RSP306 Exam 1, Midterm and Exam 2 ,3 Questions

All of the following are advantages of using the Iron Lung except:

airway protection

The iron lung transformed healthcare by treating patients with what disorder?

polio

Who designed a simple demand valve utilized in pneumatic ventialtors?

Dr. Forrest Bird

The most significant change in mechanical ventilation technology was the development of (blank) in modern management?

microprocessors

a complete ventilatory cycle or breath includes all of the following phases except:

active expiration

is elastic forces obstrictive or restrictive?

Restrictive

is fricitonal forces obstructive or restrictive?

obstructive

is static compliance obstructive or restrictive?

restrictive

is airway resistance obstructive or restrictive?

obstructive

is pulmonary edem obstructive or restrictive?

restrictive

is chronic bronchitis obstructive or restrictive?

obstructive

the peak inspiratory pressure or PIP can be described as

pressure observed at its height during inspiration

the plateau pressure or static pressure can be described as

pressure generated by stretch of the lungs at end-inspiraton

what must be done to measure the static pressure of a patient's airway while on mechanical ventilation?

administer an inspiratory breath hold

what is airway resistance (RAW) formula?

(PIP-Plat)/Flow LPS (divide flow number by .60 to get seconds)

what is static compliance (CSTAT) formula?

exhaled Vt/ (Plat-PEEP)

ina volume control mode, the (blank) is preset by the RT with a variable (blank) depending on the compliance and airway resistance of the lung.

tidal volume (VT) and PIP

Non-Invasive Positive Pressure Ventilation (NIPPV) may be used to prevent intubation in COPD patients and to support patients with acute ventilatory failure.

true

a NPPV device can be used as a CPAP device by setting the IPAP and EPAP at the same level.

true

the pressure gradient that must be generated between the airway opening and the alveoli in order to produce inspiratory flow is known as

transairway pressure

the pressure gradient that must be generated between the pleural space and alveoli is known as:

transpulmonary pressure

Positive Expiratory Pressure (PEEP) is most therapeutic for (blank) due to (blank)

hypoxemia, intrapulmonary shunting

PEEP offers which of the following physiological benefits?

increased functional residual capacity, improves V/Q mismatch, lowes alveolar distending pressure

Mrs.smith is being ventilated with the assist control mode at a rate of 15 breaths per minute. Under this setting, a time-triggered breath will be delivered every (blank) seconds?

4

which of the following modes delivers mandatory breaths and allows spontaneous breathing?

SIMV

which of the following modes delivers patient triggered and time triggered mandatory breaths?

Assist control

a patient with decreasing lung compliance is being ventilated with pressure controlmode. What should you closely montior?

expired tidal volume

pressure support should be titrated to ensure spontaneous tidal volumes of?

5-7 ml/kg

mandatory tidal volumes should be set between?

6-8 ml/kg

How to calculate total alveolar volume?

(tidal volume VT - deadspace VD) x respiratory rate RR

the following blood gas results were obtained from a 66 year old male who was admitted with left lower lobe pneumonia. PH= 7.33; paCO2 = 48 mmHg; PaO2 = 64 mmHg; FiO@ = 40%. Which of the following statements describes the need for mechanical ventilation?

mechanical ventilation is not indicated

the absolute contraindiction to mechanicla ventilation is

untreated tension pneumothorax

after intubation and initation of mechanical ventilation, the physcician asks you to provide an initial tidal volume for a 5"11 male patient. You would recommend a tidal volume between:

452-602ml (multiple Kg by 6-8 to get range for tidal volume)

Ideal Body Weight

Male: 106 +6 (Height in inches -60)

Female: 105 +5 (Height in inches - 60)

divide by 2.2 for Kg

after intubation and initation of mechanical ventilation, the physcician asks you to provide an initial tidal volume for a 5"4 female patient. You would recommend a tidal volume between:

328-438ml (multiple Kg by 6-8 to get range for tidal volume)

for patients who are placed on mechanical ventilator for non-cardiopulmonary complications, where no ABG has been drawn, the initial FiO2 may be set at

40%

one of the complications of positive pressure ventilation is that it can cause an (blank) venous return and (blank)

decreased; hypotension

this scalar waveform (showing resistance issue) which shows pressure-time, represents what changes in lung characteristics.

increased RAW

this scalar waveform (showing compilance issue), which shows pressure-time, represents what change in lung characteristics

decreased compliance

what range is recommended for tidal volume (VT) in a patient with severe ARDS who is being mechanically ventilated?

4-6 ml/kg

what peak inspiratory pressure (PIP) should be avoided when managing ventilation in patients on mechanical ventilators

40 cmH2O

what static (plateau) should be avoided when managing ventilation in patients on mechanical ventilation?

30 cmH2O

Which of the following are true regarding pressure control ventilation?

used for time-triggered and patient triggered mechanical breaths, flowrate is variable

pressure support is an adjunct mode that supports spontaneous tidal volume by decreasing work of breathing

true

in volume control ventilation, what is set by the clincian?

tidal volume (VT)

in pressure control ventilation, which parameter is fixed?

pressure

PEEP is used primarily to:

prevent atelectasis (lung collaspe)

pressure support cannot be used with which of the following modes?

CMV

Mr.camper is being ventilated mechanically with the control mode. which of the following parameters is NOT determined by the patient?

tidal volume (VT), inspiratory flow rate, respiratory rate

mrs.smith is being ventilated with the assist control mode at a set rate of 6 breaths per minute and an assisted rate of 4 breaths per minute. Under this mode, a ventilator triggered breath will be delivered every (blank) seconds

10

the major advantage of assist control mode ventilation is that the patient can

breathe at a minute volume necessary to normalize the PaCO2

during synchronized intermittent mandatory ventilation (SIMV), the breaths delivered may be

mandatory, assisted, spontaneous

when the pressure is released on APRV, it stimulates an effective (blank) maneuver

exhalation

when patients are being ventilated in APRV, spontaneous breathing is available

true

all of the following problems concerning the artifical airway and ventilator circuit that would increase airway resistance exist except

increasing the pressure support

problems concerning the artifical airway and ventilator circuit that would increase airway resistance that exist are

downsizing I.D of ETT, mucous plugging the airway, lengthening the ventilator circuit

CPAP provides postivie airway pressure during the (blank) phase, and it (blank) include mechanical breaths.

inspiratory and expiratory, does not

interpret the blood gas

PH- 7.47

CO2- 28

O2- 69

HCO3- 24

uncompensated respiratory alkalosis with uncorrected hypoxemia

if FiO2 is set at .60, what Fio2 would you set to normalize the PaO2 in an uncompensated respiratory alkalosis with uncorrected hypoxemia?

.70 (normally 10 above the initial set)

the P/F ratio is used to evaluate the severity of ARDS based on the Berlin Definition to determine mortality risk

true

if it was determined that switching fromvolume to pressure control mode was appropriate for your patient, how would you set the inspiratory pressure?

used the monitored plateau pressure

refractory hypoxemia is present when the PaO2 is less than (blank) mmHg at an FIO2 of greater than (blank) precent

60; 50

interpret the ABG

PH- 7.30

CO2- 50

O2- 80

HCO3- 25

uncompensated respiratory acidosis with corrected hypoxemia

what approach might you take witthin volume controlled mode of mechanical ventilation to correct the ABG FIRST (PH- 7.30, CO2- 50, O2- 80, HCO3- 25)

increase the RR

what is contributing to the worsening hypoxemia despite oxygen therapy?

refractory hypoxemia due to atelectasis

how would you protect the trachea for this patient who is anticipated to be on mechanical ventilation for an extended period of time

monitor cuff pressure

what approach might you take witthin volume controlled mode of mechanical ventilation to correct the ABG FIRST (PH- 7.25, CO2- 75, O2- 70, HCO3- 28)

increase the inspiratory pressure

which of the following conditions contributes tot he results noted in the ABG (PH- 7.25, CO2- 75, O2- 70, HCO3- 28)

increased RAW

all of the folloeing breath types are availible in Synchronized Intermittent Mandatory Ventilation (SIMV) except

intermittent

adaptive and combo modes of mechanical ventilation may not be appropriate for TBI patients due to

higher risk of irregular breathing patterns

due to the need for extended ventialary support, the cuff pressure should not exceed

20-25 mmHg

Airway care should include

routine oral hygiene, routine reposiitoning of ET tube, routine inspection of mucous membranes

total minute ventilation formula

respiratory rate (RR) X tidal volume (VT)

how to calculate deadspace percentage

(PaCO2 - PeCO2) / PaCO2

how to calculate P[a-et]CO2 difference

PaCO2 - ETCO2

what mode of mechanical ventilation would be appropiate for a patient who is post-op abdominal surgery with history of controlled hypertension and hypothyroidism

SIMV

End Stage COPD ABG

7.25 / 59 / O2 55 / 44

Asthma ABG

7.25 / 59 / O2 65 / 24

Pulmonary edema ABG

7.55 / 29 / O2 55 / 24

Pain/anxiety ABG

7.49 / 25 / O2 98 / 24

Diabetic Ketoacidosis (DKA) ABG

7.25 / 20 / O2 100 / 18

PEEP is used primarily to

prevent atelectasis

positive end-expiratory pressure (PEEP) is most therapuetic for BLANK due to BLANK

hypoxemia, intrapulmonary shunting

which of the following physiological benefits does PEEP offer?

increased functional residual capacity, improves V/Q mismatch and lowers alveolar distending pressure

the physician is concerned about the risk of barotrauma and aks you to outline some potential criteria for more prudent ventilator amangement. You would recommend all of the following criteria EXCEPT:

keeping the PEEP less than 5 cmH2O

PEEP is usually indicated in severe restrictive lung disease because it can:

reduce alveolar distending pressure and correct refractory hypoxemia

complications and hazards of increasing PEEP include all of following EXCEPT:

decreased intracranial pressure

when the pressure-volume loop moves towards the RIGHT, what lung characteristics changes?

decreased static compliance

What mode should you never put a COPD patient in?

APRV mode

All of the following signs on the chest radiograph indicate COPD EXCEPT:

increased vascular markings

In PRVC mode all of the following breath types are avaliable EXCEPT:

intermittent

all ventilator parameters should be considered when managing the patient EXCEPT:

utilize permissive hypercapnia

what is the primary risks associated with htperventilating this patient?

ischemic brain injury

interpret the blood gas: PH 7.30, CO2 50, O2 50, HCO3 25

uncompensated respiratory acidosis with uncorrected hypoxemia

based on PEEP study above, what is the optimal PEEP by compliance

15

what is contributing to the worsening hypoxemia despite oxygen therapy

refractory hypoxemia due to atelectasis

on a pressure volume loop, what does the lower inflection point indicate

alveolar recruitment

which graphic would tell you if a bronchodilator was effective

flow time scalar

in a pressure volume loop with bird beaking, what does the upper inflection point indicate?

overdistension of the lungs

what is a limiting variable in pressure support ventilation (PSV)

pressure