Deck 8: Management of Mechanical Ventilation

Question 1

The PaCO₂ of a patient is 65 mm Hg. Which of the following ventilator changes would be least effective in normalizing the PaCO₂?

A) Increase the frequency.
B) Increase the tidal volume.
C) Increase the pressure support.
D) Decrease the PEEP.

Answer 1

D

Question 2

When the airway pressure gradient (∆P) is increased during the BiPAP or APRV mode of ventilation, which of the following parameters are usually increased under normal conditions?

A) Ventilation and oxygenation
B) Oxygenation and cardiac output
C) Dead space ventilation and perfusion
D) Dead space ventilation and cardiac output

Answer 2

A

Question 3

High lung compliance, insufficient peak flow, and excessive frequency or tidal volume are some conditions that may lead to:

A) respiratory acidosis and hypoxemia.
B) metabolic alkalosis and hypoxemia.
C) air trapping and auto-PEEP.
D) pneumothorax and cardiomegaly.

Answer 3

C

Question 4

The severe acidosis associated with permissive hypercapnia should be managed by the following alkalizing agent because it directly reduces the H⁺ ion concentration and indirectly reduces the CO₂ level.

A) Bicarbonate
B) Calcium chloride
C) Tromethamine (THAM)
D) Sodium carbonate

Question 5

The PaO₂ of a mechanically ventilated patient is 50 mm Hg. Which of the following changes is least effective to increase the PaO₂?

A) Increase FIO₂.
B) Increase frequency.
C) Increase PEEP.
D) Increase CPAP.

Question 6

A spontaneously breathing patient has the following arterial blood gas results: pH 7.33, PaCO₂ 52 mm Hg, PaO₂ 56 mm Hg, F_IO₂ 60%. The best action to normalize the blood gas results is:

A) increase F_IO₂.
B) initiate CPAP.
C) initiate mechanical ventilation and pressure support.
D) initiate mechanical ventilation and PEEP.

Question 7

For a mechanically ventilated patient with simple venous admixture, hypoxemia may be managed by increasing the:

A) F_IO₂.
B) frequency.
C) PEEP.
D) CPAP.

Question 8

A mechanically ventilated patient has a PaO₂ of 50 mm Hg on an F_IO₂ of 0.60. The chest radiographs over the past 12 hours show worsening bilateral infiltrates. The patient's oxygenation status should be managed by using the:

A) CPAP.
B) frequency.
C) F_IO₂.
D) PEEP.

Question 9

Based on the ARDSNet initial settings for ARDS, the frequency and tidal volume should be set for a target plateau pressure of:

A) < 25 cm H₂O.
B) < 30 cm H₂O.
C) < 35 cm H₂O.
D) < 40 cm H₂O.

Question 10

The initial high pressure alarm should be set at:

A) the same level as the plateau pressure.
B) 5 cm H₂O above the plateau pressure.
C) 10 cm H₂O above the peak inspiratory pressure.
D) 15 cm H₂O above the positive end-expiratory pressure.

Question 11

The physiologic basis of implementing prone positioning for a patient is to improve:

A) V/Q matching.
B) lung functions.
C) stroke volume and cardiac output.
D) tolerance to hypoxia.

Question 12

Tracheal gas insufflation (TGI) can be used as an adjunctive method for lung protection because this procedure reduces the need for:

A) PEEP or CPAP.
B) high frequency.
C) permissive hypercapnia.
D) high tidal volume.

Question 13

Which of the following is a noninvasive cough-assist technique that uses adjustable pressures during a respiratory cycle?

A) Tracheal gas insufflation
B) Bilevel positive airway pressure
C) Mechanical insufflation-exsufflation
D) Airway pressure release ventilation

Question 14

Decremental recruitment maneuver includes

A) determination of optimal PEEP and recruitment.
B) sedation, determination of optimal PEEP, and recruitment.
C) initial recruitment, determination of optimal PEEP, and final recruitment.
D) sedation, initial recruitment, determination of optimal PEEP, and final recruitment.

Question 15

Positive pressure ventilation (PPV) with PEEP may be beneficial to patients with heart failure because a combination of PPV and PEEP reduces myocardial work by the following sequential outcomes.

A) Increase intrathoracic pressure, decrease right atrial pressure, decrease pressure gradient between vena cava and right atrium, decrease cardiac output
B) Increase intrathoracic pressure, increase right atrial pressure, decrease pressure gradient between vena cava and right atrium, decrease cardiac output
C) Increase intrathoracic pressure, increase right atrial pressure, increase pressure gradient between vena cava and right atrium, decrease cardiac output
D) Decrease intrathoracic pressure, decrease right atrial pressure, increase pressure gradient between vena cava and right atrium, increase cardiac output

Question 16

When air trapping occurs during noninvasive positive pressure ventilation or mechanical ventilation, the most effective strategy is to reduce the:

A) frequency or tidal volume.
B) flow or tidal volume.
C) PEEP or frequency.
D) PEEP or flow.

Question 17

The START (Simple Triage and Rapid Treatment) and JumpSTART protocols are used to quickly assess patients:

A) in the ICU.
B) in the emergency department.
C) on the site of a mass casualty incident.
D) during ground or air transport.

Question 18

During a mass casualty incident, what tool should be used to determine and allocate the limited resources available in the hospital to those who are most likely to survive?

A) Sequential Organ Failure Assessment (SOFA)
B) Simple Triage and Rapid Treatment (START)
C) Jump Simple Triage and Rapid Treatment (JumpSTART)
D) Acute Physiology and Chronic Health Evaluation (APACHE II)

Question 19

A patient arrives at the emergency department with severe carbon monoxide poisoning. The critical care specialist should obtain an arterial blood gas sample and analyze it with a:

A) blood gas analyzer.
B) co-oximeter.
C) pulse oximeter.
D) carbon monoxide monitor.