TMC Mechanical Ventilation Practice questions

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95 terms AF_ A 43-year-old male patient was admitted to the emergency department with a suspected drug overdose.The patient is receiving oxygen via nonrebreather but is unconscious and isn't making any respiratory efforts to breathe. The patient's body weight is 57 kg and his ABG

results are as follows:

pH 7.28 PaCO2 74 torr HCO3 20 mEq/L PaO2 315 torr Which of the following would you recommend?

A. Apply BiPAP with: IPAP 20 cm H2O, EPAP 5 cm H2O,

FiO2 30%

B. Intubate and apply: SIMV, tidal volume 600 mL, rate

6/min, FiO2 40%

C. Intubate and apply: A/C ventilation, tidal volume 450

mL, rate 12/min, FiO2 50%

• Apply CPAP at 10 cm H2O and an FiO2 of 100%

C A 63-year-old female patient is intubated and receiving mechanical ventilation in the pressure controlled A/C mode. If the patient's compliance were to decrease, which of the following would you expect to occur?

• Her delivered volume will decrease
• Her peak pressure will increase
• Her inspiratory time will increase
• Her PEEP level will decrease

A

A 70-year-old male patient is intubated and receiving mechanical ventilation in the volume controlled A/C mode. After performing endotracheal suctioning, which of the following would indicate the effective clearance of retained secretions?

• An increased tidal volume
• A decreased inspiratory time
• A decreased plateau pressure
• A decreased peak pressure

D A 176 lb male patient is intubated and receiving volume

control A/C ventilation with the following settings: FiO2

of 40%, Rate of 12/min, and Tidal Volume of 550 mL. An ABG was analyzed and the following results were

obtained:

ABG Results and Ventilator Settings pH 7.39 PaCO2 37 mmHg HCO3- 23 mEq/L PaO2 107 mmHg Spontaneous Tidal Volume 180 mL Spontaneous Rate 37/min Vital Capacity 550 mL MIP/NIF -12 cm H2O Which of the following would you recommend?

• Place the patient on a 40% T-piece and monitor

closely B. Switch the patient to SIMV at a rate of 5/minute

• Place the patient on CPAP and monitor closely
• Maintain the current ventilator settings and re-evaluate

later B?D!A 51-year-old female patient with a history of asthma is receiving mechanical ventilation in the assist-control mode. Upon assessment, you note that she is struggling to initiate inspiration. Which of the following settings would you check first in order to resolve of this problem?

• Tidal volume
• Pressure limit
• Sensitivity

D. PEEP

C During the assessment of an adult patient who is receiving mechanical ventilation, you suddenly notice the simultaneous sounding of both the high pressure and low volume alarms. What is the most likely cause of this finding?

• There is a disconnection in the ventilator circuit
• There is a leak in the ET tube cuff
• There is a mucous plug in the ET tube
• The patient has developed pneumonia

C

A 68-year-old male patient with COPD is receiving

volume control SIMV with the following settings:

Tidal volume 480 mL Rate 12/min Pressure support 10 cm H2O PEEP 5 cm H2O During a spontaneous breathing trial via T-tube, the patient's breathing rate increased drastically which required that he be placed back on the ventilator. Which of the following would you recommend during the next breathing trial?

• Increase the sedation dosage
• CPAP with pressure support via ET tube
• CPAP without pressure support via ET tube
• Extubate and provide BiPAP via full face mask

B A 63-year-old male patient with a tracheostomy is being mechanically ventilated in the ICU. Upon assessment, you noticed that as the patient coughs, blood and secretions were blown back into the circuit. What action should you take at this time?

• Flush the blood out of the circuit with normal saline
• Sedate the patient to prevent more coughing
• Nebulize a local anesthetic to reduce surgical pain
• Replace the circuit with a new one

D A 60-year-old female patient who in orally intubated is going through a spontaneous breathing trial. Which of the following would indicate the need to stop the trial and return the patient back to full ventilatory support?

• An increase in heart rate from 96 to 114/min
• An increase in respiratory rate from 17 to 27/min
• An increase in arterial PCO2 from 44 to 52 torr
• A decrease in SpO2 from 92% to 83%

Eithe A or B D!The physician has requested the dynamic compliance measurement for an adult patient who is receiving mechanical ventilation. This value can be obtained by dividing the patient's tidal volume by which of the

following:

• (Pplat - PEEP)

B. (PIP - PEEP)

• (PIP - Paw)
• (Paw - Pplat)

B

An alert 59-year-old male patient is orally intubated with an endotracheal tube. During a weaning trial, the patient was switched to CPAP mode with an FiO2 of 40%. Within the first 5 minutes, the patient's respiratory rate has increased from 22 to 31 breaths/min with increased usage of accessory muscles while breathing. Which of the following would you recommend?

• Return the patient to full ventilatory support B.

Increase the FiO2 to 50%

• Apply 5-10 cm H2O of pressure support
• Extubate the patient and reassess

C?A..A stable adult patient who is receiving mechanical

ventilation displays the following results:

pH 7.49 PaCO2 29 mm Hg HCO3 24 mEq/L BE +1 PaO2 87 mm Hg SaO2 96% Which of the following would you recommend?

• Add 10 cm H2O PEEP
• Increase the minute ventilation
• Decrease the tidal volume
• Maintain the current setting

C A 68-year-old female patient in the ICU is receiving mechanical ventilation but appears to be breathing asynchronously with the ventilator. Which of the following medications would you recommend?

• Fluoxetine (Prozac)
• Lorazepam (Ativan)
• Dextroamphetamine (Dexedrine)
• Cisatracurium (Nimbex)

B A 70-year-old male patient with COPD is receiving ventilatory support in a volume-controlled mode. Upon assessment, the high pressure alarm suddenly begins to sound. Which of the following would recommend?

• Increase the flow setting
• Increase the pressure limit setting
• Suction the airway
• Remove air from the endotracheal tube cuff

C A 69-year-old male patient is undergoing a spontaneous breathing trial for weaning from mechanical ventilation.Which of the following changes in the patient's status would be acceptable?

• A decrease in SpO2 from 91% to 81%
• An increased usage of the scalene muscles during

breathing

• An increase in heart rate from 97 to 115/min
• A decrease in the systolic blood pressure from 115 to

76 mmHg D C! Hasnt gone over 20