During each cycle of normal resting ventilation, a volume of gas is moved into and out of the lungs. This cyclical volume is called the:
Tidal Volume
In individuals with disorders characterized by an increased frictional work of breathing, such as emphysema, which of the following breathing patterns results in the minimum work?
Slow and deep respirations
Regional factors affecting the distribution of gas in the normal lung result in which of the following?
More ventilation goes to the bases and lung periphery
In a patient with right sided basal pneumonia, which of the following positions would allow the patient to achieve maximum
on the left side
Which of the following formulas are used to compute the time constant of a lung unit?
resistance X compliance
If a patient has a VT of 370 mL and a respiratory rate of 20 breaths per minute, what is the minute ventilation?
7.40 LPM
Which is the correct formula to calculate the alveolar minute ventilation of a spontaneously breathing subject?
f x (VT - VDphys)
A patient has a VT of 625 mL and a VD/VT of 44% and is breathing at a frequency of 16 per minute. What is the alveolar ventilation?
5.6 LPM
Which of the following pressures normally remains negative (relative to atmospheric pressure) during quiet breathing?
Pleural Pressure
Which of the following ventilatory patterns would result in the most alveolar ventilation if physiologic deadspace is constant at 120 ml?
RR 8, Vt 450
A patient has a PCO2 of 56 mm Hg. Based on this information, what can you conclude?
The patient is hypoventilating
The normal value for oxygen consumption at rest is:
250 ml O2/min
Deadspace is also defined as
(Both) ventilation with perfusion and ventilation without perfusion
The normal range for Minute Volume is:
5-10 LPM
Which of the following pressure gradients is responsible for maintaining alveolar inflation?
Transpulmonary Pressure Gradient
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
12 LPM
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
115 ml
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
18%
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
15 ml/cmH20
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
Patient is hypoventilating.
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
16.5 cmH2O/L/sec
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
90 ml
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
410 ml
A 5'2" female patient comes into the Emergency Room intubated. Her tidal volume is 500 ml per breath. She is breathing 24 breaths per minute. She is on 60% O2 with 5 PEEP. Her blood gas reveals pH 7.28, PaCO2 50 mmHg, PaO2 62 mmHg. Her PECO2 on the capnog
9.8 LPM
Which of the following pressure gradients is responsible for the actual flow of gas into and out of the lungs during breathing?
Transrespiratory pressure gradient
What happens during normal inspiration?
I. Pleural pressure decreases.
II Air moves from airway opening to alveoli
III. The transpulmonary pressure gradient widens (becomes more neg.).
IV. Volumes within the lungs decrease
Pleural pressure decreases, Air moves from airway opening to alveoli, The transpulmonary pressure gradient widens (becomes more neg.).
The presence of surfactant in the alveoli tends to do which of the following?
Increases compliance
Normal lung compliance is approximately which of the following?
100 ml/cmH2O
What is the term for the opposition to ventilation caused by the movement of gas through the conducting airways?
Airway resistance
Alveolar deadspace is volume of gas not participating in gas exchange as a result of lost volume in conducting airways. True or False?
False
Ventilation is distributed evenly throughout the lungs.
True or False?
False
Transthoracic pressure is the total pressure necessary to expand and contract the lungs and chest wall together.
True or False?
True
Surfactant is produced by Type I alveolar cells.
True or False?
False
The greatest laminar gas movement occurs in the smallest airways of the tracheobronchial tree.
True or False?
True
Compliance is decreased in patients with emphysema.
True or False?
False
Patients with noncompliant lungs have an increase in work of breathing due to elastic component of work.
True or False?
True
Lung bases ventilate twice as much as the apical segments of the lungs.
False
A fibrotic lung would exhibit which of the following characteristics?
Decreased lung compliance
How is airway resistance computed?
Change in pressure/ flow
Normal airway resistance is approximately which of the following?
0.5 to 2.5 cmH2O/L/sec
According to Poiseuille's law, which of the following are true if we wish to maintain a constant flow of gases?
Halving the tube radius will require a 16-time increase in driving pressure
In what portion ofthe lungs does alveolar deadspace normally occur?
Apices
How can the body effectively compensate for physiologic deadspace?
Increase tidal volume
Under resting metabolic conditions, how much carbon dioxide does a normal adult produce per minute?
200 ml/min
Hypoventilaion is defined as:
Elevated blood carbon dioxide level
What is ventilation in excess of metabolic needs called?
Hyperventilation
What is the single best indicator of the adequacy or effectiveness of alveolar ventilation?
PaCO2
Hypercapnic (type II) respiratory failure is a synonym for which one of the following terms?
ventilatory failure
Inadequate respiratory muscle strength is likely when a patient's MVV is which of the following?
<2 times the resting VE
What is the normal range for PaO2/FIO2?
350 to 450
Which of the following indicators are useful in assessing respiratory muscle strength?
I. maximum voluntary ventilation (MVV)
II. forced vital capacity (FVC)
III. dead space - to - tidal volume ratio (VD/VT)
IV. maximum inspiratory pressure (MIP)
maximum voluntary ventilation (MVV) , forced vital capacity (FVC), maximum inspiratory pressure (MIP)
Based on the respiratory rate alone, when is ventilatory support indicated?
> 35 bpm
What is respiratory failure due to inadequate ventilation?
hypercapnic
HypoxHypoxemia can be caused by which of the following?
I. diffusion impairment
II. alveolar hypoventilation
III. V/Q mismatch
IV. intrapulmonary shunting
diffusion impairment, alveolar hypoventilation, intrapulmonary shunting
Based on the respiratory rate alone, when is ventilatory support indicated?
> 35 bpm
What is respiratory failure due to inadequate ventilation?
hypercapnic
HypoxHypoxemia can be caused by which of the following?
I. diffusion impairment
II. alveolar hypoventilation
III. V/Q mismatch
IV. intrapulmonary shunting
diffusion impairment, alveolar hypoventilation, V/Q mismatch, intrapulmonary shunting
Which of the following is false about the "acute-on-chronic" form of respiratory failure?
It usually involves patients with hypoxemic respiratory failure.
You have a patient to present to the ED with a possible Upper airway obstruction. You draw an arterial blood gas and obtain the following data: pH-7.30, PaCO2- 72 mm Hg, PaO2- 60, HCO3- 34. Based on these findings, how would you interpret this type of res
Acute on chronic hypercapnic failure
Which of the following measures should be used in assessing the adequacy of a patient's alveolar ventilation?
I. PaO2
II. arterial pH
III. PaCO2
arterial pH, PaCO2
Breathing 100% O2, a patient has a PAO2-PaO2 of 60 mm Hg. Based on this information, what might you conclude?
The patient has acceptable oxygenation
In patients suffering from acute respiratory acidosis, below what pH level are intubation and ventilatory support generally considered?
7.2
A patient with an opiate drug overdose is unconscious and exhibits the following blood gas results breathing room air: pH = 7.25; PCO2 = 89; HCO3 - = 27; PO2 = 48. Which of the following best describes this patient's condition?
chronic hypercapnic respiratory failure
What is the normal range of maximum inspiratory pressure, or MIP (also called negative inspiratory force, or NIF), generated by adults?
-80 to -100 cm H2O
Based on PaO2/FiO2 alone, when would ventilatory support be indicated?
< 200
All of the following are associated with hypercapnic respiratory failure due to respiratory muscle weakness or fatigue except:
hyperthyroidism
Which of the following indicate severely impaired oxygenation requiring high FIO2s and positive end-expiratory pressure?
I. PAO2-PaO2 greater than 350 mm Hg on 100% O2
II. VC less than 10 ml/kg
III. PaO2/FIO2 less than 200
PAO2-PaO2 greater than 350 mm Hg on 100% O2, PaO2/FIO2 less than 200
All of the following are associated with hypercapnic respiratory failure due to increased work of breathing except:
myasthenia gravis
Which of the following is the cardinal sign of increased work of breathing?
tachypnea
Which of the following measures is/are useful indicators in assessing the adequacy of a patient's oxygenation?
I. PAO2-PaO2
II. PaO2-to-FIO2 ratio
III. VD/VT
IV. pulmonary shunt ( s/ t)
PAO2-PaO2, PaO2-to-FIO2 ratio
You determine that an acutely ill patient can generate an MIP of -18 cm H2O. Based on this information, what might you conclude?
The patient has inadequate respiratory muscle strength
You have a patient present to the ED with a possible obstructive lung disease. You draw an arterial blood gas and obtain the following data: pH- 7.16, PaCO2- 72 mm Hg, PaO2- 60 mm Hg, HCO3- 27 mEq/L. Based on these finds, how would you interpret this type
Acute Hypercapnic failure
Which of the following modes of ventilatory support would you recommend for a severely hypoxemic patient with acute lung injury or acute respiratory distress syndrome (ARDS)?
pressure-controlled ventilation
All of the following would tend to cause hypercapnic respiratory failure except:
smoke inhalation
A need for some form of ventilatory support is usually indicated when an adult's rate of breathing rises above what level?
35/min
Which of the following are associated with hypercapnic respiratory failure due to decreased ventilatory drive?
I. brainstem lesions
II. encephalitis
III. hypothyroidism
IV. asthma
brainstem lesions, encephalitis, hypothyroidism
In intubated patients, what do sources of increased imposed work of breathing include?
I. endotracheal tube
II. ventilator circuit
III. auto-PEEP
endotracheal tube, ventilator circuit, auto-PEEP
What would you estimate the mean Alveolar-arterial difference to be in a patient that is 74 years old breathing room air.
22.5 mm Hg
What is the definition of ptosis?
drooping eyelids
A patient who just suffered severe closed-head injury and has a high intracranial pressure (ICP) is about to be placed on ventilatory support. Which of the following strategies could help to lower the ICP?
Maintain a PaCO2 from 25 to 30 mm Hg (deliberate hyperventilation).
Which of the following best describes the difference between V/Q mismatch and shunt when supplemental oxygen is administered?
V/Q mismatch will respond well but shunt will not.
Which of the following patients are at greatest risk for developing auto-PEEP during mechanical ventilation?
those with COPD
Ventilatory support may be indicated when the VC falls below what level?
10 ml/kg
Which of the following modes of ventilatory support would you recommend for a hypoxemic patient with congestive heart failure?
continuous positive airway pressure (CPAP)
Common bedside measures used to assess the adequacy of lung expansion include all of the following except:
VD/VT
Which of the following equations represents the total arterial oxygen content?
CaO2= (Hb X 1.34 X SaO2) +( 0.003 X PaO2)
Which of the following information best helps to distinguish chronic hypercapnic respiratory failure from acute hypercapnic respiratory failure?
kidneys retaining bicarbonate to elevate the blood pH
A patient with interstitial lung disease who presents with hypoxemia due to diffusion defect would have which of the following clinical signs?
I. fine bibasilar crackles
II.clubbing of the finger nail beds
II. jugular venous distention
fine bibasilar crackles, clubbing of the finger nail beds, jugular venous distention
A diagnosis of respiratory failure can be made if which of the following are present?
I. PaO2 55 mm Hg, FIO2 0.21, PB 760 mm Hg
II. PaCO2 57 mm Hg, FIO2 0.21, PB 760 mm Hg
III. P(A-a)O2 45 mm Hg, FIO2 1.0, PB 760 mm Hg
IV. PaO2/FIO2 400, PB 750 mm Hg
PaO2 55 mm Hg, FIO2 0.21, PB 760 mm Hg, PaCO2 57 mm Hg, FIO2 0.21, PB 760 mm Hg
What is the normal P(A - a)O2 range while breathing room air?
10 mm Hg to 25 mm Hg
You need to determine the adequacy of oxygenation in your patient with congestive heart failure. Your patient is breathing room air. You draw an arterial blood gas and obtained the following values: pH- 7.45 mm Hg, PaCO2- 33 mm Hg, PaO2- 40 mm Hg, HCO3- 2
68 mm Hg
Which of the following measures taken on adult patients indicate unacceptably high ventilatory demands or work of breathing?
VE of 17 L/min
A patient presents to the ED with a possible bacterial infection. You draw an arterial blood gas and report the following values: pH-7.41, PaCO2- 35 mm Hg, PaO2- 55 mm Hg, HCO3- 24 mEq/L. Based on these values, what type of respiratory failure is the pati
Respiratory failure Type I
Based on the VT only, when is ventilatory support indicated?
< 5 ml/Kg
Which of the following MIP measures taken on an adult patient indicates inadequate respiratory muscle strength?
-15 cm H2O
What type of disease is associated with perfusion/diffusion impairment?
liver disease
What is the most common cause of low mixed venous oxygen?
cardiac disease
A patient with a 10-year history of chronic bronchitis and an acute viral pneumonia exhibits the following blood gas results breathing room air: pH = 7.20; PCO2 = 67; HCO3 - = 26; PO2 = 60. Which of the following best describes this patient's condition?
acute hypercapnic respiratory failure
Which of the following is a feature of Guillain-Barr�?
ascending muscle weakness
Which of the following patients has the most serious problem with the adequacy of oxygenation?
Patient
FIO2 PaO2
PT. A . 70 90
PT. B . 40 95
PT. C. 1.00 85
PT. D . 28 65
Pt. C
A patient receiving continuous mandatory ventilation in the control mode has an inspiratory time of 1.25 seconds and an expiratory time of 3.75 seconds. What is the frequency of breathing?
12/min
A patient is receiving continuous mandatory ventilation in the control mode at a rate of 12/min. The expiratory time is 3.3 seconds. What is the inspiratory time?
1.7 seconds
A patient is receiving continuous mandatory ventilation in the control mode at a rate of 18/min. The inspiratory time control is set at 33%. What is the expiratory time?
2.23 seconds
A patient is receiving continuous mandatory ventilation in the control mode at a rate of 12/min. The inspiratory time is 0.8 second. What is the expiratory time?
4.2 seconds
A patient is receiving continuous mandatory ventilation in the control mode at a rate of 10/min. The inspiratory time control is set at 20%. What is the I:E ratio?
1:4
A patient is receiving continuous mandatory ventilation in the control mode at a rate of 15/min. The inspiratory time is 1.32 second. What is the percentage inspiratory time?
33%
A patient is receiving continuous mandatory ventilation in the control mode at a rate of 15/min. The inspiratory time is 1.32 second. What is the I:E ratio?
1:2
You are mechanical ventilating a drug overdose patient in the ICU with the following given settings: %TI= 25, VE= 7.5L, RR=8 bpm. What is this patient's mechanical TI?
1.87 second
You are mechanical ventilating a drug overdose patient in the ICU with the following given settings: %TI= 25, VE= 7.5L, RR=8 bpm. What is this patient's mechanical TE?
5.62 second
You are mechanical ventilating a drug overdose patient in the ICU with the following given settings: %TI= 25, VE= 7.5L, RR=8 bpm. What is this patient's mechanical I:E ratio?
1:3
You are mechanical ventilating a drug overdose patient in the ICU with the following given settings: %TI= 25, VE= 7.5L, RR=8 bpm. What is this patient's minimum mechanical peak flow?
30 LPM
You are mechanical ventilating a drug overdose patient in the ICU with the following given settings: %TI= 25, VE= 7.5L, RR=8 bpm. What is this patient's mechanical VT?
938 mL
You are mechanical ventilating a patient in the ICU with the following given settings: %TI= 33, VE= 11 L, RR=14 bpm. What is this patient's mechanical TI?
1.41 second
You are mechanical ventilating a patient in the ICU with the following given settings: %TI= 33, VE= 11 L, RR=14 bpm. What is this patient's mechanical TE?
2.87 second
You are mechanical ventilating a patient in the ICU with the following given settings: %TI= 33, VE= 11 L, RR=14 bpm. What is this patient's mechanical I:E ratio?
1:2
You are mechanical ventilating a patient in the ICU with the following given settings: %TI= 33, VE= 11 L, RR=14 bpm. What is this patient's minimum mechanical peak flow?
33 L/M
You are mechanical ventilating a patient in the ICU with the following given settings: %TI= 33, VE= 11 L, RR=14 bpm. What is this patient's mechanical VT?
786 mL
Which of the following major categories of ventilator function are useful in classifying ventilators?
I. control scheme
II. power conversion
III. ventilator output
IV. Input power
V. Alarm controls
control scheme, power conversion, ventilator output, Input power, Alarm controls
A ventilator can derive its input power from which of the following sources?
I. alternating current (AC) electricity
II. battery
III. pneumatic
alternating current (AC) electricity, battery, pneumatic
For which of the following uses might you consider the use of a purely pneumatically powered ventilator?
I. as a backup to electrically powered ventilators
II. when electrical device cannot be used (e.g., magnetic resonance imaging)
III. during certain ty
as a backup to electrically powered ventilators, when electrical device cannot be used (e.g., magnetic resonance imaging), during certain types of patient transport
Which of the following types of ventilators would you select for use during an MRI procedure?
I. electronically controlled
II. pneumatically controlled
III. fluidically controlled
IV. electrically controlled
pneumatically controlled, fluidically controlled
Which of the following equations best describes the pressure (P) necessary to drive gas into the airway and inflate the lungs?
P = Volume/ Compliance + (Resistance X Flow)
A complete ventilatory cycle or breath consists of which of the following phases?
I. expiration
II. initiation of inspiration
III. inspiration
IV. end of inspiration
expiration, initiation of inspiration, inspiration, end of inspiration
According to the equation of motion of the respiratory system, a ventilator can control all of the following variables except:
resistance
Which of the following is true of the relationship between flow and volume?
I. Volume is the integral of flow.
II. Volume is the derivative of flow.
III. Flow is the derivative of volume
Volume is the integral of flow, Flow is the derivative of volume
During mechanical ventilation, what variable causes a breath to begin?
trigger
During mechanical ventilation, what variable causes a breath to end?
cycle
To describe what happens during the expiratory phase of mechanical ventilation, you must know the value of which variable?
baseline
If a ventilator, not the patient, initiates a breath, what is the trigger variable?
time
A patient receiving time-triggered continuous mechanical ventilation at a preset rate of 10/min stops breathing. Which of the following will occur?
The patient will continue to receive 10 breaths/min
If a patient initiates a ventilator breath, the trigger variable could be all of the following except:
time
A volume-cycled ventilator has a rate knob for setting the controlled frequency of breathing. If this control is set to 12/min, which of the following other settings will determine the inspiratory and expiratory times?
I. FIO2
II. flow
III. volume
flow, volume
When you adjust the pressure drop necessary to trigger a breath on a ventilator, what are you adjusting on the machine?
sensitivity
When using pressure as the trigger variable, where do you typically set the trigger level?
0.5 to 1.5 cm H2O below the baseline expiratory pressure
Compared to using pressure as the trigger variable, what is the major advantage of flow-triggering?
decreased work of breathing
A ventilator providing pressure support ventilation to a patient is set to flow trigger on spontaneous breaths (base flow = 10 L/min; trigger = 3 L/min below base flow). While at the bedside, you observe that the ventilator trigger rate is much higher tha
circuit leaks, circuit movement
What ventilatory variable reaches and maintains a preset level before inspiration ends?
limit
Which of the following parameters can serve as the cycle variable during ventilatory support?
I. volume
II. pressure
III. flow
IV. time
volume, pressure, flow, time
What is the name of a breath where a patient is able to change the inspiratory time?
patient triggered
A volume-cycled ventilator provides gas under positive pressure during inspiration until what point?
A preselected volume of gas is expelled from the device
What parameter serves as the baseline variable on all modern ventilators?
pressure
What is the default baseline value during mechanical ventilation?
zero end-expiratory pressure (ZEEP)
What is the application of pressure above atmospheric at the airway throughout expiration during mechanical ventilation?
positive end-expiratory pressure (PEEP)
What is the primary physiological effect of positive end-expiratory pressure (PEEP)?
increase the functional residual capacity (FRC)
Which of the following can be used by a ventilator as a conditional variable?
I. volume
II. pressure
III. flow
IV. time
volume, pressure, flow, time
During mechanical ventilation, a spontaneous breath is defined as one that:
initiated and terminated by the patient
During mechanical ventilation, a mandatory breath is defined as one that is:
initiated or terminated by the machine
While observing a patient receiving ventilatory support, you notice that all delivered breaths are initiated or terminated by the machine. Which of the following modes of ventilatory support is in force?
CMV
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?
IMV
During volume-targeted ventilation, which of the following settings determine the machine-delivered minute volume?
I. volume
II. flow
III. rate
volume, rate
During volume-targeted ventilation, which of the following settings determine the total cycle time?
I. volume
II. flow
III. rate
rate
In which of the following situations is volume-controlled ventilation sometimes used?
I. when a precise PaCO2 has to be maintained (some closed-head injuries)
II. when the clinician needs to determine a precise minute volume.
III. when ventilating patient
when a precise PaCO2 has to be maintained (some closed-head injuries), when the clinician needs to determine a precise minute volume.
In which of the following situations is pressure-controlled ventilation sometimes used?
I. when a precise PaCO2 has to be maintained (some closed-head injuries)
II. when the clinician needs to maintain a precise minute volume
III. when ventilating patient
when ventilating patients with severe, refractory hypoxemia, when tidal volume in unstable due to leaks
Which of the following is the primary parameter used to alter the breath size in pressure controlled?
positive inspiratory pressure (PIP)- positive end-expiratory pressure (PEEP)
Which of the following modes is commonly selected for patients with neuromuscular disorders?
VC-IMV
Spontaneous breath modes include all of the following except:
VC-CMV
What is the mode of ventilatory support in which patient's inspiratory efforts are augmented with a set amount of positive airway pressure?
PSV
What is the primary use of pressure support ventilation at low pressure levels?
decreases imposed work of breathing caused by the ETT and ventilator circuit
What type of event alarm will warn the RCP that possible changes in the clinical data of the patient?
Patient event alarm
Which priority alarm level alerts the RCP of a life-threatening situation and requires immediate attention from the RCP?
Level I
In which of the following modes of ventilatory support is muscle atrophy most likely to occur?
volume-controlled continuous mandatory ventilation
Which of the following is the consequence of decreased resistance and compliance
It takes less time to fill and empty the alveoli
Harmful effects of PEEP include which of the following:
I. Increased incidence of barotrauma
II. Increased pulmonary vascular resistance (PVR)
III. Decreased venous return or decreased cardiac output
Increased incidence of barotrauma, Increased pulmonary vascular resistance (PVR), Decreased venous return or decreased cardiac output
All of the following factors would tend to increase mean airway pressure EXCEPT:
short inspiratory times
At what plateau level would you recommend changing the patient from VC-CMV to PC-CMV?
> 30 cm H2O
On what does volume delivered depend during pressure-targeted modes of ventilatory support?
I. set pressure limit
II. patient lung mechanics
III. patient effort
set pressure limit, patient lung mechanics, patient effort
Which of the following is the explanation for the increased V/Q ratio when excessive positive end-expiratory pressure (PEEP) is used?
diversion of blood from ventilated alveoli to hypoventilated alveoli
Which of the following modes of ventilatory support would result in the highest mean airway pressure?
volume-controlled continuous mandatory ventilation
The patient's WOB depends on which of the following?
I. compliance
II. resistance
III. ventilatory drive
IV. trigger sensitivity
V. peak flow
compliance, resistance, ventilatory drive, trigger sensitivity, peak flow
The volume of gas actually delivered to a patient by most positive-pressure ventilation is always less than that expelled from the machine. Which of the following factors help to explain this finding?
I. gas compression under pressure
II. presence of buil
gas compression under pressure, expansion of the ventilator circuitry
In which of the following modes of ventilatory support would the patient's work of breathing be greatest?
continuous positive airway pressure (CPAP)
Which of the following modes of ventilatory support is used to help decrease airway and pleural pressures?
pressure-controlled continuous mandatory ventilation
Which of the following conditions does not require high mechanical respiratory rates?
metabolic alkalosis
In which mode of ventilatory support does the patient breathe spontaneously at an elevated airway pressure, with short, intermittent decreases in pressure to a lower level?
airway pressure release ventilation (APRV)
Administration of positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) is associated with all of the following benefits EXCEPT:
maintaining alveoli closed
Primary indications for using positive end-expiratory pressure (PEEP) in conjunction with mechanical ventilation include which of the following?
I. when dynamic hyperinflation(Auto-PEEP) occurs in chronic obstructive pulmonary disease (COPD) patients
II.
when dynamic hyperinflation(Auto-PEEP) occurs in chronic obstructive pulmonary disease (COPD) patients, when acute lung injury causes refractory hypoxemia
What are some key causes of patient-ventilator asynchrony and increased work of breathing during pressure-triggered volume-controlled continuous mandatory ventilation?
I. improper trigger setting
II. insufficient inspiratory flow
III. improper PEEP settin
improper trigger setting, insufficient inspiratory flow, improper PEEP setting
Beneficial physiological effects of positive end-expiratory pressure (PEEP) include which of the following?
I. increased PaO2 for given FIO2
II. increased lung compliance (CL)
III. increased functional residual capacity
increased PaO2 for given FIO2, increased lung compliance (CL), increased functional residual capacity
What factor primarily determines the effect of positive-pressure ventilation (PPV) on the cardiac output?
Mean airway pressure
Which of the following conditions is associated with a lack of response to increased FIO2 in patients receiving positive-pressure ventilation?
shunt
Which of the following is a benefit of high inspiratory flows during positive-pressure ventilation?
reduced air trapping
Assuming a constant rate of breathing, which of the following inspiratory/expiratory ratios (I:E) would tend to lead to a better chance of air-trapping?
1:1
What does pressure-supported ventilation consist of?
patient-triggered, pressure-limited, flow-cycled breaths
Which level of FIO2 and what time of exposure have been associated with oxygen toxicity?
FiO2 > or = to .50 for longer than 24 to 48 hours
In which of the following modes does the clinician have the most control over the patient's ventilatory pattern, PaO2, PaCO2, and acid-base balance?
volume-controlled continuous mandatory ventilation
Mean airway pressure may be increased by all of the following adjustments, EXCEPT:
increasing the FIO2
What are some primary uses for pressure-supported ventilation (PSV)?
I. recruiting collapsed alveoli and
improving oxygenation
II. augmenting patient's spontaneous VT
III. overcoming the imposed work of
breathing
augmenting patient's spontaneous VT, overcoming the imposed work of breathing
Which of the following statements are TRUE about negative-pressure ventilation (NPV)?
I. NPV is similar to spontaneous breathing.
II. Airway (mouth) pressure during NPV is zero.
III. Expiration during NPV is by passive recoil.
IV. NPV decreases pressure a
NPV is similar to spontaneous breathing, Airway (mouth) pressure during NPV is zero, Expiration during NPV is by passive recoil, NPV decreases pressure at the body surface
During volume-controlled continuous mandatory ventilation, should either compliance decrease or airway resistance (Raw) increase, what will happen?
The peak airway pressure will increase.
After accounting for the compressed volume loss on a stable adult patient receiving volume-controlled continuous mandatory ventilation at a preset volume of 700 ml, you still note a 150-ml difference between the expected and the actual delivered volume. W
leak in the patient-ventilator system
What spontaneous pressure-controlled breath mode allows separate regulation of the inspiratory and expiratory pressures?
bilevel positive airway pressure (BiPAP)
Pressure-controlled (PC) modes of ventilatory support include all of the following EXCEPT:
volume-controlled continuous mandatory ventilation
In which of the following modes of ventilatory support would the patient's work of breathing be least?
continuous mandatory ventilation (CMV)
Which of the following modes of ventilatory support combines the advantages of pressure-controlled and volume-controlled ventilation?
volume-assured pressure-supported ventilation
Which of the following are potential effects of positive-pressure ventilation on the cardiovascular system?
I. decreased venous return
II. increase cranial perfusion pressures
III. increased pulmonary blood flow
IV. decreased ventricular stroke volume
decreased venous return, decreased ventricular stroke volume
Volume-controlled (VC) modes of mechanical ventilation include which of the following?
I. VC continuous mandatory ventilation
II. VC intermittent mandatory ventilation
III. Pressure control Inverse Ratio Ventilation
IV. bilevel positive airway pressure
VC continuous mandatory ventilation, VC intermittent mandatory ventilation
Which of the following is FALSE about continuous positive airway pressure (CPAP)?
It provides the pressure gradient needed for ventilation.
Physical assessment indicating the presence of a tension pneumothorax includes all of the following except:
loud breath sounds
Detrimental effects of auto-positive end-expiratory pressure (PEEP) include all of the following EXCEPT:
decreased lung compliance
Positive-pressure ventilation (PPV) can reduce urinary output by how much?
30% to 50%
Which of the following modes of support provides all of the patient's minute ventilation (VE) as mandatory volume-controlled (VC) breaths?
VC continuous mandatory ventilation
What do the letters in APRV stand for?
Airway Pressure Release Ventilation
Which of the following mechanisms explains the hepatic dysfunction in patients receiving positive-pressure ventilation (PPV)?
decreased hepatic blood flow
Types of damage associated with pulmonary barotrauma include all of the following except:
pneumoconiosis
Which of the following groups of patients are primarily affected by ventilator-associated pneumonia?
I. infants
II. adults older than 65 years
III. immunosuppressed
IV. thoracoabdominal surgery
V. depressed sensorium
infants, adults older than 65 years, immunosuppressed, thoracoabdominal surgery, depressed sensorium