Pilbeams Mechanical Ventilation 5th Edition By Cairo -Test Bank

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Pilbeams Mechanical Ventilation 5th Edition By Cairo -Test Bank

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WITH ANSWERS

Pilbeams Mechanical Ventilation 5th Edition By Cairo -Test Bank

Chapter 2; How Ventilators Work

Test Bank

 

MULTIPLE CHOICE

 

  1. The respiratory therapist enters modes and parameters into the ventilator with which of the following?
a. Control logic
b. Input power
c. User interface
d. Drive mechanism

 

 

ANS:   C

The user interface or control panel contains certain knobs, dials, or keypads where the ventilator operator sets or enters certain information to establish how the pressure and pattern of gas flow is delivered by the machine. Inside the ventilator is the control logic or control system which interprets the operator settings and produces and regulates the desired output. The input power is the ventilators power source that provides the energy to enable the ventilator to perform the work of ventilating the patient. The drive mechanism is a mechanical device that produces gas flow to the patient.

 

DIF:    1                      REF:    pg. 18

 

  1. Which of the following ventilators is pneumatically powered?
a. LTV 1000
b. Bio-Med MVP-10
c. Lifecare PLV-102
d. Intermed Bear 33

 

 

ANS:   B

The Bio-Med MVP-10 is a fluidic ventilator and uses only gases for its operation. The LTV 1000, Lifecare PLV-102, and Intermed Bear 33 are electrically controlled and powered ventilators.

 

DIF:    1                      REF:    pg. 18

 

  1. A patient being transferred from a hospital to a skilled nursing facility requires mechanical ventilation with a fractional inspired oxygen (FIO2) of 0.21. The skilled nursing facility has no piped in gases. Which of the following ventilators will be able to function in the skilled nursing facility without any extra equipment?
a. Servoi
b. LTV 1000
c. Bird Mark 7
d. Bio-Med MVP-10

 

 

ANS:   B

The type of ventilator that will be appropriate for this situation is one that is electrically controlled and powered with a built-in air compressor. The LTV 1000 fits this description. The Servoi requires both a high-pressure gas source as well as electrical power. The Bird Mark 7 is a pneumatic ventilator and will not be able to function in this situation. The Bio-Med MVP-10 is also a pneumatic ventilator that wont function in this situation.

 

DIF:    2                      REF:    pg. 18

 

  1. The internal circuit of a ventilator allows the gas to go directly from its power source into the patient. This is known as which of the following?
a. Single-circuit
b. Open loop
c. Closed loop
d. Double-circuit

 

 

ANS:   A

There are two types of internal circuits, the single- and the double-circuit. The single-circuit allows the gas to flow from its power input source to the patient. The double-circuit utilizes a primary power source to generate a gas flow that compresses a mechanism such as a bellows. The gas within the bellows will then flow to the patient. Open and closed loop refer to the absence or presence, respectively, of a feedback loop system.

 

DIF:    1                      REF:    pg. 21

 

  1. A ventilator for which the primary power source generates a gas flow that compresses another mechanism and causes the gas from inside the mechanism to be delivered to the patient is known as which of the following?
a. Single-circuit
b. Double-circuit
c. Closed loop
d. Open loop

 

 

ANS:   B

In a double circuit ventilator, the primary power source generates a gas flow that compresses a mechanism such as a bellows or bag-in-a-chamber. The gas in the bellows or bag then flows to the patient. In a single-circuit ventilator, the primary power source travels directly to the patient. The closed and open loop refer to whether or not the ventilator has a feedback loop system.

 

DIF:    1                      REF:    pg. 21

 

  1. The function of the exhalation valve is to do which of the following?
a. Adjust the flow going to the patient
b. Close during exhalation to vent patient gas
c. Seal the external circuit during inspiration
d. Determine the volume being delivered

 

 

ANS:   C

During inspiration, gas fills the balloon and closes a hole in the expiratory valve. Closing of the hole makes the patient circuit a sealed system. During expiration, the balloon deflates, the hole opens, and gas from the patient is exhaled into the room through the hole.

 

DIF:    1                      REF:    pg. 23

 

  1. In the image, what does B represent?

 

a. Expiratory valve line
b. Exhalation valve
c. Expiratory line
d. Main inspiratory line

 

 

ANS:   C

The external exhalation valve is represented by the letter C in the figure. B is pointing to the expiratory line. The main inspiratory line is represented by the letter A. The expiratory valve line is represented by D.

 

DIF:    1                      REF:    pg. 19; Figure 2-8A

 

  1. The type of compressors that are used by hospitals to supply wall compressed air has which of the following?
a. Piston
b. Bellows
c. Rotating blades
d. Moving diaphragm

 

 

ANS:   A

Hospitals use large, piston-type, water-cooled compressors to supply wall gas outlets.

 

DIF:    1                      REF:    pg. 25

 

  1. The power transmission and conversion system of a ventilator is defined as which of the following?
a. A mechanical device that produces gas flow to the patient
b. An electrical motor that is connected by a special gearing mechanism
c. The system that interprets the settings and produces or regulates the desired output
d. Internal hardware that changes electrical or pneumatic energy into mechanical energy

 

 

ANS:   D

The power transmission and conversion system changes the energy from the power source into mechanical energy. The linear drive piston is a mechanical device that produces gas flow to the patient. The drive mechanism is an electrical motor that is connected by a special gearing mechanism. It is the control system that interprets the operator settings and produces or regulates the desired output.

 

DIF:    1                      REF:    pg. 25

 

  1. The volume displacement device that creates a sinusoidal flow waveform is which of the following?
a. Rotary drive piston
b. Linear drive piston
c. Spring-loaded bellows
d. Proportional solenoid

 

 

ANS:   A

The rotary drive piston creates a flow pattern that is slow at the beginning of inspiration, achieves highest speed at mid-inspiration, and tapers off at end-inspiration, creating a sinusoidal waveform (sine waveform).

 

DIF:    1                      REF:    pg. 27

 

  1. Modern intensive care units (ICU) ventilators regulate gas flow to the patient by using which of the following?
a. Rotary drive pistons
b. Linear drive pistons
c. Proportional solenoids
d. Spring-loaded bellows

 

 

ANS:   C

Proportional solenoid valves control flow by opening and closing either completely or in small increments. These valves, which are driven by various motor-based mechanisms, have a rapid response time and great flexibility in flow control. The other answers are all volume displacement devices.

 

DIF:    1                      REF:    pg. 25

 

Chapter 12; Methods to Improve Ventilation in Patient-Ventilator Management

Test Bank

 

MULTIPLE CHOICE

 

  1. During mechanical ventilation of a patient with COPD, the PaCO2 = 58 mm Hg and the  = 5.5 L/min. The desired PaCO2 for this patient is 45 mm Hg. To what should the  be changed?
a. 4.3 L/min
b. 4.8 L/min
c. 6.6 L/min
d. 7.1 L/min

 

 

ANS:   D

Desired VT =

 

DIF:    2                      REF:    pg. 224

 

  1. A patient with CHF is being mechanically ventilated. The patients current PaCO2 = 28 mm Hg, and the ventilator set rate is 16/minute. The desired PaCO2 for this patient is 40 mm Hg. To what should the set rate be changed?
a. 7/min
b. 11/min
c. 14/min
d. 18/min

 

 

ANS:   B

Desired f =

 

DIF:    2                      REF:    pg. 225

 

  1. 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?
a. 400 mL
b. 800 mL
c. 1000 mL
d. 1200 mL

 

 

ANS:   B

Desired VT =

 

DIF:    2                      REF:    pg. 223

 

  1. The average tidal volume range in an individual with no pulmonary problems is which of the following?
a. 4 to 5 mL/kg IBW
b. 5 to 8 mL/kg IBW
c. 8 to 10 mL/kg IBW
d. 12 to 15 mL/kg IBW

 

 

ANS:   B

Recommended guidelines are to target the VT to 5 to 8 mL/kg ideal body weight (IBW) while ensuring that the plateau pressure (Pplateau) is maintained at less than 30 cm H2O.

 

DIF:    1                      REF:    pg. 223

 

  1. A male patient (76-kg IBW) with no history of pulmonary disease is brought to the emergency department for treatment of a drug overdose. He is intubated and placed on mechanical ventilation with VC-CMV, f = 12/min, VT = 450 mL. The resulting arterial blood gas values are: pH 7.32, PaCO2 53 mm Hg, and HCO3 25 mEq/L. The most appropriate action to correct the acid-base disturbance is which of the following?
a. Increase VT to 595 mL
b. Increase VT to 760 mL
c. Increase frequency to 16/min
d. Decrease frequency to 10/min

 

 

ANS:   A

Desired VT =

The desired target for VT for this patient is 5 to 8 mL/kg IBW. Because the set VT of 450 mL is at 5.9 mL/kg, there is room to increase the VT. After calculating the desired VT using the formula, the new volume is at 7.8 mL/kg. A VT of 760 mL would be at 10 mL/kg IBW.

 

DIF:    3                      REF:    pg. 225

 

  1. A female patient (59-kg IBW) with no history of pulmonary disease is being invasively ventilated with VC-CMV, f = 12/min, VT = 470 mL, PEEP = 5 cm H2O, FIO2 = 0.5. ABG results with these settings are: pH 7.31, PaCO2 54 mm Hg, PaO2 92 mm Hg, SaO2 90%, HCO3 24 mEq/L. The most appropriate action for the respiratory therapist to take is which of the following?
a. Increase f to 16/min
b. Increase VT to 635 mL
c. Decrease VT to 400 mL
d. Decrease PEEP to 3 cm H2O

 

 

ANS:   A

The target VT for an individual without pulmonary disease is 5 to 8 mL/kg IBW. This patients VT range is 295 mL to 472 mL, meaning that the upper limit of this range has been reached. The f should be changed to increase this patients minute ventilation.

 

Desired f = ; desired f = 16

 

DIF:    3                      REF:    pg. 226

 

  1. A male patient (74-kg IBW) is being ventilated with PC-CMV, f = 12/min, PIP = 20 cm H2O, TI = 1.5 seconds; the resulting flow-time scalar is shown below. The patients measured VT is 435 mL. ABG results on these settings are: pH 7.32, PaCO2 54 mm Hg, HCO3 25 mEq/L. The most appropriate action to take is which of the following?

 

a. Increase f to 16 /min
b. Increase TI to 2.5 sec
c. Increase PIP to 27 cm H2O
d. Decrease flow rate to 40 L/min

 

 

ANS:   C

The flow-time scalar shows that TI is adequate, because it shows a time of zero flow during inspiration. Therefore, changing TI would not be appropriate. The measured VT for this patient is at 5.9 mL/kg IBW; therefore, the VT could be increased. In the PC mode, this would be done with by increasing the set PIP using the following formulas:

 

Desired VT =   = approximately 590 mL

Desired P =  = 26.8 cm H2O

 

DIF:    3                      REF:    pg. 223| pg. 225

 

  1. A 28-year-old female (55-kg IBW) is being mechanically ventilated with VC-CMV, f = 14/min, VT = 700 mL. The patient has no history of pulmonary disease. The resulting ABG values are: pH 7.55, PaCO2 27 mm Hg, HCO3 23 mEq/L. The most appropriate action to take is which of the following?
a. Decrease VT to 600 mL
b. Decrease VT to 450 mL
c. Decrease f to 12/min
d. Decrease f to 10/min

 

 

ANS:   B

The original volume setting exceeded the maximum VT for this patient. The VT should be set between 275 mL and 440 mL to achieve 5 to 8 mL/kg IBW. Therefore, the VT must be reduced to avoid overdistention. Using the formula:

 

Desired VT =

Desired VT = 473 mL

The VT of 450 mL is closest to the desired VT and is more in line with the acceptable range.

 

DIF:    3                      REF:    pg. 223

 

  1. A male patient (83 kg IBW) is intubated and ventilated with PC-CMV, f = 12/min, set PIP = 28 cm H2O, resulting in a VT of 430 mL. The ABG results on this setting are: pH 7.35, PaCO2 45 mm Hg, and HCO3 23 mEq/L. Forty-eight hours later on the same settings, the ABG results are: pH 7.54, PaCO2 27 mm Hg, and HCO3 21 mEq/L with an exhaled VT of 800 mL. The most appropriate action at this time is which of the following?
a. Decrease PIP to 25 cm H2O
b. Decrease PIP to 19 cm H2O
c. Decrease f to 10/min
d. Decrease f to 8/min

 

 

ANS:   B

At first the patient responded appropriately to the PC-CMV settings. At that point the Cs was 15 mL/cm H2O. After 48 hours, the patients lungs improved and the same pressure, 28 cm H2O, resulted in a VT of 800 mL. The patients Cs now is 28.5 mL/cm H2O, and the combination of Cs and PIP is resulting in respiratory alkalosis. The acceptable VT range for this patient is 415 to 664 mL (5 to 8 mL/kg IBW). Because the exhaled tidal volume now exceeds this range, the volume needs to be reduced. This is accomplished by reducing the set PIP using the following formulas:

 

Desired VT =  and Set PIP = VT/CS = 19 cm H2O.

 

DIF:    3                      REF:    pg. 223| pg. 225

 

  1. A patient with an IBW of 68 kg is intubated and being mechanically ventilated with VC-CMV, f = 12/min, and VT = 470 mL. The patient has a combined respiratory rate of 25/min. The ABG results are: pH 7.56, PaCO2 26 mm Hg, and HCO3 22 mEq/L. The most appropriate action is to do which of the following?
a. Decrease the set f to 8/min
b. Decrease the set VT to 300 mL
c. Sedate and paralyze the patient
d. Change the mode to VC-IMV

 

 

ANS:   D

The patient has ventilator-induced respiratory alkalosis, because the patient is triggering the machine breaths each time there is a spontaneous effort. Decreasing the set f will not alter the rate at which the patient is assisting. Decreasing the set VT to 300 mL will most likely result in the patient breathing at a faster rate because of the low volume. The patient could be sedated and paralyzed. However, the patient is not demonstrating a need for this option (i.e., extreme agitation, increased WOB, and patient-ventilator asynchrony). Changing to the VC-SIMV mode will allow the patient to breathe spontaneously and not trigger a machine breath each time.

 

DIF:    3                      REF:    pg. 226

 

  1. Metabolic acidosis may be caused by which of the following?
a. Overdose with salicylate
b. Diuretic administration
c. Nasogastric suctioning
d. Lactate administration

 

 

ANS:   A

Ingestion of salicylate causes the production of acid, resulting in metabolic acidosis.

 

DIF:    1                      REF:    pg. 226

 

  1. Metabolic alkalosis can be caused by which of the following?
a. Renal failure
b. Potassium deficiency
c. Carbonic anhydrase inhibitors
d. Ethylene glycol

 

 

ANS:   B

Potassium deficiency causes acid to shift into the cells, reducing the amount of acid in the blood.

 

DIF:    1                      REF:    pg. 226

 

  1. If respiratory acidosis persists after alveolar ventilation of a patient has been increased, which of the following could be the cause?
a. Chronic obstructive pulmonary disease
b. Pulmonary embolism
c. Pulmonary edema
d. Low PEEP levels

 

 

ANS:   B

If pure respiratory acidosis persists even after alveolar ventilation has been increased, the patient may have a problem with increased dead space. One cause of increased dead space is a pulmonary embolism or low cardiac output, resulting in low pulmonary perfusion.

 

DIF:    1                      REF:    pg. 228

 

  1. A 59-kg IBW female patient is being mechanically ventilated in the CMV mode, f = 12/min, VT = 400 mL, PEEP = 5 cm H2O, FIO2 = 0.5. The ABG results on these settings show a respiratory acidosis and severe hypoxemia. The respiratory therapist increases the set VT and increases the PEEP to 12 cm H2O. The resulting ABGs show improved oxygenation, but the patient still has a respiratory acidosis. The respiratory acidosis may be due to which of the following?
a. Tissue hypoxia
b. Increased dead space
c. Increased cardiac output
d. Continued hypoventilation

 

 

ANS:   B

If an increase in alveolar ventilation does not correct a respiratory acidosis, the condition usually is caused by pulmonary embolism, low pulmonary perfusion, or increased dead space. The reduction in pulmonary blood flow caused by high alveolar pressures can increase dead space. In this patients case, the increase in PEEP is most likely the reason for the continued respiratory acidosis.

 

DIF:    2                      REF:    pg. 228

 

  1. A patient diagnosed with sepsis who is being mechanically ventilated has a combined minute ventilation of 25 L/min with a PaCO2 of 38 mm Hg. The reason for these findings is most likely which of the following?
  2. Increased
  3. Decreased
  4. Increased VD/VT
  5. Decreased VD/VT

 

a. 1 and 3 only
b. 1 and 4 only
c. 2 and 3 only
d. 2 and 4 only

 

 

ANS:   A

Sepsis increases the metabolic rate and . However, given the  level, the PaCO2 should be lower. The reason it is not lower is the increased  and VD/VT.

 

DIF:    1                      REF:    pg. 228

 

  1. In which of the following situations should iatrogenic hyperventilation be considered?
a. Severe traumatic brain injury
b. Initial treatment for increased intracranial pressure
c. Acute head injuries with increased intracranial pressure
d. Acute neurological deterioration with increased intracranial pressure

 

 

ANS:   D

Hyperventilation may be needed for brief periods when acute neurological deterioration is present and the ICP is elevated. Current therapeutic guidelines for head injuries with increased ICP do not recommend prophylactic hyperventilation (PaCO2 <25 mm Hg) during the first 24 hours. Hyperventilation during the first few days after severe traumatic brain injury (TBI) may actually increase cerebral ischemia and cause cerebral hypoxemia

 

DIF:    1                      REF:    pg. 229

 

  1. Treatment for increased intracranial pressure includes all of the following except which technique?
a. Hyperosmolar therapy
b. Neuromuscular blockade
c. Iatrogenic hyperventilation
d. Cerebral spinal fluid drainage

 

 

ANS:   C

The practice of iatrogenic hyperventilation is controversial, and it may actually increase cerebral ischemia and cause cerebral hypoxemia in certain cases (severe TBI). Treatments for increased ICP include sedation and analgesia, neuromuscular blockade, cerebral spinal fluid drainage, and hyperosmolar therapy.

 

DIF:    1                      REF:    pg. 229

 

  1. Permissive hypercapnia would benefit patients with which of the following?
a. Cerebral trauma
b. Intracranial lesion
c. Acute lung injury
d. Cardiovascular instability

 

 

ANS:   C

Patients with ALI benefit from permissive hypercapnia to protect the lungs from ventilator-induced lung injury. Contraindications to PHY include cerebral disorders, because CO2 is a powerful vasodilator. PHY also is contraindicated in patients with pre-existing cardiovascular instability, because the circulatory effects of PHY can include decreased myocardial contractility, arrhythmias, vasodilation, and increased sympathetic activity.

 

DIF:    1                      REF:    pg. 229

 

  1. A 45-year-old female (58-kg IBW) with a past medical history of asthma arrives at the emergency department short of breath, anxious, diaphoretic, and unable to perform a peak expiratory flow measurement. She also has a combined acidosis. Breath sounds reveal the patient is not moving much air. The patient is intubated, stabilized, and transported to the ICU. The ventilator settings are: PC-CMV, f = 12/min, PIP = 30 cm H2O, FIO2 = 0.6, and PEEP = 3 cm H2O. The patient is sedated and paralyzed; the resulting ABGs are: pH 7.17, PaCO2 69.3 mm Hg, PaO2 90 mm Hg, and HCO3 21 mEq/L after continuous bronchodilator therapy. The respiratory rate is increased to 20/min, and the next ABG results are: pH 7.26, PaCO2 58 mm Hg, PaO2 96 mm Hg, and HCO3 22 mEq/L. The respiratory therapist should suggest which of the following at this time?
a. Increase PIP to 38 cm H2O
b. Decrease PIP to 25 cm H2O
c. Continue with current therapy
d. Change to VC-CMV, f = 12/ min, VT = 700 mL

 

 

ANS:   C

The current therapy should be continued in an effort to prevent lung injury.

 

DIF:    3                      REF:    pg. 229

 

  1. At what point during deep suctioning should negative pressure be applied?
a. Five seconds after resistance is met
b. Ten seconds after insertion of the catheter
c. After 1-cm withdrawal from the point of resistance
d. After 2-cm withdrawal from the point of resistance

 

 

ANS:   C

During deep suctioning, once resistance is met, the catheter is withdrawn approximately 1 cm before negative pressure is applied.

 

DIF:    1                      REF:    pg. 231

 

  1. A suction catheter long enough to reach a mainstem bronchus should be what length?
a. 22 cm (8.7 in)
b. 25 cm (9.8 in)
c. 46 cm (18 in)
d. 56 cm (22 in)

 

 

ANS:   D

A catheter of about 56 cm (22 inches) should be long enough to reach a mainstem bronchus.

 

DIF:    1                      REF:    pg. 231

 

  1. What size suction catheter is appropriate for use in a patient with a 7-mm ET tube?
a. 8 Fr
b. 10 Fr
c. 12 Fr
d. 14 Fr

 

 

ANS:   B

Multiply the ET tube size by 3; this converts the ET size to French units (Fr). Then divide the result by 2, for a size that is half or less of the ET diameter.

 

DIF:    2                      REF:    pg. 232

 

  1. What size suction catheter is appropriate for use in a patient with a 6-mm ET tube?
a. 8 Fr
b. 10 Fr
c. 12 Fr
d. 14 Fr

 

 

ANS:   A

Multiply the ET tube size by 3; this converts the ET size to French units (Fr). Then divide the result by 2, for a size that is half or less of the ET diameter. In this case, the answer is 9; therefore, round down to the lower size so as not to obstruct more than 50% of the ET tube during suctioning.

 

DIF:    2                      REF:    pg. 232

 

  1. Advantages of closed suctioning include which of the following?
  2. No need to prehyperoxygenate or posthyperoxygenate
  3. No need to prehyperventilate or posthyperventilate
  4. Decreased risk of infection for caregiver
  5. No loss of PEEP during the procedure
a. 1 and 2 only
b. 3 and 4 only
c. 1, 2, and 4 only
d. 2, 3, and 4 only

 

 

ANS:   B                     DIF:    1                      REF:    pg. 232

 

  1. During a closed suctioning procedure, the patients heart rate changes from 95 beats/min to 58 beats/min. The respiratory therapist should take what immediate action?
a. Continue the procedure until secretions are removed.
b. Stop the procedure and switch to the open suctioning method.
c. Stop the procedure and use the ventilator to hyperoxygenate the patient with 100% oxygen.
d. Remove the patient from the ventilator and ventilate the person with a resuscitator bag.

 

 

ANS:   C

Cardiac arrhythmias can occur during aggressive suctioning. Bradycardia may occur when the catheter stimulates vagal receptors in the upper airways. The procedure should be stopped and the ventilator should be used to hyperoxygenate the patient.

 

DIF:    3                      REF:    pg. 232

 

  1. Which of the following is recommended when administering aerosols to mechanically ventilated patients with a small-volume nebulizer?
a. Make sure the flow-by is turned on during administration.
b. Keep the HME in-line during the aerosol treatment.
c. Use the ventilator nebulizer system when appropriate.
d. Bypass the humidifier during the aerosol treatment.

 

 

ANS:   C

Use the ventilator nebulizer system if it meets the SVN flow needs and cycles on inspiration. Flow-by should be turned off, because it produces a continuous flow through the circuit during exhalation while nebulization is proceeding. Remove the HME from the circuit, because it will trap the aerosol particles. Do not disconnect the humidifier.

 

DIF:    1                      REF:    pg. 239

 

  1. When using a SVN or pMDI with NPPV, where in the NPPV circuit should the device be placed to obtain the greatest aerosol deposition?
a. Before the leak port
b. Anywhere in the circuit
c. Between the NPPV and the humidifier
d. Between the leak port and the face mask

 

 

ANS:   D

To achieve the greatest aerosol deposition when using a pMDI or SVN, the device should be placed close to the patient, between the leak port and the face mask.

 

DIF:    1                      REF:    pg. 237

 

  1. Which of the following ventilator graphics could be used to assess the response to bronchodilator therapy for a patient receiving mechanical ventilation with VC-CMV?
  2. Pressure-time scalar
  3. Flow-time scalar
  4. Pressure-volume loop
  5. Volume-time scalar
a. 1 and 2 only
b. 3 and 4 only
c. 1 and 3 only
d. 1, 2 and 4 only

 

 

ANS:   D

With VC-CMV, the volume-time scalar will remain constant. The expiratory portion of the flow-time scalar can show improvement if there is a response to the bronchodilator. The changes in PIP can be monitored with the pressure-time scalar and/or the pressure-volume loop.

 

DIF:    2                      REF:    pg. 241

 

  1. A mechanically ventilated patient continues to have rhonchi after deep suctioning. The respiratory therapist should recommend which of the following?
a. Prone position
b. Vest Airway Clearance System
c. Prone position with the foot of the bed elevated 12 inches
d. Supine position with the foot of the bed elevated 18 inches

 

 

ANS:   B

The Vest Airway Clearance System creates vibrations around the entire thorax, which helps mobilize secretions from all areas of the lungs. The prone position is used for patients with ARDS to assist with oxygenation and perfusion of the good lung areas. The head-down positions may cause an increase in ICP or BP or may increase the risk of vomiting.

 

DIF:    2                      REF:    pg. 241

 

  1. Bedside bronchoscopy of an invasively ventilated patient is being performed by a physician and respiratory therapist. Fentanyl and midazolam were used for conscious sedation. After the bronchoscopy, the patient is not arousable. Which of the following should be done at this time?
a. Draw a sample for arterial blood gas determinations
b. Increase the patients respiratory rate
c. Administer naloxone
d. Administer atropine

 

 

ANS:   C

The patient requires reversal of the sedation. Naloxone or flumazenil may be used to reverse sedation.

 

DIF:    2                      REF:    pg. 242

 

  1. An invasively ventilated patient with ARDS is on PC-CMV, PIP = 30 cm H2O, PEEP = 12 cm H2O, FIO2 = 1.0. The patients 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 46mm Hg, PaO2 83 mm Hg. The respiratory therapist should do which of the following?
a. Keep the patient in the prone position.
b. Place the patient in the supine position.
c. Keep the patient in the prone position and decrease the FIO2.
d. Place the patient in the supine position and decrease PEEP.

 

 

ANS:   C

This patient has shown a positive response to the prone position; therefore, the patient can be maintained in this position for 2 to 12 hours. A reduction in the FIO2 would be appropriate, because the level is at 1.0.

 

DIF:    3                      REF:    pg. 244

 

  1. A patient with extensive infiltrates throughout the right lung should be placed in which of the following positions to improve oxygenation?
a. Left lung down laterally
b. Right lung down laterally
c. Left lung down with right lung 45 degrees from supine
d. Right lung down with left lung 45 degrees from supine

 

 

ANS:   A

To improve oxygenation without uneven distribution of PEEP to the normal lung, the patient should be placed with the good lung down.

 

DIF:    2                      REF:    pg. 246

 

  1. What effect does positive pressure ventilation have on fluid balance?
a. It increases urinary output.
b. It increases renal perfusion.
c. It causes renal malfunction.
d. It increases plasma ADH levels.

 

 

ANS:   D

Positive pressure ventilation increases the plasma antidiuretic hormone level. Renal malfunction does directly affect fluid balance, but it is not caused by PPV. PPV decreases urinary output because of the increased levels of ADH. PPV may also also decrease renal perfusion.

 

DIF:    1                      REF:    pg. 247

 

 

Chapter 22; Neonatal and Pediatric Ventilation

Test Bank

 

MULTIPLE CHOICE

 

  1. Respiratory failure is imminent in infants who demonstrate which of the following?
a. Substernal retractions
b. Tachypnea
c. Grunting
d. Nasal flaring

 

 

ANS:   C

Infants attempt to maintain a back pressure in the lungs to preserve the functional residual capacity by narrowing the glottis and maintaining respiratory muscle activity (active exhalation). This results in vocalization during exhalation, or grunting, which often is mistaken for crying. Grunting, which usually can be heard without auscultation, is a useful clinical sign of impending respiratory failure.

 

DIF:    1                      REF:    pg. 461

 

  1. The primary goals of mechanical ventilatory support in newborns and pediatric patients include all of the following except ____________________.
a. improving lung compliance
b. eliminating airway resistance
c. achieving adequate lung volume
d. limiting lung injury

 

 

ANS:   B

The goals of mechanical ventilatory support in newborns and pediatric patients are to (1) provide adequate ventilation and oxygenation, (2) achieve adequate lung volume, (3) improve lung compliance, (4) reduce WOB, and (5) limit lung injury. If airway resistance is a problem, it needs to be addressed; however, eliminating it is not a goal of mechanical ventilatory support.

 

DIF:    1                      REF:    pg. 462

 

  1. A newborn with which of the following clinical manifestations should receive nasal CPAP?
a. Substernal retractions, PaCO2 = 65 mm Hg, PaO2 = 48 mm Hg, FIO2 = 0.4.
b. Tachypnea, nasal flaring, PaCO2 = 50 mm Hg, PaO2 = 50 mm Hg, FIO2 = 0.6.
c. Grunting, substernal retractions, pH = 7.20, PaCO2 = 70 mm Hg, PaO2 = 40 mm Hg, FIO2 = 0.7.
d. Tachypnea, pale skin, pH = 7.32, PaCO2 = 45 mm Hg, PaO2 = 75 mm Hg, FIO2 = 0.21.

 

 

ANS:   B

A newborn with tachypnea, nasal flaring, a PaCO2 of 50 mm Hg, a PaO2 of 50 mm Hg, and an FIO2 of 0.6 meets the criteria for nasal CPAP. A newborn with these findings has adequate minute ventilation, as evidenced by the PaCO2 of 50 mm Hg, but also has hypoxemia that is not being corrected by an FIO2 of 0.6. The newborn in option A (substernal retractions, PaCO2 = 65 mm Hg, PaO2 = 48 mm Hg, FIO2 = 0.4) does not have an adequate minute ventilation and requires some ventilatory assistance. Mechanical ventilation is indicated for the newborn in option C (grunting, substernal retractions, pH = 7.20, PaCO2 = 70 mm Hg, PaO2 = 40 mm Hg, FIO2 = 0.7), because this patient has respiratory acidosis and uncorrected hypoxemia. The newborn in option D (tachypnea, pale skin, pH = 7.32, PaCO2 = 45 mm Hg, PaO2 = 75 mm Hg, FIO2 = 0.21) has two of the physical indications for CPAP, but the ABG findings demonstrate adequate oxygenation.

 

DIF:    2                      REF:    pg. 463; Box 22-1

 

  1. Infants with which of the following problems would benefit from nasal CPAP?
a. Cleft palate
b. Choanal atresia
c. Patent ductus arteriosus
d. Tracheoesophageal fistula

 

 

ANS:   C

A newborn with a patent ductus arteriosus has increased pulmonary blood flow and reduced lung compliance and FRC and therefore would benefit from the positive intrathoracic pressure produced by CPAP. The use of CPAP can be dangerous in newborns with choanal atresia, a tracheoesophageal fistula, or a cleft palate.

 

DIF:    1                      REF:    pg. 464

 

  1. The most common interface for infants receiving CPAP is which of the following?
a. Nasopharyngeal tube
b. Binasal prongs
c. Nasal mask
d. Endotracheal tube

 

 

ANS:   B

The short binasal prongs are the most commonly used interface for infants receiving nasal CPAP. Nasal masks are slowly becoming more popular. The least popular method of administering CPAP is through nasopharyngeal or endotracheal tubes, because they are invasive.

 

DIF:    1                      REF:    pg. 464

 

  1. Nasal CPAP should be administered to a neonate with _______________.
a. cleft palate
b. choanal atresia
c. apnea of prematurity
d. tracheoesophageal fistula

 

 

ANS:   C

The use of CPAP can be dangerous in a newborn with choanal atresia, a tracheoesophageal fistula, or a cleft palate. CPAP can be used successfully in infants with apnea of prematurity.

 

DIF:    1                      REF:    pg. 464

 

  1. The gas flow rate for a noncommercial bubble CPAP device should be set at _______ L/min.
a. 3
b. 5
c. 8
d. 10

 

 

ANS:   B

Gas flow in noncommercial bubble CPAP devices should be set at 5 L/min.

 

DIF:    1                      REF:    pg. 465

 

  1. A full-term neonate shows signs of respiratory distress after delivery by cesarean section. The baby is placed on nasal CPAP at 4 cm H2O with an FIO2 of 0.6. The ABG results on these settings are: pH = 7.32, PaCO2 = 45 mm Hg, PaO2 = 48 mm Hg, SaO2 = 70%, HCO3 = 22 mEq/L. The respiratory therapist should recommend which of the following?
a. Switch to NIPPV.
b. Increase the FIO2 to 0.7.
c. Increase the CPAP to 6 cm H2O.
d. Intubate and use ventilator CPAP.

 

 

ANS:   C

The ABG results show that the neonate is adequately ventilated. This eliminates the need for NIPPV because the CPAP level is not optimized at this time, and the FIO2 is set at a high level. The ABG results also show that the patient has not had an adequate response to the CPAP of 4 cm H2O with an FIO2 0.6. The CPAP can be increased in increments of 1 to 2 cm H2O until it reaches 10 cm H2O. Intubating for the use of ventilator CPAP would not provide any benefit over noninvasive CPAP and would increase the risk of nosocomial infection.

 

DIF:    3                      REF:    pg. 466

 

  1. Bubble CPAP should _________________.
a. bubble only on expiration
b. bubble only on inspiration
c. bubble on inspiration and expiration
d. have a gas flow setting of 10 L/min

 

 

ANS:   C

Bubble CPAP should have the lowest possible flow to maintain constant bubbling throughout the respiratory cycle.

 

DIF:    1                      REF:    pg. 465| pg. 466

 

  1. NIPPV can be used successfully in neonates for which of the following?
a. Severe ventilatory impairment
b. Persistent apnea
c. After extubation
d. Cleft palate

 

 

ANS:   C

NIPPV can be used as an initial form of respiratory support and also after extubation from invasive mechanical ventilation.

 

DIF:    1                      REF:    pg. 467

 

  1. A neonate of 30 weeks gestation shows signs of respiratory distress after delivery, including grunting, nasal flaring, and cyanosis. The baby is placed on nasal CPAP at 6 cm H2O with an FIO2 of 0.6. The grunting and nasal flaring are alleviated, and the ABG results on these settings are: pH = 7.20, PaCO2 = 64 mm Hg, PaO2 = 48 mm Hg, SaO2 = 70%, HCO3 = 21 mEq/L. The respiratory therapist should recommend which of the following?
a. Increase the CPAP to 8 cm H2O and the FIO2 to 0.7.
b. Switch to nasal IMV, an inspiratory pressure of 18 cm H2O, PEEP of 4 cm H2O, and an FIO2 of 0.8.
c. Continue with the current settings and monitor the patient closely.
d. Intubate and use PC-IMV, an inspiratory pressure of 16 cm H2O, PEEP of 5 cm H2O, and an FIO2 of 0.8.

 

 

ANS:   D

This neonate meets the requirements for invasive mechanical ventilation because of continued signs of respiratory distress: respiratory acidosis and a PaO2 of 48 mm Hg with an FIO2 of 0.6. Remaining in CPAP would not address the respiratory acidosis or the hypoxemia. Increasing the CPAP level and the FIO2 would not address the respiratory acidosis. This patient is showing severe ventilatory impairment (pH < 7.25, PaCO2 > 6 mm Hg) and refractory hypoxemia (PaO2 < 50 mm Hg on an FI

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