A 45 YO with sepsis is developing ARDS. She weighs 64 kg (141 lbs) and has a ventilator tidal volume of 450ml, rate of 13 and 10cm PEEP. Her ABGs are accceptable but her CL is decreasing and plateau pressure is now 35cm. What should be recommended to the physician?
A) Vt of 300 and rate of 20
An unconscious apneic adult male patient with a drug OD has been admitted through the ED. He will be placed on a ventilator that cannot compensate for compressed volume. His ideal body weight is 80kg (176 lbs). The most appropriate uncorrected Ct would be?
D) 800 ml
A patient with ARDS is receiving mechanical ventilation in the PC, A/C mode with a Vt of 400ml, rate of 24, 60%O2 and 15cm PEEP. after performing a lung recruitment maneuver, the therapist determines the lower inflection point at 20cm and the upper inflection point at 35cm. Where should the PEEP level be set?
C) between 20 and 35cm
An adult male patient is on the PC, A/C SIMV mode with a Vt of 600ml and a backup rate of 10. His total rate is 18. The physician would like to evaluate the patient's readiness to wean from the ventilator. Which of the following parameters indicate that the ventilator can be D/C'd?
D) apontaneous Vt of 5ml/kg & Vd/Vt ratio 0.4 & intrapulmonary shunt of 10%
The physician asks the therapist about which weaning methods would be most successful in the patient with weaning parameters listed in question 4. The spontaneous Vt is 400ml. Which of the following methods should be recommended?
A) SIMV weaning
A 25 YO female postop patient is receiving mechanical ventilation. She is alert with a spontaneous Vt of 200ml and the desire to breathe on her own. Because of the emergency nature of her surgery, she has a smaller than normal ETT. Her PaO2 is 93 torr on 40% O2. What ventilator mode should be recommended for her?
B) SIMV with PS
An adult patient is recovering from ARDS. The ventilator is providing CPAP at 10cm and 40% O2 during a spontaneous breathing trial. In evaluating the patient after 1 hour, you note the following: SpO2 has dropped from 95% to 90%, rate has increased from 14 to 23 and the patient c/o tiredness. What should be done first?
C) continue for another hour & reevaluate
A patient has an HME in place for humidification. The therapist notices that the peak pressure has increased by 10 cm in the past hour. The nurse reports that the patient has thick secretions when last suctioned. What should be done in this situation?
A) switch to a heated wick type humidifier
A ventilated female patient with pulmonary edema has the following ABGs on 40% O2: pH 7.43 PaCO2 35 PaO2 75. She is on VC, A/C mode with a backup rate of 10 and is assisting for a total rate of 18. Her peak airway pressure is 50cm and her plateau is 40. She developed a pneumothorax and had a chest tube inserted. What should be suggested to her physician?
C) switch her to the PC, A/C mode
The therapist has started a patient on the A/C mode and will be using pressure sensitivity breath triggering. What should the sensitivity control be set at?
B) -1 to -2 cm
In preparing for a mode change from A/C to SIMV, the following must be done:
A) inform the patient & turn off the sigh & remove any mechanical deadspace
Which of the following indicates that the patient is not tolerating PEEP?
A) decreased Cst, increased intrapulmonary shunt & decreasing BP
An adult ventilated patient has had a trach tube placed in the ICU. When the patient coughs vigorously, about 10cm of blood is coughed into the ventilator circuit. What should be done?
C) replace the circuit with a new one
A patient with pneumonia is receiving ventilation and an HME is being used for humidification. After receiving an aerosolized BD rx, the patient coughs secretions into the HME. The high pressure alarm begins to sound. What should be done?
B) replace the HME
A patient's breathing is being supported by a ventilator with a circuit with an external exhalation valve. The nurse calls the therapist to evaluate the patient because the alarm is going off. Upon arrival, the therapist notices that the patient's chest is barely moving during a control breath, the peak pressure does not rise above 3 cm and the exhaled Vt spirometer show the set Vt when the control breath is delivered. The most likely cause of these findings is:
D) the tubing to the exhalation valve is disconnected
Expiratory retard would be indicated in a pateint with?
D) air trapping
All of the following parameters indicate the need for intubation and mechanical ventilation EXCEPT:
A) P(A-a)O2 on 100% of 40 torr
A patient with post polio syndrome is being ventilated with NPPV and has an IPAP of 15 cm and an EPAP of 5 cm. The patient c/o being SOB. The therapist checks the Vt and finds that it has dropped. How should the Vt be restored?
A) raise the IPAP level
A therapist is working with a patient with obstructive sleep apnea who is receiving bilevel NPV through a nasal mask. During a sleep period, it is noticed that he is snoring. Which of the following adjustments should be made?
C) increase the lower pressure level
A theapist is working with an 80kg (175 lbs) patient who is apnic after abdominal surgery. The patient is being ventilated and has the following parameters: MV 5.6
l, rate 10, I:E Ratio 1:3, FiO2 35%, mechanical dead space 100ml. The ABGs show: pH 7.31 PaCO2 50 PaO2 70 BE 0 Sat 95%. Which of the following should be recommended?
B) remove the deadspace
It is noticed that a patient's peak pressure has increased from 20 to 40cm without a change in static pressure. Possible causes of this include which of the following:
B) retained secretions & bronchospasm
Which of the following will have the greatest impact on increasing the mean airway pressure?
C) adding 5 cm PEEP
If a ventilator dependent patient has a large amount of thick tracheal secretions, it is best to:
A) use a cascade type humidifier
All of the following are needed to assemble a free standing CPAP system EXCEPT:
C) exhaled volume spirometer
A pediatric patient is receiving VC ventilation with a Vt of 250ml. The patient's breath sounds are clear, but the expiratory flow is seen on the monitor to not return to baseline before the next breath. How could this be interpreted?
D) presence of autoPEEP
The following are found on an adult patient receiving VC ventilation with A/C mode: Vt 500ml, Peakflow 45 lpm, Peak Pressure 40cm, Plateau 20cm, PEEP 5cm. Calculate the patient's Raw.
Raw = (Peak-Plateau)/Flow in lps
A 16 YO patient with severe asthma has been receiving nebulized albuterol treatments through the ventilator system over the past 12 hours. What can the therapist recommend to best evaluate the patient's response?
A) check airway resistance changes
A 75 YO male with CHF has been receiving ventilation over the past 24 hours. The diuretic drug furosemide has been given several times. What is the best way to evaluate how the patient's lung function is responding?
D) Compare Clt measurements at the start of therapy and now
After open heart surgery, a patient is receiving ventilation. The patient needs to have a pacer inserted in the cath lab. It is expected the patient will be back in the ICU in an hour or two. How should ventilatory support be provided during this time?
B) Pressure cycled transport ventilator
A patient with emphysema is receiving ventilation with the following settings: Mode VC A/C, Vt 600ml, Set Rate 12, Total Rate 12, FiO2 0.30, I:E Ratio 1:2. During a ventilator check, you measure the patient's exhaled Vt at 500ml. What can be done to help the patient exhale more completely?
D) increase the expiratory time
After abdominal surgery, a female patient is awakening gradually from anesthesia. Her ventilator settings are as follows: Mode VC SIMV, Vt 550, Spontaneous Vt 400 when awake, Set Rate 12, Total Rate 16, FiO2 0.30, Inspiratory Flow 40 lpm. When awake, she uses accessory muscles and her breathing is not synchonized. What can be done to improve synchrony?
C) increase the inspiratory flow to 50 lpm
An adult patient with myasthenia gravis is receiving ventilation with these settings: Mode PC A/C, Set Vt 450,ml, Set rate 10. Total rate 15, FiO2 0.40, Inspiratory Flow 60lpm. The patient's ABGs are all within the normal range. You notice the patient is making 24 breathing efforts per minute and using accessory muscles. What should be done?
B) increase the flow sensitivity
An unconscious adult patient has been received in the ED after suffering a stroke. The only ventilator available is an older volume cycled unit. The physician asks the therapist for a recommendation on the initial ventilator Vt to use with this patient who weighs 73kg (160 lbs). What should be recommended?
A 6 YO patient will be started on ventilation. What should the initial respiratory rate be?
A) 20 bpm
A 50 YO, 75kg (165 lbs) male patient has just returned from open heart surgery adn has been placed on a microprocessor ventilator with the following settings: Mode Vc A/C, Set Vt 500ml, Set Rate 12, Total rate 12. FiO2 0.50, I:E Ratio 1:2. After 45 minutes, the ABGs are pH 7.50 pCO2 30, PaO2 115 HCO3 22 BE -2. What should be done in this situation?
D) decrease the rate to 10 bpm
A patient with bilateral pneumonia is receiving ventilation with the following settings: Mode PC SIMV, Set Vt 650ml, Set Rate 14, FiO2 0.50, I:E Ratio 1:2, PEEP 10 cm. The nurse is concerned that the patient's SpO2 value drops from 94% to 85% when suctioned. How can this be prevented?
B) give 100% O2 before suctioning
A 40 YO, 60kg (132 lbs) female patient is recovering from ARDS. Her current settings are as follows: Mode VC A/C, Set Vt 400ml, Set Rate 12, Total Rate 18, FiO2 0.40 and I:E Ratio 1:3. She has the following ABGs: ph 7.42 PaCO2 37, PaO2 85 HCO3 25 BE +1. She has no complications and is
An adult male is recovering from flail chest injury and the physician wants to wean him from the ventilator. The patient is intubated with a 7.0 ETT and is breathing with the support of the SIMV mode. When the set rate was decreased for 8 to 6npm, the patient becomes tired. How can the patient's WOB be decreased?
C) add automatic tube compensation
A 65 YO male, 70kg(155 lbs) males patient who suffered a heart attack is receiving ventilation with the following settings: Mode PC,SIMV, Set Vt 500ml, Set Rate 12, Total Rate 18, FiO2 0.70. The physician is concerned that the patient may be developing pulmonary edema. These ABGs were recorded while the patient was on the ventilator: pH 7.43 PaCO2 35 PaO2 50 HCO3 22 BE -2. What should be done to help this patient?
D) add 5 cm PEEP
A 42 YO patient was accidentally given an OD or morphine for pain after surgery. Because the drug caused hypoventilation, the patient was intubated and started on ventilation in the Vc A/C mode. THe morphine has now been reversed and the patient is awake. The patient has the following beside spirometry values: RR 16bpm, VC 2300 Vt 400ml MIP -55cm H2O. What should be done at this time?
B) spontaneous breathing trial on a T-piece
The PCIRV mode is indicated in which of the following conditions:
A patient is receing CPAP at 10 cm with 40% O2 and a flow of 6lpm. THe nurse calls the therapist because the low pressure alarm is periodically sounding. The therapist finds the patient to be alert and breathing comfortably. The pressure gauge shows the CPAP fluctuating between 10 and 6 cm H2O. The low pressure alarm is set at 8 cm with a delay of 5 seconds. What should be done about this situation?
D) increase the flow
Which of the following clinical conditions could result in a decreased Clt and increasing pressure plateau?
C) pulmonary edema & pneumonia & ARDS
C) is similar to the VC A/C mode
High frequency ventilation would be indicated for all of the following situations EXCEPT:
D) near drowning
A patient undergoing a spontaneous breathing trial for weaning should be carefully assessed. Weaning should be terminated when:
D) the patient's rapid/shallow breathing index is 120 & the patient's PaCO2 is 60
Indications for ventilatory support:
rapid/shallow breathing index of 105 or more
a PaCO2 of >55 torr
cardiac dysrhythmias occur
An adult patient was receiving a Vt of 500ml on the ventilator before going to the OR for a left pneumonectomy. How should the patient's breathing be supported after surgery?
B) Vt less than before surgery
A negative pressure ventilator is indicated for the following types of patients EXCEPT:
An adult patient with an active lung injury has had an optimal PEEP study performed. Which of the following parameters found during the study would help determine the best PEEP setting?
A patient with pulmonary edema is receiving VC A/C with the following clinical data: Vt set 700ml, Corrected Vt 600ml, Peak pressure 65cm, Plateau 48cm. PEEP 12 cm. Calculate the patient's static compliance,
A mechanically ventilated patient has an exhaled Vt of 700ml. Because of refractory hypoxemia, 6 cm of PEEP is started. The peak pressure is 35cm and the plateau is 25cm. The compliance factor has been determined to be 4ml/cm. Calculate the Cst for this patient.
A mechanically ventilated patient has an exhaled Vt of 700ml. Because of refractory hypoxemia, 6 cm of PEEP is started. The peak pressure is 35cm and the plateau is 25cm. The compliance factor has been determined to be 4ml/cm. Calculate the Cdyn for this patient.
When preparing to ventilate a patient with HFJV, it is necessary to have all of the following EXCEPT:
C) spirometer to measure the Vt
Over the course of an 8 hour shift, the therapist notices that a patient receiving constant volume ventilation has had a increase in peak pressure from 25 to 40 cm H2O. What could have caused this change?
C) Raw increased & Clt decreased
A 45 YO patient has developed pulmonary edema. Thy physician asks the RT for the best ventilator adjustment to adjust the patient's intrapulmonary shunting. The therapist should recommend?
A) increasing the PEEP
A trauma patient has a pleural tube to the left lung. A microprocessor ventilator is delivering an inspiratory Vt of 800ml. The expiratory Vt is shown to be 600ml. What could best explain the volume difference?
A) air leak through the chest tube
Ina patient with ARDS, the indication to switch from VC to PC is:
C) Plateau pressures of >30cm H2O
A 70 kg (154 lbs) patient with a stroke and increasing ICP is being mechanically ventilated in the A/C mode with the following settings: MV 6.0L, I:E Ratio 1:2, FiO2 0.35, Rate 12. The patients ABGs are: pH 7.39 PaCO2 43 PaO2 107 BE 0 Sat 100%. On the basis of this information, it would be most appropriate to recommend:
B) increase the rate
Indications for increasing the expiratory time
air trapping or autoPEEP
The CXR of a patient receiving ventilation indicates atlectasis in both bases. In addition, the breath sounds are diminished bilaterally and she has a low grade fever. Which of the following ventilator adjustments should the therapist recommend?
C) increase the sigh volume
A patient with ARDS is receiving a smaller than normal Vt with resulting hypercarbia. What guidelines should be followed with permissive hypercarbia?
A) bivarb may be given to increase the pH & the CO2 is allowed to increase & the pH should be kept > 7.25
An adult female has the desire to breathe spontaneously and has a Vt that is 4 ml/kg. Because of her facial trauma from an MVA, she has a 6.5 ETT. he also has lung contusions in the MVA. Her PaO2 is 63 on 55% O2. What ventilator mode should be recommended for her?
C) SIMV with low level pressure support and PEEP
An apneic 60kg (132lbs) patient si being ventilated in the PC A/C mode. The patient's settings are: Vt 400ml, RR 10, O2 100%, Mech Ds 100ml. His ABG's show: pH 7.32 PaCO2 55 PaO2 66 HCO3 28 BE +4. Considering all of the above, all of the following ventilator adjustments would improve upon the ABGs EXCEPT:
D) Change to SIMV with a rate of 10
Indications that the patient is tolerating SIMV include all of the following EXCEPT:
C) RR has increased
A 55kg (120 lbs) female pateint is being vetnilated with the PC SIMV mode and a rate of 10, Vt 400, PEEP 10 and 35% O2. She has an 8.0 trach tube. Her spontaneous Vt is 300ml with a rate of 10. The most recent ABGs: pH 7.40 PaCO2 41 PaO2 95 HCO# 24 BE 0. What should be recommended?
C) reduce SIMV rate to 3
When working with a pateint who recently had a bowel resection and is receiving paralyzing meds to prevent fighting against the ventilator, it is important to
A) give the patient meds for pain
A patient with a closed head injury and increased ICP is being ventilated in the VC A/C mode with an FiO2 of 0.5, Rate of 12 and Vt of 600ml. The ABGs are: pH 7.43, PaCO2 35, PaO2 195 HCO3 22 BE -2 at 100%. The physician orders a PaCO2 of 25 for this patient. What should the therapist change on the ventilator to accomplish this?
B) increase the Vt
An 80kg (176 lbs) man with bilateral pneumonia is being ventilated in the PC A/C mode with set rate 12, total rate 16, exhaled Vt 800 and inspiratory pressure of 28. Four hours later, the total rate has increased to 26 and the exhaled Vt has decreased to 600. What is the most appropriate thing to do at this time?
C) increase the inspiratory pressure
A 17 YO female has been admitted with status asthmaticus and is place on a microprocessor ventilator. The physician wants to know if she has any autoPEEP. What is the best waveform to determine this?
B) flow time tracing
An adult female patient will be receiving NIV at night in her home for sleep apnea. THe nasal mask has been applied and these NIV parameters have been set: IPAP 15 cm EPAP 4 cm Rate 14 30% O2. after trying the NIV system for 10 minutes, the patient states she is not getting enough air. What is the first adjustment to make?
B) increase the IPAP to 20cm
After suffering mutiple trauma in an MVA, a 43 YO male patient is recovering. Ventilation has been needed for 5 days and weaning is being tried for the first time. After breathing on a T-piece for 40 minutes, the patient has the following ABFs: 7.30 PaCO2 54 PaO2 65 HCO3 26 BE =2 St 91%. Bedside spirometry shows: Vc before 1100, after 700; Vt before 400, after 300; Rate before 14, rate after 28, MIP before -26, MIP after -15, Based on this information, what should be recommended?
D) return to mechanical ventilation
An adult patient with ARDS has developed a pneumothorax during VC mechanical ventilation. The physician has decided to change the patient to HFO. The HFO settings are: f4, Amplitude 20 cm H20, I:E Ratio 1:2; O2 60%, PEEP 8 cm. After 50 minutes of HFO, gases were pH 7.31 PaCO2 52, PaO2 66 HCO3 37, BE +2 Sat 92%. What should be recommended?