Although treated with several antiarrhythmic drugs, a patient with ventricular tachycardia
begins to exhibit hypotension and decreased consciousness. Which of the following actions
would you recommend at this time?
immediately initiate CPR
apply cardioversion
administer epinephrine
defibrillate the patient - ANSWER apply cardioversion
*If drug management fails, if the ventricular rate exceeds 150/min, or if the patient becomes
hemodynamically unstable, synchronous cardioversion is indicated.
A physician orders intubation and volume-controlled A/C ventilation for a 6-foot, 3-inch tall
190-lb (86-kg) adult male patient with ARDS. Which of the following ventilator settings
would you aim for to support this patient?
rate/min: 10; VT (mL): 800
rate/min: 15; VT (mL): 500
rate/min: 20; VT (mL): 900
rate/min: 8; VT (mL): 1200 - ANSWER rate/min: 15; VT (mL): 500
Tidal volume 6ml/kg IBW
6ft 3= 85kg IBW
1
,Vt= 500
Rate= 10 to 20
A doctor institutes volume-controlled ventilation for a 70-kg ARDS patient with a targeted
tidal volume of 420 mL To maintain adequate ventilation with this tidal volume, the maxi-
mum respiratory rate you would allow is:
25/min
35/min
20/min
30/min - ANSWER 35/min
Which of the following PaCO2 levels would be considered a positive result for brain death
determination at the end of an apnea test?
-at least 50 mm Hg
-at least 45 mm Hg
-at least 60 mm Hg
-at least 55 mm Hg - ANSWER at least 60 mm Hg
or 20+ from baseline CO2
A COPD patient receiving volume-controlled A/C ventilation at a rate of 15 and a VT of 650
mL exhibits signs of air trapping (auto-PEEP). Which of the following alternatives would you
recommend to help overcome this problem?
1. add an end-inspiratory pause
2. switch to SIMV and decrease the rate
3. increase the inspiratory flow
2
,2 and 3 only
1, 2, and 3
1 and 3 only
1 and 2 only - ANSWER 2 and 3 only
* Adding an end-inspiratory pause would cause more airtrapping
A patient who just underwent major thoracic surgery is placed on pressure-controlled A/C
ventilation with 10 cmH2O PEEP. You observe continuous bubbling in the water seal cham-
ber of his pleural drainage system. Which of the following is the most likely cause of this ob-
servation?
-the patient has a pleural effusion
-the suction/ vacuum pressure is too low
-the drainage system is obstructed
-the patient has a bronchopleural fistula - ANSWER the patient has a bronchopleural
fistula
* Constant bubbling indicates a leak; either in the patient or in the tubing/chamber system.
To measure the amount of auto-PEEP present in a patient receiving ventilatory support, you
would:
-measure pressure during an end-expiratory pause
-measure expiratory flow before and after bronchodilator
-measure pressure at volume increments using a super syringe
-measure pressure during an end-inspiratory pause - ANSWER measure pressure dur-
ing an end-expiratory pause
3
, Which of the following indicate that a pleural drainage system is working properly?
1. the water seal chamber level rises and falls with breathing
2. there is continuous bubbling in the suction control chamber
3. there is continuous bubbling in the water seal chamber
1, 2, and 3
1 only
1 and 2
3 only - ANSWER 1 and 2
* Suction control should bubble continuously and water seal chamber should rise and fall.
* Continuous bubbling in the water seal chamber= leak.
A physician wants to calculate the static lung compliance for a 110-kg patient receiving vol-
ume controlled ventilation. Patient settings and monitoring data are as follows: Vt 900 ml,
Rate 14/min, Peak pressure 50 cmH2O, Plateau pressure 35 cmH2O, PEEP 10 cmH2O, Me-
chanical dead space 100ml. The patient's static lung compliance is:
22 mL/cmH2O
26 mL/cmH2O
18 mL/cmH2O
36 mL/cmH2O - ANSWER 36 mL/cmH2O
*VT/(Plat-PEEP)
A physician has attempted on several occasions to insert a central venous catheter into the
right subclavian vein of a patient receiving mechanical ventilation. Suddenly the ventilator's
high-pressure alarm sounds, the patient's blood pressure drops, and the SPO2 value drips
4
begins to exhibit hypotension and decreased consciousness. Which of the following actions
would you recommend at this time?
immediately initiate CPR
apply cardioversion
administer epinephrine
defibrillate the patient - ANSWER apply cardioversion
*If drug management fails, if the ventricular rate exceeds 150/min, or if the patient becomes
hemodynamically unstable, synchronous cardioversion is indicated.
A physician orders intubation and volume-controlled A/C ventilation for a 6-foot, 3-inch tall
190-lb (86-kg) adult male patient with ARDS. Which of the following ventilator settings
would you aim for to support this patient?
rate/min: 10; VT (mL): 800
rate/min: 15; VT (mL): 500
rate/min: 20; VT (mL): 900
rate/min: 8; VT (mL): 1200 - ANSWER rate/min: 15; VT (mL): 500
Tidal volume 6ml/kg IBW
6ft 3= 85kg IBW
1
,Vt= 500
Rate= 10 to 20
A doctor institutes volume-controlled ventilation for a 70-kg ARDS patient with a targeted
tidal volume of 420 mL To maintain adequate ventilation with this tidal volume, the maxi-
mum respiratory rate you would allow is:
25/min
35/min
20/min
30/min - ANSWER 35/min
Which of the following PaCO2 levels would be considered a positive result for brain death
determination at the end of an apnea test?
-at least 50 mm Hg
-at least 45 mm Hg
-at least 60 mm Hg
-at least 55 mm Hg - ANSWER at least 60 mm Hg
or 20+ from baseline CO2
A COPD patient receiving volume-controlled A/C ventilation at a rate of 15 and a VT of 650
mL exhibits signs of air trapping (auto-PEEP). Which of the following alternatives would you
recommend to help overcome this problem?
1. add an end-inspiratory pause
2. switch to SIMV and decrease the rate
3. increase the inspiratory flow
2
,2 and 3 only
1, 2, and 3
1 and 3 only
1 and 2 only - ANSWER 2 and 3 only
* Adding an end-inspiratory pause would cause more airtrapping
A patient who just underwent major thoracic surgery is placed on pressure-controlled A/C
ventilation with 10 cmH2O PEEP. You observe continuous bubbling in the water seal cham-
ber of his pleural drainage system. Which of the following is the most likely cause of this ob-
servation?
-the patient has a pleural effusion
-the suction/ vacuum pressure is too low
-the drainage system is obstructed
-the patient has a bronchopleural fistula - ANSWER the patient has a bronchopleural
fistula
* Constant bubbling indicates a leak; either in the patient or in the tubing/chamber system.
To measure the amount of auto-PEEP present in a patient receiving ventilatory support, you
would:
-measure pressure during an end-expiratory pause
-measure expiratory flow before and after bronchodilator
-measure pressure at volume increments using a super syringe
-measure pressure during an end-inspiratory pause - ANSWER measure pressure dur-
ing an end-expiratory pause
3
, Which of the following indicate that a pleural drainage system is working properly?
1. the water seal chamber level rises and falls with breathing
2. there is continuous bubbling in the suction control chamber
3. there is continuous bubbling in the water seal chamber
1, 2, and 3
1 only
1 and 2
3 only - ANSWER 1 and 2
* Suction control should bubble continuously and water seal chamber should rise and fall.
* Continuous bubbling in the water seal chamber= leak.
A physician wants to calculate the static lung compliance for a 110-kg patient receiving vol-
ume controlled ventilation. Patient settings and monitoring data are as follows: Vt 900 ml,
Rate 14/min, Peak pressure 50 cmH2O, Plateau pressure 35 cmH2O, PEEP 10 cmH2O, Me-
chanical dead space 100ml. The patient's static lung compliance is:
22 mL/cmH2O
26 mL/cmH2O
18 mL/cmH2O
36 mL/cmH2O - ANSWER 36 mL/cmH2O
*VT/(Plat-PEEP)
A physician has attempted on several occasions to insert a central venous catheter into the
right subclavian vein of a patient receiving mechanical ventilation. Suddenly the ventilator's
high-pressure alarm sounds, the patient's blood pressure drops, and the SPO2 value drips
4
