Deck 14: Ventilator-Associated Pneumonia

Question 1

A patient was intubated in the emergency department just after arrival at the hospital from home.This patient develops VAP 36 hours after intubation.What type of pneumonia is this considered?

A) Early-onset VAP
B) Late-onset VAP
C) Health care-associated pneumonia
D) Non-hospital-acquired pneumonia

Answer 1

Non-hospital-acquired pneumonia

Question 2

Effective treatment of ventilator-associated pneumonia can be ensured by diagnosis based on findings from which of the following?

A) Chest radiographs
B) Hematological studies
C) Bronchial alveolar lavage
D) Patient signs and symptoms

Answer 2

Bronchial alveolar lavage

Question 3

Healthy individuals usually have which of the following bacteria in their upper airways?

A) Haemophilus sp.
B) Acinetobacter sp.
C) Pseudomonas aeruginosa
D) Staphylococcus aureus

Answer 3

Haemophilus sp.

Question 4

A patient with which of the following CPIS criteria should be placed on empiric antibiotic therapy pending the outcome of a bronchial alveolar lavage?

A) CPIS = 4
B) CPIS = 5
C) CPIS = 6
D) CPIS = 7

Question 5

The incidence of ventilator-associated pneumonia for all intubated patients is ___________.

A) 8% to 28%
B) 15% to 35%
C) 25% to 50%
D) 38% to 76%

Question 6

Sixty percent of all VAP infections are caused by which of the following?

A) Aerobic gram-negative bacilli
B) Anaerobic gram-negative bacilli
C) Aerobic gram-negative rods
D) Anaerobic gram-positive cocci

Question 7

A 63-year-old male,post head trauma,is intubated and has been mechanically ventilated for 78 hours.The respiratory therapist notes the following during ICU rounds: partial pressure of oxygen in the arteries (PaO₂)is 82 mm Hg on 60% supplemental oxygen with a positive end-expiratory pressure (PEEP)of 8 cm H₂O;static compliance is averaging 38 to 41 cm H₂O/L,breath sounds are diminished bilaterally.Bronchoalveolar lavage (BAL)results are pending,but MRSA is suspected.Chest radiograph shows bilateral,patchy infiltrates.Patient has a temperature of 38.8°C,and the most recent white blood cell (WBC)count is 11,300 $\mu$
L.The most appropriate recommendation for this patient is which of the following?

A) Monotherapy with an antipseudomonal carbepenem
B) Monotherapy with an antipseudomonal fluoroquinolone
C) Combination therapy with two types of antipseudomonal agents and vancomycin
D) Combination therapy with ampicillin/sulbactam and linezolid

Question 8

Which of the following is not a method to reduce the risk of VAP?

A) Nasally intubate whenever possible.
B) Provide intermittent nasogastric tube feedings.
C) Keep patient in a semirecumbent position.
D) Use heat/moisture exchangers when possible.

Question 9

The mortality rate for VAP depends on which of the following?
1)Length of stay on the ventilator
2)Presence of underlying disease
3)Prior antimicrobial therapy
4)Presence of a heated humidifier

A) 1 and 2 only
B) 2 and 3 only
C) 1 and 4 only
D) 1,2,3,and 4

Question 10

A pneumonia that was not incubating at the time of admission is one that develops a minimum of how many hours after admission?

A) 12 hours
B) 24 hours
C) 48 hours
D) 72 hours

Question 11

Critically ill patients receiving invasive mechanical ventilation have been found to have which of the following microorganisms not typically present in healthy individuals?

A) Anaerobes
B) Haemophilus species
C) Gram-negative bacilli
D) Viridans group of streptococci

Question 12

The mortality rate for VAP associated with prolonged hospital stays is which of the following?

A) 5% to 25%
B) 15% to 40%
C) 25% to 50%
D) 45% to 75%

Question 13

The type of organism that most often causes ventilator-acquired pneumonia is which of the following?

A) Fungi
B) Bacteria
C) Viruses
D) Protozoa

Question 14

The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with late-onset VAP is which of the following?

A) Linezolid
B) Gentamicin
C) Tobramycin
D) Ciprofloxacin

Question 15

Relying on clinical findings for the treatment of ventilator-associated pneumonia may do which of the following?

A) Decrease the morbidity of VAP.
B) Decrease the mortality of VAP.
C) Create multidrug-resistant organisms.
D) Reduce the need for invasive microbiologic procedures.

Question 16

Patients with chronic obstructive pulmonary disease (COPD)are at higher risk for infection with which of the following organisms?
1)Haemophilus influenzae
2)Pseudomonas aeruginosa
3)Moraxella catarrhalis
4)Staphylococcus aureus

A) 1 and 2 only
B) 1 and 3 only
C) 2 and 4 only
D) 3 and 4 only

Question 17

The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with early-onset VAP is which of the following?

A) Linezolid
B) Vancomycin
C) Gentamicin
D) Levofloxacin

Question 18

Reasons for the shift in oropharyngeal flora in patients receiving invasive mechanical ventilation with endotracheal tubes include which of the following?

A) Lowered pH levels
B) Increase in mucus-producing cells
C) Decreased production of proteases
D) Decreased mucosal immunoglobulin A

Question 19

The most common gram-positive bacterium that causes ventilator-associated pneumonia is which of the following?

A) Streptococcus pneumoniae
B) Enterococcus faecalis
C) Methicillin-resistant Staphylococcus aureus
D) Pseudomonas aeruginosa

Question 20

Calculate the Clinical Pulmonary Infection Score (CPIS)for a patient with the following assessments: 56-year-old female,post motor vehicle accident,intubated and mechanically ventilated for 4 days.Static compliance is 42 cm H₂O/L.Tracheobronchial suctioning reveals a moderate amount of yellow secretions;culture and sensitivity is pending.Breath sounds reveal bilateral lower lobe coarse rhonchi.Chest radiograph shows diffuse infiltrates.Partial pressure of oxygen in the arteries (PaO₂)is 72 mm Hg on 40% supplemental oxygen.Patient has a temperature of 39.2°C,and white blood cell count (WBC)is 12,800 $\mu$
L.

A) CPIS = 5
B) CPIS = 6
C) CPIS = 7
D) CPIS = 8

Question 21

The main strategy for the management of VAP focuses on which of the following?

A) Pharmacological treatment
B) Early diagnosis and treatment
C) Prophylactic antibiotic therapy
D) Reduction of host-related risk factors

Question 22

To avoid ventilator-associated pneumonia,how often should ventilator circuits be changed?

A) Every 24 hours
B) Every 48 hours
C) Once weekly
D) Not unless visibly dirty

Question 23

A "ventilator bundle" may include which of the following?
1)Keeping the head of the bed at 30 degrees from the horizontal.
2)Changing the ventilator circuits every 48 hours.
3)Using heated humidifiers whenever possible.
4)Using noninvasive positive pressure ventilation (NPPV)whenever possible.

A) 1 and 3 only
B) 1 and 4 only
C) 2 and 3 only
D) 1,2,and 4 only

Question 24

Which pathogen is commonly found in patients who had percutaneous tracheostomies?

A) Klebsiella spp.
B) Pseudomonas sp.
C) Enterobacter spp.
D) Candida albicans