Mechanical Ventilation
When a patient is receiving controlled ventilation,
the PaC02 might be raised by an increase in the
•
•
•
•
A. FiO2.
B. mechanical dead space.
C. tidal volume.
D. respiratory rate.
The static compliance of a patient who is receiving
controlled mechanical ventilation is being
monitored. The tidal volume is 1.0 L, the plateau
pressure is 20 cm H2O, and the peak pressure is
30 cm H20.What is the static compliance?
•
•
•
•
A. 25 ml/cm H2O
B. 30 ml/cm H2O
C. 50 ml/cm H2O
D. 75 ml/cm H2O
A patient is being mechanically ventilated in the
SIMV mode at a rate of 12/min with an FI02 of
0.80 and 5 cm H2O PEEP. The following arterial
blood gas results are obtained.
•
•
•
•
pH 7.42
• The respiratory therapist should
do which of the following?
PaC02 37 torr
HC03 23 mEq/liter • A. Maintain the present therapy.
• B. Increase the FI02 to 1.0.
Pa02 59 torr
• C. Increase PEEP to 10 cm H2O.
• D. Decrease mechanical dead
space.
If a patient has a tidal volume of 450 ml and her
respiratory frequency is 15/min, what is the minute
ventilation?
•
•
•
•
A. 5.75 L/min
B. 6.75 L/min
C. 7.75 L/min
D. 8.25 L/min
The pressure setting on a pressure-cycled
ventilator will determine the pressure
•
•
•
•
A. at which inhalation ends.
B. gradient from the ventilator to the alveoli.
C. required to open the exhalation valve.
D. required to activate the pop-off mechanism.
A patient who is being mechanically ventilated with
an FIO2 of 0.60 and 8 cm H2O PEEP has the
arterial blood gas results below.
•
•
•
•
•
pH 7.36
PaC02 44 torr
HCO3 24 mEq/liter
Pa02 48 torr
The most appropriate
action would be to
• A. decrease PEEP to 5
cm H2O.
• B. increase PEEP to 12
cm H2O.
• C. increase the FIO2 to
1.0.
• D. maintain the present
therapy.
A patient is being mechanically ventilated with a
volume ventilator in the assist/control mode. When
the patient begins to inhale, airway pressure drops
5 cm H2O below baseline before the mechanical
breath is triggered. Which of the following should
be adjusted?
•
•
•
•
A. respiratory rate
B. tidal volume
C. peak flow
D. sensitivity
PEEP may increase arterial oxygen tension by
increasing
•
•
•
•
A. functional residual capacity.
B. the fraction of inspired oxygen.
C. vital capacity.
D. cardiac output.
A patient who is being mechanically ventilated has
just received pancuronium bromide (Pavulon).
Which of the following is the most important
ventilator alarm to monitor to ensure patient
safety?
•
•
•
•
A. I:E ratio
B. circuit temperature
C. high pressure
D. low pressure
A 36-year-old woman who has just undergone
intestinal bypass surgery is intubated and is
brought to the post-anesthesia care unit (PACU).
She has normal pulmonary function, weighs 136
kg (300 Ib), and is 159 cm (5 ft 2 in) tall. In this
situation, the respiratory care practitioner should
recommend which of the following ventilator
settings?
•
•
•
•
A.
B.
C.
D.
Tidal Volume(ml) Rate(/min)
400
8
600
10
800
12
1,300
8
A patient with a history of COPD is being
mechanically ventilated because of respiratory
failure. Current ventilator settings and arterial
blood gas results are as follows.
•
•
•
•
•
•
•
pH 7.38
PaCO2 55 torr
HCO3 32 mEq/liter
PaO2 65 torr
FiO2 0.30
Rate 10
Vt 1.0 L
• The respiratory care
practitioner should
recommend which of the
following?
• A. Set the tidal volume at
750 ml.
• B. Set the frequency at 6.
• C. Add PEEP.
• D. Maintain the present
settings.
A patient receiving mechanical ventilation has the
following ventilator settings and arterial blood gas
results.
•
•
•
•
•
•
•
•
•
FIO2 0.55
SIMV rate 12
Spontaneous rate 0
Tidal volume 750 ml
pH 7.56
PaCO2 26 torr
HCO3 22 mEq/liter
PaO2 92 torr
SaO2 96%
• Which of the following
should the respiratory
care practitioner
recommend?
• A. Increase the
inspiratory time.
• B. Increase the tidal
volume to 800 ml.
• C. Decrease the FIO2 to
0.50.
• D. Decrease the SIMV
rate.
Which of the following can a respiratory
therapist do to increase mean airway
pressure?
A.Add mechanical dead space.
B.Decrease the mandatory rate.
C.Decrease the inspiratory time.
D.Add inspiratory plateau.
A patient receiving mechanical ventilation who
has a total rate of 20/min and an I:E of 1:1.5
will have which of the following inspiratory
and expiratory times?
Inspiratory
Expiratory Time
(sec)
(sec)
A.
1.0
2.0
B.
1.2
1.8
C.
1.3
1.7
D.
1.5
3.0
Which of the following controls, when adjusted
independently, can increase expiratory time
during time-triggered, volume-controlled
ventilation?
I. volume
II. rate
III. flow
IV. sensitivity
A.I, II, and III only
B.I, II and IV only
C.I, III, and IV only
D.II, III, and IV only
When setting a ventilator to assist a patient with
severe obstructive lung disease, the respiratory
care practitioner should use sufficient inspiratory
flow to attempt to prevent
•
•
•
•
A. circulatory collapse.
B. rupture of the bronchi.
C. destruction of surfactant.
D. air trapping.
The respiratory care practitioner is monitoring the
effects of mechanical ventilation on a patient in
congestive heart failure. The practitioner's
IMMEDIATE concern should be to
•
•
•
•
A. obtain secretions for culture.
B. note changes in intracranial pressure.
C. check the patient's blood pressure.
D. obtain serial chest x-rays.
Which of the following is characteristic of a
volume-cycled ventilator?
• A. It ends expiration after a preset volume is
delivered.
• B. It begins inspiration after a specific volume is
inhaled.
• C. It ends inspiration after the patient exhales a
preset volume.
• D. It ends inspiration after a preset volume is
delivered by the ventilator.
The adequacy of ventilation is best reflected by
which of the following?
•
•
•
•
A. PaO2
B. PaCO2
C. vital capacity
D. FEF25- 75%
A post-op patient who just awakened from sedation
has the following blood gas values on 40%
oxygen: PaO2 75 mmHg; PaCO2 28 mmHg; pH
7.51. She is on A/C mode with a back up rate of
10 breaths per minute and is assisting at a rate of
18 breaths per minute. Her spontaneous tidal
volume is 300 ml. What would you suggest?
A.Change the mode to SIMV
B.Add 200 ml of mechanical deadspace
C.Sedate her so that she does not assist
D.Increase the back up rate to 18 breaths/min
so that she will not assist
A 70-kg man is being mechanically ventilated on
the following settings: mode: SIMV, mechanical
rate: 6 breaths/min, total ventilatory rate 15
breaths/min, mechanical tidal volume: 700 ml,
spontaneous tidal volume: 450 ml, FIO2: 0.40.
His ABG values are as follows: pH: 7.49,
PaCO2: 26 mmHg, PaO2: 100 mmHg. What
change should the RRT suggest at this point?
A.decreasing the tidal volume to 600 ml
B.increasing the machine rate to 10
breaths/min
C.administer a sedative
D.extubate
When SIMV is used for weaning, how is the
proportion of ventilation assumed by the patient
increased over time?
A.Progressively decreasing the inspiratory
flow rate
B.Progressively decreasing the mandatory VT
C.Progressively decreasing the mandatory
rate of breathing
D.Progressively lengthening the automatic
sigh interval
Which of the following statements is false about PPV?
A.During inspiration, pleural pressure
decreases.
B.During inspiration, pressure in the alveoli
increases.
C.The pressure gradients of normal breathing
are reversed.
D.During inspiration, alveolar pressure exceeds
pleural pressure.
Which of the following modes of ventilatory support
would result in the highest mean airway pressure?
A.VC-SIMV
B.(VC-SIMV) + PSV
C.PC-SIMV
D.VC-A/C
Inspection of the airway pressure waveform of a
patient receiving VC assist-control with constant
flow reveals a large dip or drop in pressure after
flow delivery begins. Which of the following
problems is most likely?
A.The trigger setting is improper.
B.The inspiratory flow is inadequate.
C.The set volume is too large.
D.The pressure limit is too low.
A patient switched from VC assist-control with positive
end expiratory pressure (PEEP) to PC-IRV shows a
good improvement in PaO2 but a decrease in
tissue oxygenation. Which of the following best
explains this observation?
A.High mean pressures caused by PC-IRV
decreased pulmonary blood flow.
B.Intrinsic PEEP caused by PC-IRV resulted in
increased alveolar recruitment
C.High mean pressures caused by PC-IRV
decreased cardiac output and delivery.
D.Intrinsic PEEP caused by PC-IRV
compressed the pulmonary capillaries.
On what does the volume delivered during
pressure-targeted modes of ventilatory support
depend?
I. The set pressure limit
II. Patient lung mechanics
III. Patient effort
A. I and II
B. I and III
C. II and III
D. I, II, and III
Hyperventilation should generally be avoided during
mechanical ventilatory support. Exceptions to this
rule include which of the following?
I. You are trying to calm down an agitated
patient.
II. Cerebral perfusion pressures must be
decreased.
III. Hypokalemia is causing cardiac arrhythmias.
A. II and III
B. I and III
C. II
D. I and II
A COPD patient who has a history of chronic
hypercapnea has been mechanically ventilated
in the assist-control mode for 24 hours. An
arterial blood gas analysis reveals: pH: 7.50,
PaCO2: 40 mmHg, PaO2: 68 mmHg. Which of
the following actions should the RRT
recommend?
A.changing to the SIMV mode
B.changing to the control mode
C.instituting PEEP
D.maintaining the present settings