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AMV final review

Terms in this set (40)

One goal of lung recruitment is to reduce pulmonary shunt by increasing the amount of lung surface area engaging in oxygenation. True or False
True
The P (A-a) oxygen gradient represents the ability to diffuse oxygen from the alveoli to the arterial blood. True or False
True
If a patient's peak pressure is going up and the plateau pressure is staying the same, the problem is decreased compliance. True or False
False
High ICP is a RELATIVE contraindication to HFOV and should be strongly considered when changing a patient's ventilation mode to HFOV. True or False
True
A bronchodilator is routinely given before a spontaneous breathing trial for weaning. True or False
False
Flow volume loops for a ventilated patient move counter-clockwise and inspiratory curve is upward. True or False
False
The lungs of patients with the disease ARDS and RDS have alveolar qualities that are homogenous. True or False
False
Which of the following parameters indicate a readiness for weaning?
1. Ve of 5.8L
2. RSBI of 90
3. NIF -10
4. VC of 15ml/kg
1, 2, and 4
When changing a patient from volume to pressure control ventilation, what is the first parameter to check?
a. exhaled VT
b. static lung compliance
c. PIP
d. auto-PEEP
a. exhaled VT
In what scenario is pressure-controlled ventilation (PCV) most often used?
a. when bilateral pneumonia is present
b. when the patient has COPD
c. when a pneumothorax is present
d. when limiting plateau pressure is needed
d. when limiting plateau pressure is needed
What forces must be overcome to move air into the respiratory system?
1. elastic forces of lung tissue
2. airway resistance
3. surface tension forces
4. tissue viscous resistance
all of the above
An inverse I:E ratio visual alert is observed during a routine check of a volume ventilator. Which of the following adjustments would be most appropriate to correct the problem?
a. increase the flow
b. increase the frequency setting
c. decrease the VT
d. activate the ratio limit control
e. switch to a decelerating wave form
a. increase the flow
The primary clinical advantage of high frequency ventilation compared to conventional ventilation is:
a. improved ventilation
b. reduced barotrauma
c. improved oxygenation
d. reduced adverse CV effects
b. reduced barotrauma
During mechanical ventilation of a COPD patient, the PaCO2 = 65mmHg and the VE = 5.0 L/m. If the desired PaCO2 is 50, the the VE needs to changed to:
a. 8.0 L/m
b. 7.2 L/m
c. 6.5 L/m
d. 5.8 L/m
c. 6.5 L/m
A physician has requested that the RT increase the ventilatory volume for a patient receiving HFOV. Which of the following settings should the therapist adjust?
a. delta P (amplitude)
b. bias flow
c. tidal volume
d. Hz
delta P (amplitude)
Which of the following represents the most sensitive pressure settings for a ventilator?
a. - 0.5 cmH2O
b. -1.0 cmH2O
c. -1.5 cmH2O
d. -2.0 cmH2O
-0.5 cmH2O
While performing an assessment on a ventilated patient, the RT notices that the patient is extremely restless and is breathing dysynchronously with the vent. The patient is tachycardic, cyanotic, and has distended neck veins. Which of the following should the RT do?
1. Perform bilateral BS ascultation
2. Suction the ETT and look for an obstruction
3. Recommend paralysis and sedation
4. Manually ventilate the patient and recommend a CXR, stat
a. 1 and 3
b. 1, 2 and 4
c. 2, 3, and 4
d. 1, 2, 3, and 4
b. 1, 2 and 4
You are called to a delivery and the NNP asks you to perform PPV via nasal intermittent mandatory ventilation on a term baby. Which of the following would be the best setting to start this therapy?
a. PEEP 5
b. PIP 16 to 20, PEEP 5
c. PIP 40, PEEP 6
d. PIP 15, PEEP 3
PIP 16 to 20, PEEP 5
A patient's PaCO2 is 50 torr and the PECO2 is 20 torr. What is the patient's VD %?
a. 25%
b. 40%
c. 60%
d. 75%
60%
In HFOV the _____________________ is the critical factor that influences the PaCO2.
a. MPaw
b. Bias flow
c. Amplitude
d. insp time %
Amplitude
A patient is receiving mechanical ventilation with increased mechanical deadspace. The minute volume has not changed. Which of the following will increase?
a. PaCO2
b. PaO2
c. VT
d. alveolar ventilation
PaCO2
A patient is receiving continuous mandatory ventilation through a constant flow generator in the A/C mode at a RR 20 with a VT of 500ml and an inspiratory time of 1.0 second. What is the flowrate?
a. 15 L/min
b. 30 L/min
c. 45 L/min
d. 60 L/min
30 L/min
Which of the following factors is NOT associated with an increased risk of auto-PEEP?
a. mechanical ventilation of a patient with obstructive lung disease
b. high VE during mechanical ventilation
c. ARDS patient
d. pulmonary fibrosis
pulmonary fibrosis
Since APRV can reduce airway pressures in patients with ALI/ARDS, it is also thought to be associated with a reduced risk of ventilator-associated lung injury. The primary reason for this is:
a. Renal function is enhanced with APRV
b. APRV may recruit consolidated lung areas over time and prevent repeated opening and closing of alveoli
c. Maximum alveolar pressures are kept below 30cm H2O
d. Cardiac index is enhanced with APRV
APRV may recruit consolidated lung areas over time and prevent repeated opening and closing of alveoli
You are giving an 80% He:20% O2 mixture to an asthmatic patient through a nonrebreathing mask with a compensated Thorpe tube O2 flowmeter set at 8L/min. What is the actual flow being delivered to the patient?
a. 10 L/min
b. 12 L/min
c. 14 L/min
d. 18 L/min
14 L/min (14.4)
This mode of vent support is designed to provide two levels of CPAP and allow the patient to breathe spontaneously.
a. ASV
b. PRVC
c. APRV
d. ILV
APRV
A growing gradient between PIP and plateau on a pressure/time waveform is indicative of increasing:
a. compliance
b. bronchodilator response
c. resistance
d. volume
resistance
A "scooped" out expiratory curve on a flow/volume loop demonstrates a(n) ______________________ process.
a. restrictive
b. resistant
c. obstructive
d. bronchodilator
obstructive
A pressure/volume loop that looks like a "football laying on its side" is demonstrating _________________ compliance.
a. decreased
b. normal
c. increased
d. expiratory
decreased
Airway resistance (Raw) is found by:
a. dividing the peak inspiratory pressure by the peak flow
b. dividing the plateau pressure minus the PEEP by the flow in liters/second
c. subtracting the plateau pressure from the peak pressure and dividing by the flow in liters/second
d. dividing the plateau pressure minus the PEEP by the VT
subtracting the plateau pressure from the peak pressure and dividing by the flow in liters/second
Which of the following is the best way (evidence based) to use NIV with Acute Cardiopulmonary Edema (ACPE), with no hypercarbia?
a. CPAP 4-6 cmH2O
b. Bi-phasic, EPAP 10 cmH2O, IPAP 15 cmH2O
c. CPAP 8-10 cmH2O
d. CPAP 10-12 cmH2O
CPAP 10-12 cmH2O
With a plateau pressure measurement:
a. inhalation is paused by the ventilator for 1-3 seconds
b. exhalation is prevented by the ventilator for 0.5-1.5 seconds
c. inhalation is paused by the ventilator for 0.5-1.5 seconds
d. inhalation is prevented by the ventilator for 1 second
exhalation is prevented by the ventilator for 0.5-1.5 seconds
Critical opening pressure is best described as:
a. the normal pressure needed to overcome resistance and finish filling of the lungs
b. the low pressure needed to overcome resistance and start filling the lungs
c. the high pressure needed to overcome resistance and finish filling of the lungs
d. the high pressure needed to overcome initial resistance and start filling the lungs
the high pressure needed to overcome initial resistance and start filling the lungs
Which of the following is true regarding plateau pressure?
a. Plateau pressure is normally zero at the end of inspiration
b. Plateau pressure is used as a measure of alveolar pressure
c. Plateau pressure is measured at the end of exhalation
d. Plateau pressure is a dynamic measurement
Plateau pressure is used as a measure of alveolar pressure
What is the optimal treatment of intrapulmonary shunt?
a. surgery
b. alveolar recruitment
c. albuterol 2.5 mg via svn
d. decrease FiO2
e. increase FiO2
alveolar recruitment
When placing a baby on HFOV, which of the following would be utilized for initiation of HFOV from conventional ventilation?
a. mean airway pressure from conventional vent settings
b. chest wiggle factor
c. PaO2 from ABG
d. I:E ratio
mean airway pressure from conventional vent settings
Overdistention injury of the lungs is associated with release of what substances from the lungs into the bloodstream?
a. bacterial endotoxins
b. surfactant
c. cytokines
d. mucus
cytokines
VILI is associated with which of the following?
1. Washout or alteration of surfactant
2. Shear stress
3. Damage to pulmonary microvasculature
4. Possible release of inflammatory mediators from pulmonary cells
a. 1 only
b. 4 only
c. 1 and 3 only
d. all of the above
all of the above
During mechanical ventilation, hyperventilation, particularly in patients with COPD, can cause which of the following?
1. Muscle twitching and tetany
2. High pH values
3. Air trapping
4. Cardiac arrhythmias
a. 2 only
b. 1 and 3 only
c. 2, 3 , and 4
d. all of the above
all of the above
Reducing the WOB can be accomplished by using which of the following?
1. Increase inspiratory flowrates
2. Increase ventilatory sensitivity
3. Putting patient in the upright position
4. Ensure patency of the ETT
a. all of the above
b. 4 only
c. 1 only
d. 1, 2, and 4
all of the above
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