Solved Questions on Pilbeam Mechanical Ventilation, Exams of Nursing

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Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions A place to measure temperature - correct answer ✅AXILLA (UNDERARM) Something in the ventilator circuit that adds dead space (abbreviation) - correct answer ✅HME A cause of abdominal distention due to fluid - correct answer ✅ASCITES The ____________inflection point indicates a time at which large numbers of alveoli are becoming overinflated - correct answer ✅UPPER A multipart procedure to check that a ventilator is working properly (abbreviation) - correct answer ✅OVP A cuffed endotracheal tube has a________balloon - correct answer ✅PILOT A common place for leaks - correct answer ✅HUMIDIFIER It puts air in the pleural space and reduces lung compliance - correct answer ✅pneumothorax Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions The setting that allows patient triggering - correct answer ✅SENSITIVITY Cell death - correct answer ✅NECROSIS The_______ inflection point indicates the pressure at which large numbers of alveoli are being recruited - correct answer ✅LOWER Type of compliance measured at no flow - correct answer ✅STATIC Type of compliance that is measured during gas movement - correct answer ✅DYNAMIC A pressure that can be measured continuously by a flow-directed catheter (abbreviation) - correct answer ✅PAP Another term used to describe tubing compliance is_______ volume - correct answer ✅COMPRESSIBLE Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions Method for ensuring no leaks around an endotracheal tube (abbreviation) - correct answer ✅MLT List eight observations that the clinician should make when assessing the physiologic status of a patient receiving mechanical ventilation. - correct answer ✅a. Patient's color, b. respiratory rate c. breathing pattern, d. accessory muscle use e. chest movement, f. breath sounds g. work of breathing, h. level of consciousness. Documentation of patient information and ventilator settings should be made on the_______. - correct answer ✅Ventilator flow sheet. Before a ventilator can be used on a patient, the respiratory therapist must confirm this procedure was performed and passed on that ventilator. - correct answer ✅An operational verification procedure. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions In addition to regularly timed checks, list six instances when patient- ventilator system checks should be performed. - correct answer ✅(any of the following) Before an ABG sample is drawn; when a physician has entered new orders; prior to obtaining hemodynamic or pulmonary function data; when a change in ventilator settings has been made; when an acute change occurs in the patient's condition; when ventilator performance is questionable; or when a patient returns from a testing procedure. - correct answer ✅ If continuous FIO2 measurement is not available on a particular ventilator, how often should it be measured for: a. An adult? b. An infant? - correct answer ✅(a) In cases where continuous FIO2 measurements are not available on a particular ventilator, intermittent measurements of FIO2 are usually sufficient for adult patients and (b) continuously for an infant. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions What is the first thing the clinician should assess following a patient being connected to a mechanical ventilator? - correct answer ✅1Chest auscultation to confirm adequate volume delivery and proper ET tube placement How long should a clinician wait after the initiation of mechanical ventilation to draw an arterial blood gas sample? - correct answer ✅15 min The appropriate range for pressure-trigger setting (sensitivity setting) is - correct answer ✅-1 to -2 cm H2O The appropriate range for flow triggering setting (sensitivity setting) is - correct answer ✅2-3 L/min A. How does auto-PEEP make triggering the ventilator more difficult for a patient? B. How can triggering the ventilator be made easier without causing autotriggering? a. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions Ideally, a plateau pressure should be kept below_______ to avoid lung injury - correct answer ✅30 cm H2O What pressure measurements are needed to calculate dynamic compliance? - correct answer ✅Peak inspiratory pressure and PEEP What pressure measurements are needed to calculate static compliance? - correct answer ✅Plateau pressure and PEEP Define transairway pressure. - correct answer ✅The difference between the PIP and Pplateau readings (PIP − Pplateau) is the transairway pressure (Pta). What does an increase in the difference between PIP and Pplateau indicate? - correct answer ✅An increase in airway resistance List four possible causes for increased airway resistance in a patient on mechanical ventilation. a. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions b. c. d. - correct answer ✅a. The patient requires suctioning or is biting on the tube b. the tube is kinked c. bronchospasm is occurring d. the HME is plugged with moisture or secretions. What is the significance of monitoring mean airway pressure? - correct answer ✅The mean airway pressure parallels the mean alveolar pressure and is therefore useful in examining the benefits and side effects of positive- pressure ventilation. It influences tissue oxygenation and affects lung volumes and cardiac output. What maneuver is performed to assess auto-PEEP? - correct answer ✅Expiratory pause The high pressure limit alarm is usually set at about______ cm H2O above the measured PIP, and when activated it will_________. - correct answer ✅10 cm H2O; terminate inspiration Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions List four possible causes that would activate the high pressure limit alarm. a. b. c. d - correct answer ✅Patient coughing; an increase in airway resistance (bronchospasm or the patient requires suctioning); a decrease in compliance (pulmonary edema, pneumonia, and pleural effusion); and the patient biting down on the tube. The low pressure alarm is usually set about________ cm H2O below the measured PIP. - correct answer ✅5-10 cm H2O; a leak in the patient- ventilator circuit. What is a common cause of activation of the low pressure alarm? - correct answer ✅Patient disconnection from the ventilator; leaks around an underinflated ET tube cuff; leaks around the humidifier, through the water feed lines to the humidifier, and at water traps; loose tubing connections; closed suction catheters; in-line thermometers; at end-tidal carbon dioxide monitors. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions cuff so that the leak can just be heard at end-inspiration. Some clinicians prefer MOT because of concerns about aspiration with MLT. List the factors that can cause hyperthermia. - correct answer ✅Infection, tissue necrosis, late-stage carcinoma, Hodgkin's disease, leukemia, and hypothyroidism or other metabolic abnormalities. The central venous pressure (CVP) directly reflects what pressures? - correct answer ✅Right arterial pressure and right ventricular end diastolic pressure. At what point during a ventilator breath should the CVP measurement be taken? - correct answer ✅CVP measurement should be taken at the end of expiration when intrapleural pressure returns to normal or is at its lowest value during the respiratory cycle. Describe a clinical scenario where a patient would benefit from the monitoring of their pulmonary artery pressure. - correct answer ✅1. Critically ill patient who has severe cardiopulmonary complications and/or problems with fluid management. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions How often should a physical examination of a ventilated patient be performed? - correct answer ✅Once per shift or following any change in patient condition What should be included in the physical examination? - correct answer ✅1. Observing and recording a patient's vital signs (i.e., systemic arterial blood pressure [BP], heart rate [HR], temperature [T], f, oxygen saturation measured by pulse oximetry [SpO2], and physical appearance) can help staff members evaluate possible changes in the patient's overall condition. In mechanically ventilated patients, f, HR, and SpO2 are monitored continuously. Temperature and arterial BP may also be monitored continuously, but more often they are measured intermittently. Inspection, palpation, percussion, and auscultation of the chest should also be performed. Describe the effect abdominal distention has on ventilation. - correct answer ✅Abdominal distention causes upward pressure on the diaphragm, which causes a restrictive-type problem, making it difficult to ventilate the patient. Endotracheal or tracheostomy cuff pressure should be maintained in what range? - correct answer ✅20-25 mm Hg or 27-34 cm H2O. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions Describe a clinical scenario where a cuff pressure of 25 mm Hg could cause tracheal damage. - correct answer ✅The trachea in a hypotensive patient could be damaged, because the cuff pressure can exceed the perfusion pressure to the trachea. List the five-step protocol designed to minimize the risk of tracheal necrosis associated with endotracheal tube cuff overinflation. a. b. c. d. e. - correct answer ✅(a) Use minimum leak technique (MLT); (b) establish MLT in which only 50-100 mL of VT is lost; (c) the cuff should require no more than 5 mL for inflation; (d) if a minimal leak cannot be maintained with a cuff volume less than 5 mL, ensure that the cuff pressure is less than 25 cm H2O; (e) if steps 1 through 4 cannot be achieved, the patient should be followed for tracheal stenosis for at least 1 year after discharge. List two situations in which a higher-than-acceptable cuff pressure may be required to maintain a minimal occlusion? a. b. - correct answer ✅(a) The cuff and artificial airway have moved up in the patient's airway and are in the larynx or pharynx and (b) the endotracheal Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions Calculate the CS when the VT is 740 mL, Pplateau is 44 cm H2O, and the end- expiratory pressure is 18 cm H2O - correct answer ✅740 mL ÷ 44 cm H2O - 8 cm H2O = 740 ÷ 36 = 0.02 L/cm H2O Calculate the Raw when the PIP is 58 cm H2O, Pplateau is 51 cm H2O, and the flow is 0.5 L/s. - correct answer ✅58 cm H2O - 51 cm H2O ÷ 0.5 L/sec = 7 cm H2O ÷ 0.5 L/sec = 14 cm H2O/L/sec Identify the problem in Figure - correct answer ✅There is a leak in the ventilator circuit. What is the plateau pressure in Figure - correct answer ✅The Pplateau is 35 cm H2O. Calculate the static compliance for the information in Figure 8-2 using the returned tidal volume of 450 mL - correct answer ✅450 mL ÷ 35 cm H2O - 5 cm H2O = 15 mL/cm H2O Critical Thinking Questions Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions During a patient-ventilator system check the clinician notices the patient making inspiratory efforts (patient is using accessory muscles), but the ventilator is not triggering. What could be causing the problem? What steps could be taken to correct it? - correct answer ✅One problem could be that the sensitivity is set too high. The patient cannot generate the negative inspiratory effort necessary to trigger the ventilator. The sensitivity needs to be adjusted to a level at which the patient can trigger a breath with minimal effort. If the sensitivity is set correctly, PEEPI is present. The patient is unable to "draw through" the positive pressure in the airway, unable to trigger a breath. If adjustments to increase the expiratory time (e.g., decrease frequency or VT, increasing the inspiratory flow rate) do not alleviate the problem, the addition of PEEPE may help. Critical Thinking Questions A 250-pound adult male has a 6.5-mm inner diameter endotracheal tube in place and is being mechanically ventilated. Cuff pressures of 40 cm H2O are required to maintain an adequate seal. What recommendations should be made to correct this problem? - correct answer ✅The endotracheal tube is too small for a person of this size. The cuff pressure of 40 cm H2O needed to maintain a seal will cause tracheal damage. The patient needs to be extubated and a larger tube inserted. To avoid problems with reintubation, a tube changer could be used. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions Critical Thinking Questions A patient with ARDS is being managed on pressurecontrolled ventilation, with a set inspiratory pressure of 30 cm H2O. According to the ventilator flow sheet, measured tidal volumes for the past 3 days have ranged between 400 and 450 mL. During the first ventilator-patient system check of the day, the respiratory therapist notes that the measured tidal volume is now 550 mL, without any change in the set pressure parameters. What is likely the cause of the tidal volume increase - correct answer ✅When a set inspiratory pressure is delivered to the airway, tidal volumes depend on lung mechanics. ARDS results in a decrease in CS. In this case, an inspiratory pressure of 30 cm H2O was delivering tidal volumes ranging from 400 to 450 mL. As the disease process resolves, the elastic recoil of the lung improves. The same delivered pressure results in an increased VT. Critical Thinking Questions When the PIP is 43 cm H2O and the plateau pressure is 18 cm H2O, how much pressure is required to overcome the resistance of the airways? - correct answer ✅1. The transairway pressure is the pressure required to overcome airway resistance; 43 cm H2O - 18 cm H2O = 25 cm H2O. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions appropriate. Vital signs should be assessed to rule out any other undetected problem. Case Study 3 A 38-year-old female patient was admitted through the emergency department 24 hours ago following a motor vehicle crash. She was intubated in the field due to respiratory arrest secondary to blunt chest trauma. She also sustained four fractured ribs. The patient is currently on VC-CMV, f 15 breath/min, VT 440 mL, FIO2 0.8, PEEP 18 cm H2O. The following values were obtained on those ventilator settings. Time PIP (cm H2O) Pplateau (cm H2O) Exhaled VT (mL) 0800 35 30 440 1000 39 34 440 1100 45 39 440 1130 50 44 440 1. What is the Pta for each patient-ventilator system check? 2. What is the likely cause for the increasing PIP over the course of the 3.5 hours? 3. What are some of the most likely causes of this problem? 4. How would you assess the patient to determine the appropriate treatment - correct answer ✅1. 0800: PTA = 35 - 30 = 5 cm H2O; 1000: PTA = 39 - 34 = 5 cm H2O; 1100: PTA = 45 - 39 = 6 cm H2O; 1130: PTA = 50 - 44 = 6 cm H2O. Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions 2. The PTA is basically unchanged throughout the course of the 3.5 hours. This shows that airway resistance has not changed. However, the Pplateau has increased each time the information was gathered. This information points to a decreasing CS. 3. The cause of the decreasing CL could be the development of ARDS, pneumothorax, hemothorax, pneumonia, pleural effusion, pneumomediastinum, or abdominal distention. 4. Assessment should include evaluation of breath sounds and percussion notes, palpation of the chest and abdominal wall, obtaining a chest radiograph, obtaining an arterial blood gas sample, and studying laboratory data. Case Study 4 A 56-year-old male patient with a history of COPD was admitted yesterday with a diagnosis of pneumonia. During the night he was intubated due to respiratory arrest. The patient is currently receiving VC-CMV, f 12 breath/min, VT 525 mL, FIO2 0.4, PEEP 13 cm H2O. The following values were obtained on those ventilator settings. Time PIP (cm H2O) Pplateau (cm H2O) Exhaled VT (mL) 0630 36 23 525 0835 39 22 523 1030 41 23 525 1230 46 19 524 1. What is the Pta for each patient-ventilator system check? Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions 2. What is the likely cause for the increasing PIP over the course of the 6 hours? 3. What are some of the most likely causes of this problem? 4. How would you assess and treat this patient? - correct answer ✅1. 0630: PTA = 36 - 23 = 13 cm H2O; 0835: PTA = 39 - 22 = 17 cm H2O; 1030: PTA = 41 - 23 = 18 cm H2O; 1230: PTA = 46 - 19 = 27 cm H2O. 2. The PTA rose over the course of the 6 hours, whereas the Pplateau remained unchanged and then improved at 1230. This information indicates increasing airway resistance. 3. The increased airway resistance could be due to retained mucus, an obstructed airway, or bronchospasm. 4. Assessing breath sounds in this situation would be most important. The presence of wheezes indicates bronchospasm, and rhonchi indicate retained mucus. The treatment for increased airway resistance needs to be directed at the specific cause of the increase, such as suctioning the airway, administering a bronchodilator treatment, and/or clearing the obstruction. NBRC-Style Questions An increase in the peak inspiratory flow rate would increase which of the following? Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions NBRC-Style Questions While responding to a ventilator alarm, the respiratory therapist sees that the low-pressure alarm is activated. She hears an audible leak, and notices that the exhaled volume is 200 mL below the set tidal volume. The measured cuff pressure is 15 mm Hg. What action should be taken next? a. Replace the endotracheal tube with a larger size. b. Increase the patient's VT to compensate for the leak. c. Introduce enough volume into the cuff to maintain a pressure of less than 20 cm H2O. d. While auscultating the larynx, introduce enough air into the cuff until a slight leak is heard on peak inspiration. - correct answer ✅D NBRC-Style Questions Why is positive end-expiratory pressure (PEEP) subtracted from plateau pressure when calculating Cs? a. To compensate for a loss in volume due to a leak b. To determine auto- PEEP c. To determine the actual pressure change Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions d. To calculate the actual PEEP level - correct answer ✅C NBRC-Style Questions Which of the following may cause an increase in heart rate? 1. Hypoxemia 2. Hypothermia 3. Anxiety 4. Pain a. 1 only b. 1 and 3 only c. 1, 2, and 3 only d. 1, 3, and 4 only - correct answer ✅D NBRC-Style Questions Which of the following physical findings would you expect when assessing an asthmatic patient? 1. Late inspiratory crackles 2. Hyper-resonant percussion note Pilbeam Mechanical Ventilation Physiological and Clinical Applications (Solved Questions) 109 Questions 3. Accessory muscle use 4. Tracheal shift a. 1 only b. 1 and 3 only c. 2 and 3 only d. 2, 3, and 4 only - correct answer ✅C NBRC-Style Questions Evaluate the following data from the patient's flow sheet. (LOOK AT THE PICTURE) Based on the above data which of the following statements is true? a. CL is improving. b. There is no change in CL. c. Raw is improving. d. There is an increase in Raw - correct answer ✅D - correct answer ✅