TEST BANK Pilbeam's Mechanical Ventilation:
Physiological and Clinical Applications, 6th Edition By
James M. Cairo, PhD, RRT, FAARC Elsevier | ISBN:
978-0-323-32009-2
Total Questions: 200
Question Type: Multiple Choice
Answer Key: Correct answer indicated in bold after each question
Rationales: Provided for each correct answer with textbook references (REF)
CHAPTER 1: BASIC TERMS AND CONCEPTS OF MECHANICAL VENTILATION
1. The body's mechanism for conducting air in and out of the lungs is known as which of the
following?
- A) External respiration
- B) Internal respiration
- C) Spontaneous ventilation
- D) Mechanical ventilation
Answer: C
Rationale: Ventilation is the conduction of air in and out of the body. Spontaneous ventilation is
the body's own mechanism for this process. External respiration involves gas exchange
between alveoli and pulmonary capillaries, while internal respiration occurs at the cellular level.
2. Which of the following structures are involved in external respiration?
- A) Red blood cells and body cells
- B) Scalenes and trapezius muscles
- C) Alveoli and pulmonary capillaries
- D) External oblique and transverse abdominal muscles
Answer: C
Rationale: External respiration involves the exchange of oxygen (O₂) and carbon dioxide (CO₂)
between the alveoli and pulmonary capillaries. The scalene and trapezius muscles are
,accessory muscles of inspiration, while the external oblique and transverse abdominal muscles
are accessory muscles of expiration.
3. During spontaneous inspiration, alveolar pressure (Pₐ) is approximately:
- A) +5 cm H₂O
- B) -1 to -3 cm H₂O
- C) 0 cm H₂O
- D) -10 cm H₂O
Answer: B
Rationale: During spontaneous inspiration, the diaphragm contracts and descends, increasing
thoracic volume and decreasing alveolar pressure to approximately -1 to -3 cm H₂O relative to
atmospheric pressure. This pressure gradient drives airflow into the lungs.
4. During spontaneous breathing, intrapleural pressure at end-expiration is approximately:
- A) 0 cm H₂O
- B) -5 cm H₂O
- C) -10 cm H₂O
- D) +5 cm H₂O
Answer: B
Rationale: During spontaneous breathing, intrapleural pressure drops from approximately -5 cm
H₂O at end-expiration to about -10 cm H₂O at end-inspiration. This negative pressure is
essential for maintaining lung inflation.
5. The primary indication for initiating mechanical ventilation is:
- A) Patient request for comfort
- B) Acute respiratory failure with hypoxemia or hypercapnia refractory to non-invasive
measures
- C) Routine postoperative care for all surgical patients
- D) Elevated white blood cell count
Answer: B
Rationale: Mechanical ventilation is indicated for acute respiratory failure (hypoxemic – PaO₂
<60 mmHg on FiO₂ >0.50, or hypercapnic – PaCO₂ >45-50 mmHg with pH <7.35) that is not
responsive to non-invasive measures. Other indications include apnea, severe respiratory
muscle fatigue, airway protection, and hemodynamic instability.
,6. Which of the following is an absolute contraindication to noninvasive ventilation (NIV)?
- A) COPD exacerbation
- B) Cardiogenic pulmonary edema
- C) Cardiac or respiratory arrest (apnea)
- D) Obesity hypoventilation syndrome
Answer: C
Rationale: Cardiac or respiratory arrest (apnea) is an absolute contraindication to NIV; these
patients require immediate intubation and invasive mechanical ventilation. Other
contraindications include facial trauma/burns, inability to protect the airway, excessive
secretions, and hemodynamic instability.
7. The normal range for PaO₂ on room air is approximately:
- A) 35-45 mmHg
- B) 60-70 mmHg
- C) 80-100 mmHg
- D) 120-140 mmHg
Answer: C
Rationale: Normal PaO₂ on room air (FiO₂ 0.21) is 80-100 mmHg (decreases with age: 80 - (age
× 0.4) ≈ 80 at age 0, 60 at age 50). PaO₂ <60 mmHg indicates hypoxemia. PaCO₂ normal range
is 35-45 mmHg.
8. The normal range for PaCO₂ is:
- A) 20-30 mmHg
- B) 35-45 mmHg
- C) 50-60 mmHg
- D) 70-80 mmHg
Answer: B
Rationale: The normal range for arterial carbon dioxide tension (PaCO₂) is 35-45 mmHg. Values
above this range indicate hypercapnia (respiratory acidosis), while values below indicate
hypocapnia (respiratory alkalosis).
9. Which of the following is NOT a normal physiologic response to hypoxemia?
- A) Tachypnea
, - B) Tachycardia
- C) Hypertension
- D) Bradypnea
Answer: D
Rationale: The normal physiologic responses to hypoxemia include tachypnea (increased
respiratory rate), tachycardia (increased heart rate), and hypertension (increased blood
pressure). Bradypnea (decreased respiratory rate) would be an abnormal or late sign indicating
respiratory depression or failure.【REF: Chapter 1】
10. Lung compliance is defined as:
- A) The resistance to airflow in the airways
- B) The change in lung volume per unit change in pressure (ΔV/ΔP)
- C) The pressure difference between alveoli and atmosphere
- D) The rate of gas exchange across the alveolar-capillary membrane
Answer: B
Rationale: Lung compliance is a measure of lung distensibility, defined as the change in lung
volume (ΔV) produced by a given change in transpulmonary pressure (ΔP). High compliance
indicates easily distensible lungs (e.g., emphysema), while low compliance indicates stiff lungs
(e.g., ARDS, fibrosis).
11. Normal lung compliance in an adult is approximately:
- A) 0.01 L/cm H₂O
- B) 0.1 L/cm H₂O
- C) 1.0 L/cm H₂O
- D) 10 L/cm H₂O
Answer: B
Rationale: Normal lung compliance in an adult is approximately 0.1 L/cm H₂O (100 mL/cm H₂O).
This value can vary based on lung size, age, and disease state. Reduced compliance (stiff
lungs) is seen in conditions such as ARDS, pulmonary edema, and fibrosis.【REF: Chapter 1】
12. Airway resistance is determined by which of the following factors?
- A) Gas viscosity and density only
- B) Lung volume only
- C) Radius of the airways (Poiseuille's law)
- D) Surface tension
Physiological and Clinical Applications, 6th Edition By
James M. Cairo, PhD, RRT, FAARC Elsevier | ISBN:
978-0-323-32009-2
Total Questions: 200
Question Type: Multiple Choice
Answer Key: Correct answer indicated in bold after each question
Rationales: Provided for each correct answer with textbook references (REF)
CHAPTER 1: BASIC TERMS AND CONCEPTS OF MECHANICAL VENTILATION
1. The body's mechanism for conducting air in and out of the lungs is known as which of the
following?
- A) External respiration
- B) Internal respiration
- C) Spontaneous ventilation
- D) Mechanical ventilation
Answer: C
Rationale: Ventilation is the conduction of air in and out of the body. Spontaneous ventilation is
the body's own mechanism for this process. External respiration involves gas exchange
between alveoli and pulmonary capillaries, while internal respiration occurs at the cellular level.
2. Which of the following structures are involved in external respiration?
- A) Red blood cells and body cells
- B) Scalenes and trapezius muscles
- C) Alveoli and pulmonary capillaries
- D) External oblique and transverse abdominal muscles
Answer: C
Rationale: External respiration involves the exchange of oxygen (O₂) and carbon dioxide (CO₂)
between the alveoli and pulmonary capillaries. The scalene and trapezius muscles are
,accessory muscles of inspiration, while the external oblique and transverse abdominal muscles
are accessory muscles of expiration.
3. During spontaneous inspiration, alveolar pressure (Pₐ) is approximately:
- A) +5 cm H₂O
- B) -1 to -3 cm H₂O
- C) 0 cm H₂O
- D) -10 cm H₂O
Answer: B
Rationale: During spontaneous inspiration, the diaphragm contracts and descends, increasing
thoracic volume and decreasing alveolar pressure to approximately -1 to -3 cm H₂O relative to
atmospheric pressure. This pressure gradient drives airflow into the lungs.
4. During spontaneous breathing, intrapleural pressure at end-expiration is approximately:
- A) 0 cm H₂O
- B) -5 cm H₂O
- C) -10 cm H₂O
- D) +5 cm H₂O
Answer: B
Rationale: During spontaneous breathing, intrapleural pressure drops from approximately -5 cm
H₂O at end-expiration to about -10 cm H₂O at end-inspiration. This negative pressure is
essential for maintaining lung inflation.
5. The primary indication for initiating mechanical ventilation is:
- A) Patient request for comfort
- B) Acute respiratory failure with hypoxemia or hypercapnia refractory to non-invasive
measures
- C) Routine postoperative care for all surgical patients
- D) Elevated white blood cell count
Answer: B
Rationale: Mechanical ventilation is indicated for acute respiratory failure (hypoxemic – PaO₂
<60 mmHg on FiO₂ >0.50, or hypercapnic – PaCO₂ >45-50 mmHg with pH <7.35) that is not
responsive to non-invasive measures. Other indications include apnea, severe respiratory
muscle fatigue, airway protection, and hemodynamic instability.
,6. Which of the following is an absolute contraindication to noninvasive ventilation (NIV)?
- A) COPD exacerbation
- B) Cardiogenic pulmonary edema
- C) Cardiac or respiratory arrest (apnea)
- D) Obesity hypoventilation syndrome
Answer: C
Rationale: Cardiac or respiratory arrest (apnea) is an absolute contraindication to NIV; these
patients require immediate intubation and invasive mechanical ventilation. Other
contraindications include facial trauma/burns, inability to protect the airway, excessive
secretions, and hemodynamic instability.
7. The normal range for PaO₂ on room air is approximately:
- A) 35-45 mmHg
- B) 60-70 mmHg
- C) 80-100 mmHg
- D) 120-140 mmHg
Answer: C
Rationale: Normal PaO₂ on room air (FiO₂ 0.21) is 80-100 mmHg (decreases with age: 80 - (age
× 0.4) ≈ 80 at age 0, 60 at age 50). PaO₂ <60 mmHg indicates hypoxemia. PaCO₂ normal range
is 35-45 mmHg.
8. The normal range for PaCO₂ is:
- A) 20-30 mmHg
- B) 35-45 mmHg
- C) 50-60 mmHg
- D) 70-80 mmHg
Answer: B
Rationale: The normal range for arterial carbon dioxide tension (PaCO₂) is 35-45 mmHg. Values
above this range indicate hypercapnia (respiratory acidosis), while values below indicate
hypocapnia (respiratory alkalosis).
9. Which of the following is NOT a normal physiologic response to hypoxemia?
- A) Tachypnea
, - B) Tachycardia
- C) Hypertension
- D) Bradypnea
Answer: D
Rationale: The normal physiologic responses to hypoxemia include tachypnea (increased
respiratory rate), tachycardia (increased heart rate), and hypertension (increased blood
pressure). Bradypnea (decreased respiratory rate) would be an abnormal or late sign indicating
respiratory depression or failure.【REF: Chapter 1】
10. Lung compliance is defined as:
- A) The resistance to airflow in the airways
- B) The change in lung volume per unit change in pressure (ΔV/ΔP)
- C) The pressure difference between alveoli and atmosphere
- D) The rate of gas exchange across the alveolar-capillary membrane
Answer: B
Rationale: Lung compliance is a measure of lung distensibility, defined as the change in lung
volume (ΔV) produced by a given change in transpulmonary pressure (ΔP). High compliance
indicates easily distensible lungs (e.g., emphysema), while low compliance indicates stiff lungs
(e.g., ARDS, fibrosis).
11. Normal lung compliance in an adult is approximately:
- A) 0.01 L/cm H₂O
- B) 0.1 L/cm H₂O
- C) 1.0 L/cm H₂O
- D) 10 L/cm H₂O
Answer: B
Rationale: Normal lung compliance in an adult is approximately 0.1 L/cm H₂O (100 mL/cm H₂O).
This value can vary based on lung size, age, and disease state. Reduced compliance (stiff
lungs) is seen in conditions such as ARDS, pulmonary edema, and fibrosis.【REF: Chapter 1】
12. Airway resistance is determined by which of the following factors?
- A) Gas viscosity and density only
- B) Lung volume only
- C) Radius of the airways (Poiseuille's law)
- D) Surface tension
