Deck 13: Improving Oxygenation and Management of Ards

Question 1

Calculate the pulmonary shunt fraction using the following data: P_b = 757 mm Hg;hemoglobin (Hb)= 11g/dL;F_IO₂ = 0.5;PaO₂ = 86 mm Hg;PaCO₂ = 40 mm Hg;SaO₂ = 91%; = 40 mm Hg; = 71%;respiratory exchange quotient (R)= 0.8.

A) 19%
B) 23%
C) 26%
D) 32%

Answer 1

19%

Question 2

An absolute contraindication to PEEP is which of the following?

A) Emphysema
B) Bronchopleural fistula
C) Untreated tension pneumothorax
D) Elevated intracranial pressures

Answer 2

Untreated tension pneumothorax

Question 3

Thirty minutes after intubation and initiation of mechanical ventilation,a patient's PaO₂ = 55 mm Hg and the F_IO₂ = 0.5.To what should the F_IO₂ be set to obtain a PaO₂ of 80 mm Hg?

A) 0.65
B) 0.75
C) 0.85
D) 0.95

Answer 3

0.75

Question 4

The most appropriate PEEP level (optimum PEEP)for the patient whose information is in the table below is which of the following?

A) 10 cm H₂O
B) 12 cm H₂O
C) 15 cm H₂O
D) 18 cm H₂O

Question 5

What is the optimal PEEP level given the following information?

A) 8 cm H₂O
B) 10 cm H₂O
C) 12 cm H₂O
D) 15 cm H₂O

Question 6

Patients with which of the following clinical disorders may benefit from PEEP?

A) COPD
B) Asthma
C) ARDS
D) Cystic fibrosis

Question 7

Assessing the outcome of PEEP at levels set above 15 to 20 cm H₂O is best done using which of the following?

A) Static compliance measurements
B) Pressure-volume loop graphics
C) Pulmonary artery occlusion pressure
D) Central venous pressure measurements

Question 8

How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?

A) 5 minutes
B) 15 minutes
C) 25 minutes
D) 40 minutes

Question 9

A patient is being ventilated with a PEEP of 10 cm H₂O and an F_IO₂ of 0.4.The arterial blood gas results show that the patient remains hypoxemic,and the respiratory therapist increases the PEEP to 18 cm H₂O,maintaining the F_IO₂ at 0.4.The patient's static compliance changes from 28 mL/cm H₂O to 22 mL/cm H₂O just after this change.The respiratory therapist should do which of the following?

A) Decrease PEEP to 10 cm H₂O and increase the F_IO₂ to 0.6.
B) Decrease PEEP to 15 cm H₂O and measure static compliance.
C) Keep PEEP at 18 cm H₂O and increase the F_IO₂ to 0.6.
D) Increase PEEP to 20 cm H₂O and measure static compliance.

Question 10

Regardless of the procedure used to establish an appropriate PEEP level,ventilating pressures should not be allowed to exceed which of the following?

A) Upper inflation point on the inspiratory limb (UIPi)
B) 2 to 3 cm H₂O above the UIPi
C) 30 cm H₂O
D) Lower inflection point on the inspiratory limb

Question 11

The level of PEEP that is most appropriate for a patient with the information shown below is which of the following?

A) 8 cm H₂O
B) 10 cm H₂O
C) 12 cm H₂O
D) 15 cm H₂O

Question 12

Calculate the pulmonary shunt fraction for a patient with the following data: P_b = 760 mm Hg;Hb = 10 g/dL;respiratory quotient = 0.8;F_IO₂ = 0.6;PaO₂ = 100 mm Hg;SaO₂ = 93%;PaCO₂ = 45 mm Hg; = 36 mm Hg; = 70%.

A) 13 %
B) 26%
C) 30 %
D) 41%

Question 13

During mechanical ventilation of a patient with CHF,the PaO₂ = 38 mm Hg and the F_IO₂ = 0.6.If the desired PaO₂ is 60 mm Hg,the F_IO₂ needs to be changed to which of the following?

A) 0.65
B) 0.75
C) 0.85
D) 0.95

Question 14

During mechanical ventilation of a patient with COPD,the PaO₂ = 58 mm Hg and the F_IO₂ = 0.5.If the desired PaO₂ is 65 mm Hg,the F_IO₂ needs to be changed to which of the following?

A) 0.44
B) 0.56
C) 0.65
D) 0.74

Question 15

Calculate the pulmonary shunt fraction for a patient with the following data: C_AO₂ = 17 vols%;CaO₂ = 16.5 vols %; = 11 vols%.

A) 8%
B) 15%
C) 30%
D) 37%

Question 16

What is the P_flex on the following pressure-volume loop?

A) 10 cm H₂O
B) 15 cm H₂O
C) 19 cm H₂O
D) 23 cm H₂O

Question 17

What is the optimal PEEP level given the following information?

A) 8 cm H₂O
B) 10 cm H₂O
C) 12 cm H₂O
D) 15 cm H₂O

Question 18

PEEP therapy is indicated for patients with which of the following?

A) PaO₂ of 95 mm Hg while receiving an F_IO₂ of 0.3
B) PaO₂ of 100 mm Hg while receiving an F_IO₂ of 0.8
C) Returned V_T of 600 mL with a P_plateau of 12 cm H₂O
D) Returned V_T of 800 mL with a P_plateau of 15 cm H₂O

Question 19

The level of applied PEEP should be set at what point on the pressure-volume curve?

A) At the upper inflection point of the inflation curve.
B) Above the lower inflection point of the deflation curve.
C) At the peak inspiration point of the inflation curve.
D) Above the upper inflection point of the deflation curve

Question 20

A patient with ARDS has the slow pressure-volume loop shown below.Based on this loop,at what level should PEEP be set?

A) 10 cm H₂O
B) 12 cm H₂O
C) 18 cm H₂O
D) 22 cm H₂O

Question 21

"Loose atelectasis," or compression atelectasis,is most often associated with _____________.

A) ALI
B) ARDS
C) anesthesia
D) pulmonary fibrosis

Question 22

The patient with which of the following assessment findings meets the criteria for beginning weaning from PEEP?

A) PaO₂ = 85 mm Hg;F_IO₂ = 0.6;C_s = 20 mL/cm H₂O;PEEP = 12 cm H₂O
B) PaO₂ = 100 mm Hg;F_IO₂ = 0.9;C_s = 22 mL/cm H₂O;PEEP = 10 cm H₂O
C) PaO₂ = 150 mm Hg;F_IO₂ = 0.7;C_s = 25 mL/cm H₂O;PEEP = 12 cm H₂O
D) PaO₂ = 95 mm Hg;F_IO₂ = 0.3;C_s = 30 mL/cm H₂O;PEEP = 15 cm H₂O

Question 23

In which ventilator mode should a patient receiving a sustained inflation technique be placed?

A) VC-CMV
B) APRV
C) PC-IMV
D) CPAP/spontaneous

Question 24

A recruitment maneuver (RM)is being performed on a patient receiving mechanical ventilation with PCV.During the maneuver the mode remains in PCV,rate = 10/min,I:E = 1:2,and PIP = 35 cm H₂O.The following information is documented during the RM: After the RM,the lungs are reinflated.At what level should the PEEP be set for this patient?

A) 12 cm H₂O
B) 17 cm H₂O
C) 22 cm H₂O
D) 27 cm H₂O

Question 25

To perform a slow-flow (quasi-static)technique for determining the appropriate PEEP level,the most appropriate ventilator flow setting is which of the following?

A) 2 L/min
B) 6 L/min
C) 10 L/min
D) 14 L/min

Question 26

The "sigmoid" shape of the static pressure-volume lung recruitment maneuver indicates which of the following?

A) All parts of the lungs open with the same pressure.
B) Independent portions of the lungs open with the same pressure.
C) Dependent portions of the lungs open with different pressures.
D) Lung units open at different times with different pressures

Question 27

Despite the risk,it is still important to use PEEP,because it can prevent alveolar collapse during exhalation and reopening,even when a low V_T is used.It now is theorized that it is important to use the pressure-volume loop to set PEEP _____________________.

A) at the upper inflection point detected during inflation of the lung
B) above the upper inflection point detected during deflation of the lung
C) at the lower inflection point detected during inflation of the lung
D) at the peak inspiration point detected during inflation of the lung

Question 28

During a patient case study,increasing increments of PEEP showed no significant effects until 15 cm H₂O was used,at which time the PaO₂ improved markedly.This represents the point at which _______________.

A) cardiac output decreased
B) airway resistance decreased
C) hemoglobin saturation improved
D) alveolar recruitment probably occurred

Question 29

The point on a static pressure-volume curve (SPV)where the alveoli begin to open is referred to as which of the following?

A) Lower inflection point on the inflation limb
B) Upper inflection point on the inflation limb
C) Upper inflection point on the deflation limb
D) Lower inflection point on the deflation limb

Question 30

The highest pressure attained during the slow-flow (quasi-static)technique should be ______ cm H₂O.

A) 25
B) 35
C) 45
D) 55