2. T or F The first Student Learning Outcome (SLO) revolves around the principles, indications, hazards, and monitoring of negative pressure ventilation.
False
3. T or F The Student Learning Outcome(SLO) for this class includes an introduction to in monitoring of cardiac functions
True
4. T or F The Mid Term and Final constitute approximately 40% of the grade for this class.
True
5. According to the institutional classroom Standards, if you are going to be absent you are to
A. contact the instructor by SJVC email prior to your absence
6. Missing deadline for homework and projects may result in
I. a 10% reduction in points
II no credit
III void the need for turning in the project
B. I or II or at the instructors discretion
7. Missed quizzes, including “pop” quizzes
A. Can be taken late in accordance with college policies
B. May not be taken later; you will get a zero for that quiz
B. May not be taken later; you will get a zero for that quiz
8. To F It is okay to have coffee or soda in the classroom during lectures
False
9. In the article “Competencies Needed by Graduate Respiratory Therapist in 2015 and Beyond” how many competencies were identified and agreed upon as being needed by both new grads and existing work force
A. 69
10. All of the following competencies were identified as being needed except
D. They must fully understand the tenets of evidence based medicine including the ability to critically read and critique the medical literature and discuss the meaning of stastical anaylsis
11. In Table 12, the responders evaluated the relative importance of the following categories of skills, which did they indicate most important
C. Critical care
12. The importance of documenting competence and quality of care by administering national board speciality certifications examinations was first identified by other professions as early as
D. 1917
13. Which of the following participant groups identified that ther is a perfect storm of healthcare issues in our society, and that the respiratory care prefession is in a good position to assume new or expanding roles
B. Hospital Administrators
14. Based on your reading of this article do you think that the ability to research apply and adapt to respiratory care patient care protols to specific patients needs will be of value
C. Very useful — because it’s at the bedside where the real issue of patiend safety and treatment efficacy are most important
15. “RTs in 2015 must assume greater responsibility for ______ in order to reduce the cost of healthcare.”
A. education of other healthcare workers in RT procedures
1. Pneumatic ventilators may incorporate which of the following components for operation?
I. Pistons
II. Air entrainers
III. Flexible Diaphragms
IV. Internal direct current batteries
D. II and III
2. An iron lung is which type of ventilator
D. Negative Pressure
3. Which type of ventilator creates a sineusodial pressure waveform pattern of positive and negative pressures?
C. combined pressure
4. A closed system can be described as which of the following
I. Feedback
II. Hierarchical
III. Unintelligent
IV. Servo-Controlled
C. I and IV
5. Which of the following is a flow waveform created by a linear-drive piston?
C. Rectangular
6. The funnction of the exhalation valve following?
C. inflate during inspiration and to divert gas coming from the ventilator into the patient
7. Which of the following flow-controlled electromagnetism?
C. Propotional selenoid
8. A patient receiving CPAP of 7.5 via a mask and freestanding system appears to be in distress. The patient is using accessory muscles and is diaphoretic the manometer is fluctuating between -5 and 7.5 the most appearant cause of the distress is
D. Inadequate Flow
9. The set tidal volume is 500 mL. During the first breath the exhaled volume measures 390 mL, with a peak pressures of 18. The second breath returns 460 mL, with 20 cm The third breath has peak pressure of 22 an exhaled volume of 500 mL. This can be described as what type of system
D. closed loop system
10. The gas that enters the ventilator from high-pressure sources goes directly to the system. This is what type of system
D. single circuit
11. Which of the following is a devic that uses a flow resistor to create expiratoi pressure?
C. Positive expiratory pressure mask
12, Who has attempted to establish a ewer classification system to describe how ventilators work?
D. Chatburn
13. The most common type of ICU ventilators today are:
B. pneumatically powered and microprocessor controlled.
14. Internal expiratory valves have which of the following characteristics?
I. high resistance
II. low resistance
III. large diameter opening
IV. Flexible plastic diaphragms
V. spring-loaded
D. II, III, IV
15. PEEP is accomplished by which of the following methods?
I. Flow resistance
II. Passive resistance
III. Threshold resistance
A. I, III
16. The main parameter that the ventilator manipulates for any given breath is referred to as which of the following?
C. Control variable
17. What variable begins the inspiratory phase of a ventilator?
C. Trigger
18. What trigger variable is used during control ventilation?
A. Time
19. Which of the following variables en s the inspiratory phase?
C. Cycle
20. Which of the following variables begins a mandatory breath?
B. Time
21. The pressure maintained at the airway during exhalation is known as which of the following
A. Baseline
22. Which two of the following patient triggers are most common?
I. Flow
II. Neural
III. Volume
IV. Pressure
D. I and IV
23. On a mechanical ventilator, pressure-triggering is usually set within which of the following ranges?
A. - 0.5 to – 1.5
24. If the base flow is 8 L/min and the flow-trigger setting is 3 L/min, at what flow rate will the ventilator be triggered?
A. 5 L/min
25. With a baseline pressure setting of 6 cm H20 and a sensitivity setting of .5 inspiration will begin at
A. 4.5
26. What is the flow rate if the set volume is 550 mL and the inspiratory time is 1.2
second?
D. 27.5
27. The maximum safety pressure sh be set at _____ cm H when the peak pressure reached during vo1ume-c ventilation is 25 cm H
C. 35
28. When the maximum safety pressure setting in a volume mode is reached, which ol the following occurs?
A. Inspiration ends prematurely
29. When the maximum safety pressure on a volume ventilator is reached, which of the following occurs?
A. inspiration ends before the entire volume is delivered
30. Which of the following represents the amount of time a pressure-targeted ventilator breath should be at the set pressure?
a. Rise time
b Inspiratory time
c. Total cycle time
d. Inspiratory hold
b Inspiratory time
31. Improving lung compliance during pressure ventilation will cause which of the following?
a, A decrease in peak pressure
b. An increase in peak pressure
c. An increase in volume delivery
d. A decrease in volume delivery
c. An increase in volume delivery
36. Improving lung compliance during volume-controlled ventilation will cause a(n)_____ in peak_____
B. Decrease; pressure
37. Worsening lung compliance during g volume-controlled ventilation will cause which of the following?
C. an increase in peak pressure
38. Worsening lung compliance during pressure-controlled ventilation will cause which of the following?
A. A decrease in volume delivery
39. What is the volume that will reach the patient when the volume setting is 700 mL, the circuit CT is 2 mL/cm, and the measured PIP is 35 cm H when the ventilator does not have tubing compliance compensation?
D. 630 mL
40. How much volume is lost in the ventilator circuit when the volume is Set at 500 mL, the PIP is 40 cm H and the circuit CT is 3 mL/cm H when the ventilator does not have tubing compliance compensation?
C. 120 mL
41. Pressure-support ventilation (PSV) is classified as:
I. F1ow-cyc1ed
II. Time triggered
III. Volume targeted
IV. Pressure targeted
V. Patient-triggered
D. I, IV, V
42. Plateau pressure may be obtained during volume ventilation by using which of the following?
B. inspiratory pause
43. During volume ventilation, PIP is the pressure needed to overcome which two of
the following factors?
I. Muscle pressure
II Airflow resistance
III. Elastic recoil pressure
IV. Transthoracic pressure
D. II and III
44. The transairway pressure (PTA) represents the pressure associated with which of the following?
D. Airflow resistance
45. Which is the formula for transairway pressure (PTA)?
D. PIP-Pplat
46. Increased Pta is associated with which two of the following changes?
I. Increased airway resistance
II Decreased airway resistance
III. Increased static compliance
IV Decreased static compliance
D. I and IV
48, What is the static lung compliance (Cs) when the returned tidal volume is 500 ml, baseline pressure is zero, and the Pplat reading is 25
A. 0.02
49. What is the Cs when the returned tidal volume is 700 ml the PEEP is 10 the PIP is 45cm and the Pplat is 35cm?
C. 0.028
50. What is the Cs when the returned tida1 volume is 460 mL, the PEEP is 8 cm the PIP is 27 cm H and the Pplat 18
B. 46
51. Increasing the functional residual capacity (FRC) of a spontaneously breathing patient to improve oxygenation can e accomplished by which of the following?
B. CPAP
52. What procedure is used to estimate the amount of air trapped in the patient’s lungs and in the patient circuit?
C. End Expiratory pause
53. Auto-PEEP can be detected without the use of an expiratory pause on which of the following curves?
C. flow-time
54. Which of the following is the technique that can actively remove gas from a ventilator circuit at the beginning of expiration?
A. NEEP
55. What is the airflow resistance (Raw) hen the PIP is 50 cm H the Pplat is 1 5 cm H and the set ventilator gas flow ate is 60 L/min?
A. 35
1. A diagnosis of respiratory failure can be made if which of the following are present
I. PaO2 of 55, FiO2 .21 Pb 760
II. PaCO2 57, FiO2 .21 Pb 760
III. P(A-a) O2 45, FiO2 1.0 Pb 760
IV. PaO2/FiO2 400 Pb 750
B. I and II
2. What is respiratory failure due to inadequate ventilation?
B. hypercapnic
3. Hypercapnic (type II) respiratory fail terms?
D. ventilatory failure
4. Hypoxemia can be caused by which of the following
I. diffusion impairment
II. alveolar hypoventilation
III. V/Q mismatch
IV. Intrapulmonary shunting
B. I, II, III, and IV
5. Which of the following best describes t e difference between V/Q mismatch and shunt when supplemental oxygen is administered?
D. V/Q mismatch will respond well but shunt will not.
6. Which of the following clinical signs is most often associated with hypoxemia due to shunt?
a. diffuse wheezing
b. “white” chest radiograph
c. stridor
d. loud P2
b. “white” chest radiograph
7. A patient with interstitial lung disease ho presents with hypoxemia due to diffusion def have which of the following clinical signs?
I. fine bibasilar crackles
II. clubbing of the finger nail beds
III. jugular venous distention
IV. increased P2
B. I, II, III, and IV
8. What type of disease is associated with perfusion/diffusion impairment?
D. vascular disease
9. What is the most common cause of low mixed venous oxygen?
C. cardiac disease, with low cardiac output
10. What is the normal P (A—a) 02 range while breathing room air?
B. l0 mmHg to 25 mmHg
11. What is the normal P (A—a) 02 with V/Q mismatch and shunt?
C. increases with both V/Q mismatch and shunt
12. What is the optimal treatment of intrapulmonary shunt?
D. alveolar recruitment
13. A patient with an opiate drug overdose blood gas results breathing room air: pH 7.19, PCO2 89, HCO3 27, PO2 48
Which of the following best describe the patient’s condition?
D. acute hypersonic respiratory failure
4. All of the following would tend to cause hypersonic respiratory failure except
D. smoke inhalation
15. Which of the following are associate with hypercapnic respiratory failure due to decreased ventilatory drive?
I. brainstem lesions
II. encephalitis
III. hypothyroidism
IV. asthma
D. I, II, and III
16. All of the following are associated with respiratory muscle weakness or fatigue
D. hyperthyroidism
17. Which of the following is a feature of Guillian Barre
D. ascending muscle weakness
18. All of the following are associated with increased work of breathing except:
C. myasthenia gravis
19. Which of the following information be respiratory failure from acute hypercapnea
A. kidneys retaining bicarbonate to elevate the blood pH
20. Which of the following is the cardinal sign of increased work of breathing
B. tachypnea
21. In patients suffering from acute respiratory failure below what pH level is intubation and ventilatory support generally considered
D. 7.20
22. Which of the following patients has the most serious problem with the adequacy of oxygenation?
B. 1.00 85
23. A need for some form of ventilatory support is usually indicated when an adult’s rate
of breathing rises above what level?
C. 35/mm
24. Which of the following measures is useful indicators in assessing the adequacy of a patient’s oxygenation?
I. PAO2 – PaO2
II. PaO2 to FiO2 ratio
III. VD/VT
D. I and II
25. Which of the following measures taken on adult patients indicate unacceptably high demands or work of breathing?
D. VE of 17 L/min
26. Ventilatory support may be indicated when the VC falls below what level?
D. 10ml/kg
27. What is the normal range of maximum inspiratory pressure, or MIP (also called negative inspiratory force, or NIF), generated by adults?
A -80 to –l00
B. -50 to -80
C. -30 to -50
D. -20 to -30
A -80 to –l00
8. Which of the following MIP measure taken on an adult patient indicates inadequate
respiratory muscle strength?
A. –l5
29. Common bedside measures used to assess the adequacy of lung expansion include all of the following except
B. VD/VT
30. You determine that an acutely ill patient can generate an MIP of -18. Based on this information, what might you conclude?
A. The patient has inadequate respiratory muscle strength.
31. Breathing 100% 02, a patient has a PA 2 of 60mm Hg. Based on this information, what might you conclude?
A. The patient has acceptable oxygenation.
32. What is the normal range for Pa02?
A. >400
33. Which of the following measures should be used in assessing the adequacy of a patient’s alveolar ventilation?
1. Pa02
II. arterial pH
III. PaC0
A. II and III
34. A patient with a 10-year history of chronic bronchitis for, with an acute viral pneumonia for the last 3 days now exhibits the following blood gas pH= 7.22; PCO =67; HCO= 26 PCO2 = 60 which of the following best describes the patient’s condition?
C. acute hypercapnic respiratory failure
35. cause an elevated PaCO2 increases ventilatory drive in normal subjects , the clinical presence of hypercapnia indicates which of the following?
I. inability of the stimulus to get to the muscles
II. weak or missing central nervous system
III. pulmonary muscle fatigue
B. I, or II, or III
36. Which of the following indicators are useful in assessing respiratory muscle strength
I. maximum voluntary ventilation (MVV)
II. forced vital capacity (FVC)
III. dead space to tidal volume ratio (VD/VT)
IV. Maximum inspiratory pressure (MIP)
A. I, II, and IV
37. A reversible impairment in the response of an overload best describes which of the following
B. contractile respiratory muscle fatigue
38. Which of the following modes of ventilatory support would you recommend for a mild hypoxemic patient from congestive heart
A. continuous positive airway pressure
39. Which of the following patients are at greatest risk for developing auto PEEP during mechanical ventilation?
D. those with COPD
40. What are some causes of dynamic hyperinflation.
I. increased expiratory time
II. increased airway resistance
III. decreased expiratory flow rate
C. II and III
1. In which of the following types of ventilation is alveolar expansion during inspiration due to a decrease in pleural pressure
I. positive-pressure ventilation
II. negative-pressure ventilation
III. spontaneous ventilation
D. II and III
2. Which of the following statements are true about negative pressure ventilation (NPV)?
I. NPV is similar to spont
II. Airway (mouth) pressure during NPV is zero
III. Expiration during NPV is by passive recoil
IV. NPV decreases pressure at the body surface
A. I, II, III, and IV
3. In which of the following types of ventilation is alveolar expansion during inspiration due to an increase in alveolar pressure
I. negative-pressure ventilation
II. positive-pressure ventilation
III. spontaneous ventilation
C. II
4. Which of the following statements is false about positive-pressure ventilation (PPV)?
A. During inspiration, pleural pressure decreases.
5. Which of following conditions is associated with a lack of response to increases FiO2 in patients receiving PPV?
B. shunt
6. Administration of PEEP or CPAP is associated with all of the following benefits except maintaining:
A. alveoli open
B alveoli stable
C. fluid-filled alveoli open
D. surfactant-depleted alveoli closed
D. surfactant-depleted alveoli closed
7. Which of the following is considered a normal spontaneous tidal volume?
A. 5 to 7 mL/kg
8. Which of the following conditions do not require high mechanical respiratory rates?
B. metabolic alkalosis
9. Which of the following is the explanation positive end-expiratory pressure (PEEP
A. diversion of blood from ventilated to hypoventilated areas
10. Which of the following is the conseque:
D. It takes less time to fill and empty f
11. Mean airway pressure may be increased by all of the following except increasing the:
D. FiO2
12. On what does volume delivered depend during pressure targeted modes of ventilatory support?
1. set pressure limit
II. patient lung mechanics
III. patient effort
B. I and II
l3. Which of the following is FALSE about pressure limited modes of ventilation?
A. The volume delivered at a given pressure must decreases as Raw rises
14. The volume delivered by a pressure limited ventilator will decrease under all of the following conditions except:
C. airway resistances rises
15. Which of the following are considered safe settings for a recruitment maneuver
I. pressures up to 50
II. pressures up to 35
III. pressures applied for 5 to 10 min
IV. pressures applied for 1 to 2 min
B. I and IV
16. The magnitude of WOB depends on which of the following?
I. compliance
II. resistance
III. ventilatory drive
IV. trigger sensitivity
V. peak flow
D. I, II, III, IV, and V
17. In which of the following modes of ventilator would the patient’s work of breathing be greatest?
B. continuous positive airway pressur (CPAP)
18. In which of the following modes of ventilatory support would the patient’s work of breathing be least?
A continuous positive airway pressure (CPAP)
B. pressure-supported ventilation (PS )
C. intermittent mandatory ventilation (IMV)
D. continuous mandatory ventilation (CMV)
D. continuous mandatory ventilation (CMV)
19. When bedside work of breathing measures are unavailable, you should adjust the level of pressure-supported ventilation (PSV) to which of the following breathing patterns?
Spontaneous Rate VT
A. 5 to 25 l/min 5 to 8 ml/kg
20. Which level of plateau pressure increases the likelihood of causing lung injury?
D doesn’t matter as long as positive inspiratory pressure is less than 50
B. >30
21. All of the following factors would tend o increase mean airway pressure except:
D. short inspiratory times
22. Beneficial physiological effects of positive end-expiratory pressure (PEEP) include which of the following?
I. increased PaO2 for given FiO2
II. increased lung compliance (CL)
III. decreased shunt fraction
IV. increased functional residual capacity
C. I, II, III, and IV
23. Detrimental effects of positive end-expiratory pressure (PEEP) include all of the following except:
C. increased CL
24. Contraindications for using positive end-expiratory pressure (PEEP) in conjunction
with mechanical ventilation include which of the following?
I. untreated bronchopleural fistula
II. chronic airway obstruction
III. untreated pneumothorax
C. I and III
25. Compared with a square wave flow pattern, a decelerating flow waveform has all of the following potential benefits except
A. improved cardiac output
26. Which of the following is a benefit of high inspiratory flows during positive-pressure ventilation?
A. reduced air trapping
27. Physiological effects of adding a volume include which of the following?
I. decreased PaCO2
II. increased inspiratory time
III. decreased VD/VT
IV. Longer expiratory times
A. I, II, and III
28. In which of the following modes does the patient’s ventilatory pattern have most control over PaO2, PaCO2, and acid base balance
A. volume-controlled continuous mandatory ventilation
29. Which of the following modes of ventilatory support would result in the highest mean airway pressure?
B. volume-controlled continuous mandatory ventilation
30. In which of the following modes of ventilatory support is muscle atrophy most likely to occure
B. volume-controlled continuous mandatory ventilation
31. What are some key causes of patient-ventilator asynchrony and increased work of breathing during pressure-triggered you ventilation?
I. improper trigger setting
II. insufficient inspiratory flows
III. high peak airway pressures
B. I and II
32. Inspection of the airway pressure waveform of a patient receiving volume controlled continuous mandatory ventilation assist control with constant flow reveals a large dip or drop in pressure ONLY at the very beginning of inspiration which of the problems is most likely?
A. The trigger setting is improper.
33. During volume-controled continous mandatory ventilation should either compliance decrease or airway resistance increases
B. The peak airway pressure will increase
34. Which of the following is FALSE about permissive hypercapnia if allowed to increase slowly?
B. It increases pulmonary vascular resistance
35. What mode of pressure-controlled ventilation is designed to prevent alveoli with short time constants from collapsing there by improving oxygenation
B. pressure-controlled inverse ratio
36. A patient switched from pressure-control with positive end-expiratory pressure ventilation to pressure control inverse ratio ventilation (PC-IRV) shows a good improvement in oxygenation. Which of the following best explains this observation?
B. High mean pressures caused by PC-IRV decreased cardiac output
37. What are some physiological advantages of volume-assured pressure-supported ventilation?
I. improved patient-ventilator synchrony
II. increased pressure-time product
III. decreased work of breathing
D. I and III
38. What factor primarily determines the effect of positive-pressure ventilation (PPV) on the cardiac output?
B. mean pleural pressure
39. Potential effects of hyperventilation on the central nervous system include which of the following?
I. increased 02 consumption
II. increased cerebral vascular resistance (CVR)
III. increased intracranial pressure (ICP)
D. II and III
40. Positive-pressure ventilation (PPV) can reduce urinary output by how much?
B. 30% to 50%
41. Detrimental effects of auto positive end -expiratory pressure (PEEP) include all of the following except:
B. pulmonary vascular resistance
42. Which of the following gastrointestinal contitions are commonly associated with long-term positive-pre ventilation
I. bleeding
II. ulceration
III. diarrhea
D. I and II
43. Which of the following terms describe the lung injury associated with low tidal volumes?
C. atelectrauma
44. Which of the following lung units would be most prone to air trapping
B. one with high resistance and high compliance
45. The increased work of breathing associated with auto PEEP during mechanical ventilation is due to
I. hyperinflation or impaired contractility of the diaphragm
II. large alveolar pressure drops required triggere breaths
III. increased volume of the intrathoracic airways
D. I and II
1. When otherwise not identified, AC mode most often refers to which of the above breath delivery strategies.
A. Volume Control Mode
2. The primary, or initial, breath delivery strategy in PRVC is which?
C. Pressure Control
3. APRV is what type of breath delivery strategy?
A. Pressure Control
4. PSV uses what type of breath delivery strategy?
C. Pressure Control
5. Which breath delivery strategy uses time as its exclusive criteria for terminating the inspiratory phase.
B. Pressure Control
6. PSV is what type of mode?
B. Spontaneous Mode
7. PC-SIMV + PSV is which of the above type of mode of ventilation?
B. Mixed mechanical and Spontaneous Mode
8. CPAP + PSV is which of the above type of mode of ventilation?
B. Spontaneous Mode
9. APRV + PSV is which of the above type of mode of ventilation?
A. Mixed mechanical and Spontaneous Mode
10. PRVC + CPAP is which of the above type of mode of ventilation?
B. Mixed mechanical and Spontaneous Mode
11. PC-IRV is which of the above type of mode of ventilation?
C. Machine-Controlled Mode
12. Primary criterion that terminates PSV mechanical breaths.
C. Flow
13. Limit variable in VC breaths on PB 840.
A. Flow
14. Variables that is not limited during inspiration phase of AC-VC.
A. Pressure
15. Secondary criterion that terminates PSV mechanical breath when the patient coughs?
A. Flow
16. Secondary criterion that terminates PSV mechanical breath when the patient has a leak in the circuit.
A. Time
17. IPAP is similar to which above?
D. PSV
18. Mode of ventilation that allows the greatest control of PaCO2.
E. APRV
19. Mode that looks like PC-IRV if patient isn’t breathing.
E. APRV
20. Just to make things really confusing, one manufacturer using the term Bipap to describe their version of mode of vent, used in most critical ARDS patient.
E. APRV
21. Least benefit in assuring alveolar ventilation.
E. PEEP/CPAP
22. Mode that describes WOB across a long, narrow ETT.
D. PSV
23. EPAP is another name for which mode above?
D. PEEP/CPAP
24. Which of the above mode has the best overall outcomes during 2 studies comparing weaning methodologies?
C. Spontaneous breathing, with or without CPAP
25. Which one could provide greatest muscle relaxation if properly set?
A. SIMV
26. MMV is most like which?
A. SIMV
27. If a patient is in VC-CMV + automode on a Servo I, and the set inspiratory time is set @ 1 second, and the patient increases inspiratory demand, the vent will:
C. The delivered vt could be greater than the set vt value and the inspiratory time could be greater or less than set inspiratory time.
28. Which of the following term does not apply to the terms used by different maufactures regarding the peak airway pressure alarm.
D. Pressure control
29. To determine static compliance of the patient, which maneuver do you do?
D. Inflation hold
30. Given that most ICU vents are pneumatically powered and microprocessor controlled machines, which of the following cycling criteria are used by vent for most modes of ventilation?
