglottic secretions? - \a pressure of 20 mmHg is applied continuously to the suction lumen a 15 yop with sever acute asthma is being mechanically ventilated. what method will deliver the largest quantity of a beta agonist to the respiratory tract? - \SVN when delivering a medication by MDI to a ventilated pt the best placement for the device in the ventilator circuit is - \less than 30 cm from the Y connector on the inspriatory side of the circuit with spacer what statement is not true when using an externally powered SVN placed in the ventilator circuit? - \the HME doesnt have to be removed from the circuit when using an SVN the use of atropine in pts who will be having fiberoptic bronchoscopy is for the purpose of - \reducing respiratory rate and Ve during fiberoptic bronchoscopy of mechanically ventilated pts the RT can anticipate what types of changes in ventilator fucntion - \increase in peak pressure postural drainage positions recommended for mechanically ventilated pts include - \seated a pt on mechanical ventilation is suctioned for large amounts of foul smelling green sputum. the pt has a temp of 39C and an elevated WBC count. the most likely cause of this problem is - \pseudomonas infection pt centered mechanical ventilation involves - \asking the pt about his or her level of comfort and dyspnea when making ventilator changes what must be performed during pt transport to reduce the risk of complications - \provide adequate oxygenation and ventilation, maintain acceptable hemodynamic stability, and monitor the pts cardiopulmonary status a 25 yow is recovering from serve pneumonia and has been receiving ventilatory support for 2 days. current FiO2 is 60% and the pts PaO2 on this setting is 200 mmHg. what changes in FiO2 would achieve a target PaO2 of 80 mmHg? - \0.25 CPAP can only be used with pts who has - \spontaneous breathing a PEEP study is being performed on a pt when the PEEP is increased form 10 to 15, CO decreases from 4 to 2. what would be the next most appropriate step? - \decreased PEEP to 10 during mechanical ventilation with VC CMV the PEEP is 10 and PIP is 34. the PEEP is increased to 15 and PIP rises to 40. the rise PIP indicates - \a normal occurrence when PEEP is increased a 38 yom with ARDS is undergoing mechanical ventilation. the results of ABG are pH 7.38, PaCO2 42, PaO2 55. the ventilator settings are FiO2 0.9, f 10 bpm, Vt 550, and PEEP 5. based on this information, what midge be changed to improve the pts oxygenation status - \PEEP recent research suggests the way to establish an optimum PEEP level in a pt with ARDS is to - \perform a recruitment de-recruitment maneuver to establish the UIPd during deflation assessment for optimum PEEP is being determined in a mechanically ventilated pt. PEEP is increased from 5 to 10 to 15. Volume delivery remains constant at 450. PaO2 increases form 55 to 63 to 78. BP remains fairly constant. mixed venous PO2 goes from 27 to 36 to 30 at 15 of PEEP. based on these findings, the mot appropriate action is to - \use a PEEP of 10 During PC-CMV the RT observes the pressure-time scalar showing a pressure spike at the beginning of the pressure curve before the pressure adjust to the set value. The most appropriate action is - \adjust the inspiratory rise time control An increase in airway resistance during pressure ventilation will result in - \inspiration will end prior to flow tapering to zero A reduction in compliance during pressure ventilation will cause - \decreased delivered Vt what is the cause of the change in a pressure volume loop when the pressure has increased from 20 to 35 and is moving to the right of the loop in VC-CMV - \decreased compliance During a patient-ventilator system check the respiratory therapist notices that the pressure-volume loop begins at zero on the x-axis but does not return to zero during expiration. The cause of this is - \ventilator circuit leak if you are shown a flow volume loop and the part of the curve occurs to the left of the y- axis this shows - \spontaneous without support What condition causes a pressure-volume loop during VC-CMV to extend farther to the right and flatten out? - \pneumonia what is permissive hypercapnia - \higher than normal PaCO2 values resulting from ventilation strategies used to protect the lungs from injury associated with ventilation what can be used to identify the mode of ventilation being used - \scalar to correct auto-PEEP you - \either make a longer Te or decrease RR desired Vt - \(Known PaCO2 x Known VT)/Desired PaCO2 During mechanical ventilation of a patient with COPD, the PaCO2 = 58 mm Hg and the minute ventilation = 5.5 L/min. The desired PaCO2 for this patient is 45 mm Hg. To what should the minute ventilation be changed? - \7.1 L/min A patient with pneumonia and underlying COPD is being mechanically ventilated in the VC-CMV mode with VT 650 mL. The resulting PaCO2 is 62 mm Hg. What change should be made to the VT to obtain a desired PaCO2 of 50 mm Hg for this patient? - \800 mL how to you determine the correct suction catheter size based on the ETT size - \multiply ET size by 3 this converts the ET size to french then divide by 2 to used half or less of ET diameter What can cause metabolic acidosis? - \overdose with salicylate and potassium deficiency what situation should iatrogenic hyperventilation be considered? - \acute neurological deterioration with increased ICP Permissive hypercapnia could benefit patients with - \acute lung injury What size suction catheter is appropriate for use in a patient with a 7-mm ET tube? - \10 Fr A mechanically ventilated patient continues to have rhonchi after deep suctioning. The respiratory therapist should recommend - \vest airway clearance system An invasively ventilated patient with ARDS is on PC-CMV, PIP = 30 cm H2O, PEEP = 12 cm H2O, FIO2 = 1.0. The patient's returned VT is 320 mL. The ABG results on these settings are: pH 7.3, PaCO2 53 mm Hg, PaO2 62 mm Hg. The patient is placed in the prone position, and after 1 hour, ABG results show: pH 7.38, PaCO2 46 mm Hg, PaO2 83 mm Hg. The respiratory therapist should do - \keep the pt in the prone position and decrease FiO2 What effect does positive-pressure ventilation have on fluid balance? - \it increases plasma ADH levels pulmonary shunt - \CcO2-CaO2/CcO2-CvO2 Calculate the pulmonary shunt fraction using the following data: Pb = 757 mm Hg; hemoglobin (Hb) = 11 g/dL; FIO2 = 0.5; PaO2 = 86 mm Hg; PaCO2 = 40 mm Hg; SaO2 = 91%; = 40 mm Hg; = 71%; respiratory exchange quotient (R) = 0.8. - \19% Calculate the pulmonary shunt fraction for a patient with the following data: Pb = 760 mm Hg; Hb = 10 g/dL; respiratory quotient = 0.8; FIO2 = 0.6; PaO2 = 100 mm Hg; SaO2 = 93%; PaCO2 = 45 mm Hg; = 36 mm Hg; = 70%. - \26% Calculate the pulmonary shunt fraction for a patient with the following data: CAO2 = 17 vol%; CaO2 = 16.5 vol%; = 11 vol%. - \8% PEEP therapy is indicated for patients with - \PaO2 of 100 mmHg while receiving an FiO2 of 0.8 Assessing the outcome of PEEP at levels set above 15-20 cm H2O is best done using - \pulmonary artery occlusion pressure An absolute contraindication to PEEP is - \untreated tension penumothorax The level of applied PEEP should be set at what point on the pressure-volume curve? - \above the upper inflection point of the deflation curve The point on a static pressure-volume curve where the alveoli begin to open is referred to as - \lower inflection point on the inflation limb The "sigmoid" shape of the static pressure-volume lung recruitment maneuver indicates - \lung units open at different times with different pressures a pt with extensive infiltrates throughout the right lung should be place in what position to improve O2 - \left lung down laterally A mechanically ventilated patient is being assessed for her level of sedation. The patient is semiasleep and responds to verbal commands. What score on the Ramsay Sedation Scale should be assigned to this patient? - \3 what is the sedation scale that uses a graduated single category? - \ramsay sedation scale The group of drugs that interact with GABA receptor complex on neurons in the brain is - \benzoiazepines