Pilbeam's Ch. 4 Mechanical Ventilation Final.docx

A closed-loop system is used to guarantee a minute ventilation to a patient. The minute ventilation delivered to the patient differs significantly from the set volume. The ventilator will do which of the following? - correct answer Alter the delivered volume A breath that is triggered, limited, and cycled by the mechanical ventilator is which of the following? - correct answer Mandatory A breath that is triggered, controlled, and ended by the patient is which of the following? - correct answer Spontaneous A breath that is patient triggered, ventilator controlled, and cycled is which of the following? - correct answer Assisted During pressure-controlled ventilation, the patient's airway resistance (Raw) increases. This will cause which of the following to occur? - correct answer The delivered VT will decrease. During volume-controlled ventilation the patient's lung compliance improves. This will cause which of the following to occur? - correct answer The peak pressure will decrease. During volume-controlled ventilation, which waveform remains unchanged with changes in the patient's lung characteristics? - correct answer Volume-time curve Flow-time curve When both pressure and volume waveforms are affected by changes in lung characteristics, which of following variables is being controlled? - correct answer Time A high-frequency oscillator controls which of the following variables? - correct answer Time When the ventilator is time triggering and the rate is set at 20 breaths/min, the time interval between breaths is which of the following? - correct answer Time During flow triggering the base flow is set at 5 L/min and the ventilator triggers when it senses 3 L/min returning to its flow measuring device. The flow sensitivity setting is which of the following? - correct answer 2 L/min During pressure-support ventilation the patient triggers the ventilator, the set pressure is reached, and the ventilator cycles at 5 seconds. What is the cause of this time cycle? - correct answer A leak in the system The most common cycling mechanism used for pressure-support ventilation is which of the following? - correct answer Flow The maneuver used to measure plateau pressure is which of the following? - correct answer Inspiratory hold What is the transrespiratory pressure if the ventilator is set at a volume of 500 mL with a flow of 60 L/min and the patient's lung compliance is 0.75 L/cm H2O and Raw is 6 cm H2O/L/s? - correct answer 6.7cmH2O A 43-year-old male was admitted last night with a stab wound to the right anterior thorax. The wound was repaired in surgery. Currently the patient is alert and continuously tries to remove his oxygen mask. He is in the ICU and has a chest tube in his right hemithorax. Vital signs show pulse 120 beats/min, respirations 36 breaths/min and shallow, BP 148/90 mm Hg, and oral temperature 38° C. Breath sounds are decreased over the right base, and chest expansion is decreased over the right side. The patient is not coughing. ABG results reveal pH 7.48, PaCO2 26 mm Hg, PaO2 66 mm Hg, SaO2 94%, HCO3 - 19 mEq/L, FIO2 0.55 (via air entrainment mask), and Hb 11.4. Which of the following is the most appropriate action to take at this time? - correct answer Intubate and mechanically ventilate with an FIO2 of 1.0. Which of the following characterizes hypercapnic respiratory failure? 1. Lower than normal PaO2 2. Alveolar hypoventilation 3. Higher than normal PaCO2 4. Increased PAO2 2 PaO2 - correct answer 2 and 3 only The underlying physiological process leading to pure hypercapnic respiratory failure is which of the following? - correct answer Alveolar hypoventilation A 65-year-old male presents to the ED complaining of increasing shortness of breath over the past 3 days and appears to be in moderate respiratory distress. He has a 100-pack-year smoking history. Vital signs are heart rate 115 beats/min, respiratory rate 32 breaths/min, BP 170/95 mm Hg, mild expiratory wheezing in his bases, and temperature 100° F oral. His ABG values on nasal cannula 3 L/min are pH 7.30, PaCO2 70 mm Hg, PaO2 48 mm Hg, SaO2 67%, and HCO3 - 35 mEq/L. The most appropriate treatment at this time is to initiate which of the following? - correct answer Noninvasive positive pressure ventilation A 55-year-old female with a history of chronic congestive heart failure and extreme obesity presents to the ED. She is alert but disoriented. Vital signs show pulse 143 beats/min, BP 145/94 mm Hg, oral temperature 37° C, and respirations 28 breaths/min shallow and labored. She has no cough. Breath sounds are decreased throughout with bilateral inspiratory coarse crackles. Electrocardiogram shows sinus tachycardia with a widened QRS complex and an occasional premature ventricular contraction. Her ABGs on a 50% air entrainment mask are pH 7.30, PaCO2 51 mm Hg, PaO2 50 mm Hg, SaO2 85%, and HCO3 - 24 mEq/L. Which of the following should the respiratory therapist should recommend at this time? - correct answer Intubation and mechanical ventilation An 18-year-old man is brought to the ED via ambulance following a serious bicycle crash with witnesses stating the patient was not wearing a helmet. The patient is unconscious and semiresponsive with a Glasgow Coma Score of 1/1/4 totaling 6. Vital signs show pulse 110 beats/min and regular, BP 96/55 mm Hg, oral temperature 36.6° C, and respirations 38 breaths/min and shallow with no cough. Chest auscultation reveals decreased breath sounds throughout. ABG results on a simple mask at 6 L/min are