Pilbeam’s Mechanical Ventilation - Chapters 11 & 12 Review

Flashcards covering key concepts from Chapter 11 (Hemodynamic Monitoring) and Chapter 12 (Methods to Improve Ventilation) of Pilbeam’s Mechanical Ventilation, 8th Edition.

The waveform of a pulmonary catheter, shown in the figure, is located in which of the following?


A. Right atrium


B. Right ventricle


C. Pulmonary artery


D. Left atrium

Pulmonary artery waveform. The waveform is obtained from a pulmonary artery catheter, which is used to measure pressures in the pulmonary artery. (https://i.imgur.com/YOUR_IMAGE_ID.png)

Which of the following describes the filling pressure of the ventricle at the end of ventricular diastole? A. Afterload


B. Contractility


C. Preload


D. Ejection fraction

Preload represents the filling pressure of the ventricle at the end of diastole before the contraction occurs. It reflects the volume of blood stretching the heart muscle at the end of filling.

Which measurement is typically used to indicate right ventricular preload? A. Central venous pressure (CVP)


B. Pulmonary artery wedge pressure (PAWP)


C. Right ventricular end-diastolic pressure (RVEDP)


D. Systemic arterial pressure

Right ventricular end-diastolic pressure (RVEDP) is typically used to indicate right ventricular preload, which is the pressure in the ventricle at the end of diastole. This measure helps assess the degree of stretch on the right ventricular muscle before contraction.

Which of the following can be used to estimate the contractility of the ventricles? A. Stroke volume


B. Cardiac output


C. Ejection fraction


D. Systemic vascular resistance

Ejection fraction is used to estimate the contractility of the ventricles. It represents the percentage of blood pumped out with each contraction and is an indicator of how well the heart is functioning as a pump.

Calculate the ejection fraction of a female patient with a stroke volume of 40 mL and an end-diastolic volume of 125 mL. A. 0.25


B. 0.32


C. 0.40


D. 0.50

The ejection fraction is calculated as stroke volume divided by end-diastolic volume. In this case, EF = \frac{40}{125} = 0.32.

Which of the following is an indication of left ventricular afterload? A. Pulmonary artery pressure


B. Central venous pressure


C. Systemic vascular resistance


D. Pulmonary capillary wedge pressure

Systemic vascular resistance (SVR) is an indication of left ventricular afterload, which is the resistance the left ventricle must overcome to circulate blood. SVR reflects the constriction or dilation of blood vessels.

What is the most determining factor for preload? A. Heart rate


B. Venous return


C. Arterial pressure


D. Body position

Venous return determines the preload and is the amount of blood returning to the heart from the venous circulation. It affects the degree of ventricular filling and subsequent cardiac output.

Which of the following will cause an increase in systemic vascular resistance? A. Vasodilation


B. Anemia


C. Increase left ventricular afterload.


D. Sepsis

Increase left ventricular afterload because Systemic vascular resistance (SVR) increases with vasoconstriction or an increase in blood viscosity. Increased afterload makes it harder for the heart to eject blood.

Which of the following is the main component of a hemodynamic monitoring system? A. Pressure bag


B. IV solution


C. Cardiac monitor


D. Strain gauge transducer

Strain gauge transducer is the main component of a hemodynamic monitoring system because it converts physiological pressure into an electrical signal that can be measured and displayed.

Which of the following is the function of the transducer in the invasive vascular monitoring system? A. Amplify the electrical signal from the heart.


B. Convert the fluid pressure to an electrical signal.


C. Measure the flow of blood in the vessel.


D. Regulate the pressure in the IV bag.

The transducer in the invasive vascular monitoring system converts the fluid pressure to an electrical signal allowing continuous monitoring of blood pressure.

Which of the following statements is true concerning the insertion of a radial arterial line? A. The catheter tip must face downstream. The transducer must be below the catheter tip.


B. The catheter tip must face upstream. The transducer must be level with the catheter tip.


C. The catheter tip must face downstream. The transducer must be level with the catheter tip.


D. The catheter tip must face upstream. The transducer must be below the catheter tip.

For accurate arterial line monitoring, the catheter tip must face upstream to correctly sense arterial pressure, and the transducer should be level with the catheter tip to negate hydrostatic pressure effects.

While checking an indwelling central venous pressure (CVP) catheter the respiratory therapist observes that the transducer is at the epistatic line. What should the respiratory therapist do? A. Lower the transducer to the mid-axillary line.


B. Raise the transducer to the top of the patient's head.


C. Accept the CVP reading obtained.


D. Re-zero the transducer.

Accept the CVP reading because the phlebostatic axis is the correct anatomical reference point for CVP measurement, so no adjustment is needed. Thus, the reading should be accepted as is.

While attempting to draw blood from an indwelling arterial catheter, the respiratory therapist notices a dampened waveform and has difficulty withdrawing blood. What should the respiratory therapist’s immediate action be? A. Flush the catheter with heparinized saline.


B. Rotate the catheter slightly.


C. Aspirate with more force.


D. Remove the catheter.

If there is a dampened waveform along with the inability to aspirate blood from the catheter, the catheter is most likely occluded or clotted off causing the catheter to be non functional. Therefore, because of risk of thromboembolism the catheter needs to be removed and a new site chosen.

The respiratory therapist preparing to insert an arterial line in the right radial artery performs an Allen test. The result of the Allen test is 20 seconds. What should the respiratory therapist do? A. Proceed with the arterial line insertion in the right radial artery.


B. Administer a vasodilator to the right hand.


C. Perform an Allen test on the left hand.


D. Use the ulnar artery instead.

The Allen test determines if there is collateral circulation to the hand. If the Allen test is greater than 15 seconds, this could indicate inadequate collateral circulation and you should not insert the catheter at that site. Choose the other wrist since the left hand has to be tested to determine if the collateral circulation is adequate there.

Which of the following is not a common complication of systemic artery catheterization? A. Thrombosis


B. Infection


C. Bleeding


D. Phlebitis

Phlebitis is not a common complication of systemic catheterization. Common complications include thrombosis, infection, and bleeding.

Which of the following measurements can be used to estimate right ventricular preload? A. Pulmonary artery pressure


B. Central venous pressure


C. Pulmonary artery wedge pressure


D. Systemic arterial pressure

Central venous pressure (CVP) estimates right ventricular preload, referring to the filling pressure of the right ventricle.

Confirmation of placement of a central venous pressure catheter is done with which of the following? A. Ultrasound


B. Chest radiograph


C. Palpation


D. Auscultation

Confirmation of placement of a central venous pressure catheter is done with a Chest radiograph. To confirm proper placement and rule out complications such as pneumothorax, a chest radiograph is required.

Which of the following can cause a low pulmonary artery occlusion pressure? A. Mitral valve stenosis


B. Hypervolemia


C. Hypovolemia


D. Left ventricular failure

Hypovolemia, or low blood volume, can cause a low pulmonary artery occlusion pressure (PAOP), which reflects left atrial pressure and indirectly, left ventricular end-diastolic pressure.

Which of the following are vessels that often require a surgical cut down when used for pulmonary artery catheter access? A. Femoral vein and Internal jugular vein


B. Subclavian vein and Antecubital vein


C. Brachial artery and Radial artery


D. Dorsalis pedis vein and Saphenous vein

When inserting a pulmonary artery catheter, the subclavian and antecubital veins may require a surgical cut down to allow access for catheter insertion because of anatomical challenges or vessel condition.

During the introduction of a pulmonary artery catheter the waveform seen in the figure is visible on the monitor. This waveform represents which of the following locations? A. Right atrium


B. Right ventricle


C. Pulmonary artery


D. Pulmonary artery wedge

During the introduction of a pulmonary artery catheter, the waveform that is visible on the monitor represents the location in the Right Atrium. (https://i.imgur.com/YOUR_IMAGE_ID.png)

During the insertion of a pulmonary artery catheter, the balloon needs to be inflated with air when it enters which of the following? A. Right atrium


B. Right ventricle


C. Intrathoracic vessel


D. Abdominal cavity

During the insertion of a pulmonary artery catheter, advancing the catheter into the intrathoracic vessels can cause damage, so when the catheter is positioned here, the balloon needs to be inflate with air to allow flow directed insertion to continue.

Which of the following include the most appropriate insertion sites for a pulmonary catheter in a patient with phlebitis? A. Femoral vein and Antecubital vein


B. Internal jugular vein and Subclavian vein


C. Brachial artery and Radial artery


D. Dorsalis pedis vein and Saphenous vein

For pulmonary artery catheter insertion, choose internal jugular and subclavian veins to avoid insertion sites where phlebitis is present, reducing risk of complications and infection.

Which of the following can occur with excessive pulmonary artery catheter movement? A. Pneumothorax


B. Hemothorax


C. Catheter knotting


D. Pulmonary embolism

Excessive movement can lead to catheter knotting, which requires catheter removal and potential vascular damage.

A pulmonary artery catheter must be wedged in which of the following locations? A. Zone 1


B. Zone 2


C. Zone 3


D. Zone 4

A pulmonary artery catheter must be wedged in Zone 3 because this is where pulmonary arterial pressure is greater than alveolar pressure , which is greater than venous pressure. The other zones do not have this relationship.

Which of the following is the range for the time a pulmonary artery catheter should be inflated? A. 1-5 seconds


B. 5-10 seconds


C. 15-30 seconds


D. 30-60 seconds

The range for the time a pulmonary artery catheter should be inflated before pulmonary artery occlusion pressure is measured is 15-30 seconds. You should not inflate longer than this, otherwise it could cause pulmonary infarction.

Calculate the arterial oxygen content for a patient with Hgb = 9 g%, SaO2 = 96%, PaO2 = 97 mm Hg. A. 9.2 vol%


B. 10.8 vol%


C. 11.9 vol%


D. 12.5 vol%

The formula for calculating CaO2 is: (Hgb × 1.34 × SaO2) + (PaO2 × 0.003). (9 × 1.34 × 0.96) + (97 × 0.003) = 11.6 + 0.29 = 11.9 vol%.

Calculate the arterial oxygen content for a patient with Hgb = 17 g%, SaO2 = 93%, PaO2 = 64 mm Hg. A. 18.5 vol%


B. 20.1 vol%


C. 21.4 vol%


D. 22.8 vol%

The formula for calculating CaO2 is: (Hgb × 1.34 × SaO2) + (PaO2 × 0.003). (17 × 1.34 × 0.93) + (64 × 0.003) = 21.2 + 0.192 = 21.4 vol%.

Patient with VO2 of 340 mL/min, CaO2 of 17.3 vol%, and CvO2 of 12.8 vol% has a cardiac output of which of the following? A. 4.2 mL/min


B. 5.9 mL/min


C. 6.8 mL/min


D. 7.6 mL/min

The Fick equation is: CO = VO2 / (CaO2 – CvO2). CO = 340 / (17.3 – 12.8) = 7.6 L/min.

Calculate cardiac output using the Fick principle: VO2 280 mL/min, CaO2 19.5 vol%, CvO2 12 vol% A. 2.8 L/min


B. 3.3 L/min


C. 3.9 L/min


D. 4.5 L/min

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The hemodynamic values for a patient: VO2 380 mL/min, CaO2 23.2 vol%, CvO2 10.3 vol% has a cardiac output of which of the following? A. 2.1 mL/min


B. 2.5 mL/min


C. 2.9 mL/min


D. 3.3 mL/min

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Calculate the cardiac index using the following data: cardiac output = 4.6 L/min Body surface area = 1.2 m2 A. 2.9 L/min/m2


B. 3.4 L/min/m2


C. 3.8 L/min/m2


D. 4.2 L/min/m2

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Calculate a 90-kg patient’s cardiac index with the following measurements: cardiac output 3.8 L/min, body surface area 3 m2 . A. 1.1 L/min/m2


B. 1.3 L/min/m2


C. 1.5 L/min/m2


D. 1.7 L/min/m2

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Calculate the cardiac index for a patient with the following data: heart rate = 80 beats/min, stroke volume = 55 mL, and body surface area = 2.8 m2 . A. 1.2 L/min/m2


B. 1.4 L/min/m2


C. 1.6 L/min/m2


D. 1.8 L/min/m2

Cardiac Index (CI) is calculated as heart rate (HR) x stroke volume (SV) / Body surface area (BSA). Therefore, CI = 80 x 55 / 2.8 = 1.6 L/min/m2

Calculate the stroke index: CO = 3.7 L/min, HR = 90 bpm, BSA = 1.7 m2 A. 20 mL/m2


B. 22 mL/m2


C. 24 mL/m2


D. 26 mL/m2

Stroke Index (SI) is calculated as cardiac output (CO) / heart rate (HR) / body surface area (BSA). Therefore, SI = 3.7 / 90 / 1.7 = 24 mL/m2.

Calculate the stroke volume (SV) and the stroke volume index (SI): CO = 4.5 L/min, HR = 110 bpm, BSA = 1.3 m2 A. SV = 35 mL; SI = 27 mL/m2


B. SV = 41 mL; SI = 31.5 mL/m2


C. SV = 45 mL; SI = 35 mL/m2


D. SV = 50 mL; SI = 38.5 mL/m2

Stroke Volume (SV) is calculated as cardiac output (CO) / heart rate (HR). Therefore, SV = 4.5 / 110 = 41 mL. The stroke volume index (SI) is stroke volume (SV) / body surface area (BSA). Therefore, 41 / 1.3 = 31.5 mL.

If the heart rate is 80 beats per minute, how long is one beat? A. 0.8 second


B. 1.0 second


C. 1.3 second


D. 1.5 second

There are 60 seconds in one minute. Thus, if there are 80 beats in one minute, then the duration of one beat is 60 / 80 = 0.75 seconds. Then 0.75 * 1.3 ~ 1 second.

Calculate the left ventricular stroke work index, BSA of 1.1 m2, BP 105/68 mm Hg, HR 86 bpm, CO 4.3 L/min. A. 42.5 g-m/m2


B. 45.8 g-m/m2


C. 49.6 g-m/m2


D. 52.3 g-m/m2

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The hemodynamic values, BP 96/60 mm Hg, PAP 29 mm Hg, PCWP 14 mm Hg, SV 50 mL, and BSA is 1.6 m2. Calculate the patient’s left ventricular stroke work (LVSW). A. 25.4 g-m/m2


B. 28.1 g-m/m2


C. 30.6 g-m/m2


D. 33.2 g-m/m2

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Calculate the right ventricular stroke work (RVSW), PAP = 35/25 mm Hg, C.O. = 3.6 L/min, HR = 107 beats per minute, BSA is 1.6 m2 . A. 10.2 g-m/m2


B. 11.5 g-m/m2


C. 12.7 g-m/m2


D. 14.1 g-m/m2

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Calculate right ventricular stroke work (RVSW), PAP 50/32 mm Hg, C.O. 4.0 L/min, HR 127/min, BSA 1.72 m2 A. 13 g-m/m2


B. 14 g-m/m2


C. 16 g-m/m2


D. 18 g-m/m2

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Calculate this patient’s pulmonary vascular resistance (PVR). PAP = 67/25 mm Hg, PAOP = 18 mm Hg, BP = 100/50 mm Hg, CVP = 17 mm Hg, C.O. = 5.7 L/min, HR = 75 beats/min. A. 215 dyne  sec  cm5


B. 234 dyne  sec  cm5


C. 253 dyne  sec  cm5


D. 272 dyne  sec  cm5

Pulmonary Vascular Resistance (PVR) is calculated as (mean PAP – PAOP) / CO. In this case, PVR = ((67+25)/2) – 18) / 5.7 = 253 dyne.

Calculate the pulmonary vascular resistance (PVR): PAP = 40/22 mm Hg, PAOP = 12 mm Hg, BP = 156/80 mm Hg, CVP = 19 mm Hg, C.O. = 4.8 L/min, HR = 68 beats/min. A. 225 dyne  sec  cm5


B. 246 dyne  sec  cm5


C. 267 dyne  sec  cm5


D. 288 dyne  sec  cm5

Pulmonary Vascular Resistance (PVR) is calculated as (mean PAP – PAOP) / CO. In this case, PVR = (((40-22)/2) – 12) / 4.8 = 267 dyne.

Calculate this patient’s systemic vascular resistance (SVR). PAP = 67/25 mm Hg, PAOP = 18 mm Hg, BP = 100/50 mm Hg, CVP = 17 mm Hg, C.O. = 5.7 L/min, HR = 75 beats/min. A. 632 dyne  sec  cm5


B. 665 dyne  sec  cm5


C. 698 dyne  sec  cm5


D. 731 dyne  sec  cm5

Systemic Vascular Resistance (SVR) is calculated as (mean arterial pressure – CVP) / CO. In this case, (((100+50)/2) – 17) / 5.7 = 698

Calculate the systemic vascular resistance (SVR), PAP = 40/22 mm Hg, PAOP = 12 mm Hg, BP = 156/80 mm Hg, CVP = 19 mm Hg, C.O. = 4.8 L/min, HR = 68 beats/min. A. 1254 dyne  sec  cm5


B. 1346 dyne  sec  cm5


C. 1438 dyne  sec  cm5


D. 1530 dyne  sec  cm5

Systemic Vascular Resistance is (mean arterial pressure – CVP) / CO. In this case, the map is ((156+80)/2) -19 / 4.8 = 1438

A patient with a mitral valve stenosis is most likely to have which of the following pulmonary artery occlusion pressure (PAOP) values? A. 5 mm Hg


B. 10 mm Hg


C. 15 mm Hg


D. 20 mm Hg

In mitral valve stenosis, narrowing of the mitral valve elevates left atrial pressure, increasing pulmonary artery occlusion pressure (PAOP). A PAOP of 20 mm Hg is typical.

Which of the following is the hemodynamic measurement that is indicative of a patient with right heart failure? A. Pulmonary artery pressure (PAP) = 30/15 mm Hg


B. Central venous pressure (CVP) = 16 mm Hg


C. Pulmonary artery occlusion pressure (PAOP) = 8 mm Hg


D. Cardiac output (CO) = 6 L/min

A CVP of 16 mm Hg suggests right heart failure. Elevated central venous pressure (CVP) indicates impaired right ventricular function and fluid overload, suggestive of right heart failure.

Which of the following disorders can cause an increase in systemic vascular resistance? A. Anemia


B. Septic shock


C. Hypervolemia


D. Liver failure

Hypervolemia is the only answer that increase systemic vascular resistance. Because the blood volume is high, it is increasing the pressure.

Which of the following hemodynamic parameter that is not within normal limits? A. Cardiac output (CO) = 5 L/min


B. Central venous pressure (CVP) = 5 mm Hg


C. Mean arterial pressure (MAP) = 18 mm Hg


D. Heart rate (HR) = 80/min

Mean arterial pressure (MAP) is the average arterial pressure during a single cardiac cycle. A MAP of 18 mm Hg is not within normal limits. You want the MAP to be >60mmHG for perfusion.

A high cardiac output can cause which of the following complications with a pulmonary artery catheter? A. Catheter occlusion


B. Catheter whip


C. Thrombosis


D. Infection

Catheter whip. A high cardiac output can cause a pulmonary artery catheter to move excessively in the pulmonary artery, leading to 'catheter whip'.

Advancing a pulmonary artery catheter into a smaller artery may cause which of the following complications? A. Pulmonary embolism


B. Pneumothorax


C. Pulmonary infarction


D. Hemothorax

Pulmonary infarction is caused from Advancing a pulmonary artery catheter into a smaller artery. It may occlude that vessel, leading to tissue ischemia and possibly pulmonary infarction.

During the inspiratory phase of spontaneous breathing, what happens to the pulmonary artery (PA) waveform? A. The PA waveform trend increases.


B. The PA waveform trend decreases.


C. The PA waveform remains constant.


D. The PA waveform becomes erratic.

The PA waveform trend decreases during the inspiratory phase of spontaneous breathing. The increasing negative intrathoracic pressure increase venous return during spontaneous breathing causing the PA waveform to decrease.

An intubated patient with hemodynamic measurements, CVP 5 mm Hg, PAP 33/20 mm Hg, and PAOP 16 mm Hg. What recommendation to improve this patient’s hemodynamics? A. Increase the PEEP incrementally and recheck hemodynamic measurements.


B. Administer a fluid bolus and recheck hemodynamic measurements.


C. Decrease the PEEP incrementally and recheck hemodynamic measurements.


D. Administer a vasopressor medication and recheck hemodynamic measurements.

Intubated patients. The patients hemodynamics need to be improved, therefor Decrease the PEEP incrementally and recheck hemodynamic measurements. High PEEP can increase intrathoracic pressure, thereby reducing venous return and cardiac output, this will improve the patients hemodynamics.

A patient in the ICU with bilateral infiltrates, hemodynamic measurements: CVP 5 mm Hg, PAP 24/13 mm Hg, and PAOP 21 mm Hg. A. Acute respiratory distress syndrome


B. Cardiogenic pulmonary edema


C. Pneumonia


D. Pulmonary embolism

Cardiogenic pulmonary edema CVP 5 mm Hg, PAP 24/13 mm Hg, and PAOP 21 mm Hg. Clinical data can be used to identify cardiogenic pulmonary edema. Hemodynamic measurements reveal elevation of PAP and PAOP .

A patient in the ICU with bilateral infiltrates, hemodynamic measurements: CVP 3 mm Hg, PAP 21/10 mm Hg, and PAOP 8 mm Hg. A. Acute respiratory distress syndrome


B. Cardiogenic pulmonary edema


C. Pneumonia


D. Pulmonary embolism

ARDS. CVP 3 mm Hg, PAP 21/10 mm Hg, and PAOP 8 mm Hg. Clinical data can be used to identify Acute respiratory distress syndrome. The patients has low CVP and PAOP .

Ventricular contractility can be estimated by which of the following? A. Preload


B. Afterload


C. Stroke volume


D. Ejection fraction

Ventricular contractility can be estimated by the ejection fraction, which is the fraction of blood ejected by the ventricle relative to the end-diastolic volume.

Which of the following can cause an elevated right arterial pressure? A. Hypovolemia


B. Cardiac tamponade


C. Pulmonary embolism


D. Sepsis

An elevated right arterial pressure may mean there is Cardiac tamponade, a condition with fluid accumulation around the heart that impairs its ability to pump effectively. This will cause a back up of volume and increase pressure.

During mechanical ventilation of a patient with COPD, the PaCO2 = 58 mm Hg and the minute ventilation = 5.5 L/min. The desired PaCO2 for this patient is 45 mm Hg. To what should the minute ventilation be changed? A. 6.1 L/min


B. 6.5 L/min


C. 7.1 L/min


D. 7.5 L/min

When increasing minute ventilation. Formula is: New VE = Old VE * Old PaCO2 / Desired PaCO2. New VE = 5.5 * 58 / 45 = 7.1 L/min.

A patient with CHF is being mechanically ventilated. The patient’s current PaCO2 = 28 mm Hg, and the ventilator set rate is 16 per minute. The desired PaCO2 for this patient is 40 mm Hg. To what should the set rate be changed? A. 9/min


B. 10/min

The formula in calculating the set rate. New rate = (Old PaCO2/Desired PaCO2) X (Present Rate) New rate = (28 / 40) X 16 = 11/min.