Question 1

Positive pressure ventilation has which of the following effects on the kidneys?&#10;A) Increases blood flow to the kidneys.&#10;B) Redistributes blood flow in the kidneys.&#10;C) Decreases sodium reabsorption in the kidneys.&#10;D) Increases urinary output.

Accepted Answer

PPV redistributes blood inside the kidneys,which may be an important factor in the changes that occur in kidney function.

Question 2

Malnutrition during mechanical ventilation can cause which of the following?&#10;A) Increased oxygen consumption&#10;B) Increased carbon dioxide production&#10;C) Increased work of breathing&#10;D) Decreased spontaneous ventilation

Accepted Answer

Malnutrition alters a patient's ability to respond effectively to infection.It also impairs wound healing and severely reduces the ability to maintain spontaneous ventilation because the respiratory muscles are weakened.

Question 3

Normovolemic patients experience decreases in cardiac output above what level of PEEP? A) 5 cm H₂O B) 8 cm H₂O C) 12 cm H₂O D) 15 cm H₂O

Accepted Answer

Decreases in cardiac output can occur in normovolemic patients with levels of PEEP >15 cm H₂O.

Question 4

The conditions that must exist to cause the interventricular septum to move to the left during positive pressure ventilation include which of the following? A) Volume overload B) Cardiac tamponade C) Mean airway pressure >15 cm H₂O D) Decreased coronary artery perfusion

Accepted Answer

Dilation of the RV can force the interventricular septum to move to the left.This phenomenon usually occurs when a high 11ea68f7_d6a3_5387_b0a4_751768b914eb_TB1877_11 (>15 cm H₂O)is used and the patient is volume depleted.

Question 5

Positive pressure ventilation increases splanchnic resistance,decreases splanchnic venous outflow,and may contribute to gastric mucosal ischemia.This last change contributes to which of the following?&#10;A) Liver metastases&#10;B) Tracheal malacia&#10;C) Gastric ulcers&#10;D) Increased portal blood flow

Accepted Answer

PPV increases splanchnic resistance,decreases splanchnic venous outflow,and may contribute to gastric mucosal ischemia,which can increase the risk of gastrointestinal bleeding and gastric ulcers.Both of these conditions are complications frequently seen in critically ill patients.

Question 6

An otherwise healthy 19-year-old male is currently intubated and being mechanically ventilated after a motorcycle accident in which he sustained a closed head injury and multiple rib fractures.Before the patient is taken to the operating room for cranial surgery,the respiratory therapist notices that he has jugular vein distention.The most likely cause of this problem is which of the following?

A) Increased cardiac output
B) Decreased ventricular preload
C) Increased intracranial pressure
D) Decreased systemic vascular resistance

Accepted Answer

Reduced venous return from the head increases the ICP;this can be caused by positive pressure ventilation and/or,in this case,the head trauma.Increased ICP can be observed clinically by an increase in jugular vein distention.

Question 7

Calculate the cerebral perfusion pressure when the mean arterial blood pressure is 120 mm Hg and the ICP is 14 mm Hg.&#10;A) 134 mm Hg&#10;B) 106 mm Hg&#10;C) 120/14 mm Hg&#10;D) 134/106 mm Hg

Accepted Answer

MABP - ICP = CPP.

Question 8

A patient with which of the following is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?&#10;A) ARDS&#10;B) Emphysema&#10;C) Kyphoscoliosis&#10;D) Third-degree chest wall burns

Accepted Answer

Patients with stiff lungs (as in ARDS or pulmonary fibrosis)are less likely to experience hemodynamic changes with high pressures,because less of the alveolar pressure is transmitted to the intrapleural space.Patients with compliant lungs (as in emphysema)or with stiff,noncompliant chest walls (as in kyphoscoliosis and extensive chest wall burns)are more likely to have higher intrapleural pressures with PPV and experience more pronounced cardiovascular effects.

Question 9

Mechanical ventilation has an effect on the hormone _____________,which causes a decrease in urinary output.&#10;A) cortisol&#10;B) arginine vasopressin&#10;C) parathyroid hormone&#10;D) thyroid-stimulating hormone

Accepted Answer

Several different types of hormones may influence urine output during mechanical ventilation.Specifically,these include ADH,atrial natriuretic factor,and the renin-angiotensin-aldosterone cascade.Increases in the release of ADH,also called arginine vasopressin,from the posterior pituitary can reduce urine production by inhibiting free water excretion.

Question 10

Physiological dead space may be increased in apneic patients receiving volume control ventilation by which of the following?&#10;A) I:E ratio >1:1&#10;B) A slow flow rate&#10;C) Adding an inflation hold&#10;D) Inspiratory time <0.5 sec

Accepted Answer

In an apneic patient receiving volume control ventilation,an inspiratory time that is too short (i.e. ,<0.5 sec)may result in an increase in physiological dead space.Large I:E ratios and addition of an inflation hold increase the mean airway pressure.A slow flow rate can inverse the I:E ratio and also cause an increase in mean airway pressure.

Question 11

Which of the following ventilator parameters would result in the highest mean airway pressure? A) PIP = 30 cm H₂O;PEEP = 10 cm H₂O;T_I = 0.5 sec;TCT = 5 sec B) PIP = 50 cm H₂O;PEEP = 10 cm H₂O;T_I = 0.5 sec;TCT = 5 sec C) PIP = 30 cm H₂O;PEEP = 15 cm H₂O;T_I = 0.5 sec;TCT = 5 sec D) PIP = 50 cm H₂O;PEEP = 10 cm H₂O;T_I = 0.5 sec;TCT = 5 sec..

Accepted Answer

The answer of Which of the following ventilator parameters would...

Question 12

The harmful cardiovascular effects of PPV are influenced most by which of the following pressures?&#10;A) Peak inspiratory pressure&#10;B) Mean airway pressure&#10;C) Positive end expiratory pressure&#10;D) Transpulmonary pressure

Accepted Answer

The answer of The harmful cardiovascular effects of PPV are...

Question 13

High tidal volumes and/or high levels of PEEP cause which of the following?&#10;A) Improvement in pulmonary blood flow&#10;B) Increased right ventricular afterload&#10;C) Interventricular septum shifts to the right&#10;D) Increased myocardial perfusion

Accepted Answer

The answer of High tidal volumes and/or high levels of...

Question 14

Urinary output is severely reduced when the renal arterial pressure decreases below what level?&#10;A) 75 mm Hg&#10;B) 85 mm Hg&#10;C) 95 mm Hg&#10;D) 105 mm Hg

Accepted Answer

The answer of Urinary output is severely reduced when the...

Question 15

The mode that causes the greatest reduction in cardiac output during ventilation is which of the following?&#10;A) CPAP&#10;B) SIMV&#10;C) SIMV with PEEP&#10;D) VC-CMV with PEEP

Accepted Answer

The answer of The mode that causes the greatest reduction...

Question 16

During spontaneous breathing,the fall in intrapleural pressure that draws air into the lungs during inspiration also draws blood into the major thoracic vessels.This phenomenon increases which of the following?

A) Systemic vascular resistance
B) Right ventricular afterload
C) Right ventricular preload
D) Pulmonary capillary resistance

Accepted Answer

The answer of During spontaneous breathing,the fall in intrapleural pressure...

Question 17

The most likely cause of uneven ventilation includes which of the following?&#10;A) Low set tidal volumes&#10;B) High inspiratory flow rates&#10;C) High mean airway pressures&#10;D) Elevated peak inspiratory pressures

Accepted Answer

The answer of The most likely cause of uneven ventilation...

Deck 16: Extrapulmonary Effects of Mechanical Ventilation