Deck 46: Monitoring and Management of the Patient in the Intensive Care Unit

Question 1

Temporary variation in pulmonary artery pressure readings due to movement of the hemodynamic monitoring line is an example of what type of variability?

A)artifact
B)factitious event
C)physiologic variation
D)instrument drift

Answer 1

A

Question 2

Which of the following is NOT likely to cause errors in SpO₂ readings?

A)anemia
B)deeply pigmented skin
C)motion due to shivering
D)significant tachycardia

Answer 2

D

Question 3

While monitoring patients, signals, or values are susceptible to variability due to all of the following, except:

A)artifacts
B)factitious events
C)instrument drift
D)seasonal variation

Answer 3

D

Question 4

What is considered normal for the PaO₂/FIO₂ ratio?

A)greater than 50
B)greater than 150
C)greater than 250
D)greater than 400

Question 5

What is the normal range for V_DS/V_T?

A)0.10 to 0.20
B)0.20 to 0.40
C)0.30 to 0.50
D)0.40 to 0.55

Question 6

Above what value for V_DS/V_T is weaning NOT likely?

A)0.10
B)0.30
C)0.50
D)0.60

Question 7

What is the normal range for P(A-a)O₂ in a healthy 30-year-old person breathing room air?

A)0 to 10 mm Hg
B)5 to 15 mm Hg
C)10 to 20 mm Hg
D)cannot predict

Question 8

In which of the following disorders would an increased V_DS/V_T ratio not be likely?

A)congestive heart failure
B)pulmonary embolism
C)acute lung injury
D)hypothalamus tumor

Question 9

In low-perfusion patients, what site would be best for monitoring SpO₂?

A)finger
B)earlobe
C)nose
D)forehead

Question 10

What parameter is considered to be the most accurate and reliable measure of oxygenation efficiency?

A)PaO₂/FIO₂ ratio
B)P(A - a)O₂/PaO₂ ratio
C) $\dot { \mathrm { Q } } _ { s } / \dot { \mathrm { Q } } _ { t }$
D)PaO₂/SaO₂ ratio

Question 11

What is the normal approximate value for oxygen consumption?

A)150 ml/min
B)200 ml/min
C)250 ml/min
D)300 ml/min

Question 12

What is the best measure of the efficiency of gas exchange in the lung?

A)PaCO₂
B)V_DS/V_T
C)end-tidal PCO₂
D)PaCO₂/PETCO₂

Question 13

What is the normal disparity between end-tidal PCO₂ and PaCO₂?

A)End-tidal PCO₂ is 1 to 5 mm Hg less than PaCO₂
B)End-tidal PCO₂ is 5 to 10 mm Hg less than PaCO₂
C)End-tidal PCO₂ is 1 to 5 mm Hg higher than PaCO₂
D)End-tidal PCO₂ is 5 to 10 mm Hg higher than PaCO₂

Question 14

Which of the following are the reasons monitors are needed?
I)continuous assessment
II)analysis of vital signs
III)measurement of values that caregivers cannot detect

A)I only
B)I and II
C)I and III
D)I, II, and III

Question 15

You are monitoring blood pressure during mechanical ventilation of a patient with pneumonia. A temporary increase in blood pressure occurs when the patient coughs. This temporary spike in blood pressure represents what type of variability?

A)artifact
B)factitious event
C)physiologic variation
D)instrument drift

Question 16

You patient has a P(A-a)O₂ of 200 mm Hg while breathing 100% oxygen. What is the estimated percentage shunt?

A)5%
B)10%
C)20%
D)30%

Question 17

What is the best single measure of effective ventilation in the intensive care unit patient?

A)dead space-tidal volume ratio
B)PaCO₂
C)end-tidal PCO₂
D) $\dot { \mathrm { Q } } _ { s } / \dot { \mathrm { Q } } _ { t }$

Question 18

Which of the following parameters is NOT used in calculating the Murray lung injury score of a patient with acute lung injury?

A)results of chest radiograph
B)PEEP setting
C)lung compliance
D)cardiac output

Question 19

What method(s) is/are used to measure oxygen consumption?
I.Fick method
II.analysis of inspired and expired gases
III. $\dot { V } / \dot { Q }$ scans

A)I only
B)I and II
C)I and III
D)I, II, and III

Question 20

Which of the following parameters is NOT a major factor in determining tissue oxygenation?

A)arterial oxygenation
B)tissue perfusion
C)oxygen uptake
D)R/Q ratio

Question 21

Which of the following is the Raw of intubated patients receiving ventilatory support?

A)1 to 2 cm H₂O/L/sec
B)3 to 5 cm H₂O/L/sec
C)5 to 10 cm H₂O/L/sec
D)10 to 20 cm H₂O/L/sec

Question 22

What is the best parameter to measure when trying to assess respiratory muscle endurance?

A)FVC
B)MIP
C)maximum voluntary ventilation (MVV)
D)NIF

Question 23

What is the normal range for lung compliance?

A)40 to 60 ml/cm H₂O
B)60 to 100 ml/cm H₂O
C)80 to 120 ml/cm H₂O
D)100 to 120 ml/cm H₂O

Question 24

What is the normal range for the percent of oxygen consumption consumed by the respiratory muscles?

A)2% to 5%
B)5% to 10%
C)10% to 15%
D)20% to 25%

Question 25

What two parameters are most commonly used for bedside assessment of respiratory muscle strength?

A)vital capacity and maximum inspiratory pressure
B)vital capacity and peak flow
C)maximum inspiratory pressure and MVV
D)MVV and vital capacity

Question 26

Which of the following breathing patterns suggests respiratory muscle decompensation?

A)rapid and deep breaths
B)rapid and shallow breaths
C)slow and shallow breaths
D)slow and deep breaths

Question 27

Which of the following does NOT lead to an increased end-tidal PCO₂?

A)decreased effective ventilation
B)increased metabolic rate
C)decreased minute ventilation
D)exercise

Question 28

What is the normal central venous pressure reading?

A)2 to 6 mm Hg
B)5 to 12 mm Hg
C)8 to 16 mm Hg
D)12 to 22 mm Hg

Question 29

Which of the following conditions is associated with an increased lung compliance measurement?

A)atelectasis
B)pneumonia
C)emphysema
D)bronchial intubation

Question 30

Which of the following is NOT associated with auto-PEEP?

A)erroneous calculation of static lung compliance
B)hemodynamic compromise
C)barotraumas
D)effective trigger sensitivity

Question 31

Which of the following factors is not associated with an increased risk for auto-PEEP?

A)mechanical ventilation of a patient with obstructive lung disease
B)high minute volume during mechanical ventilation
C)acute respiratory distress syndrome (ARDS) patients
D)pulmonary fibrosis

Question 32

What is the upper limit for plateau airway pressure that is recommended during mechanical ventilation?

A)less than 30 cm H₂O
B)40 to 50 cm H₂O
C)60 to 80 cm H₂O
D)depends on the patient

Question 33

What is the normal range for mean arterial pressure?

A)60 to 80 mm Hg
B)50 to 100 mm Hg
C)80 to 100 mm Hg
D)90 to 120 mm Hg

Question 34

A vital capacity (VC) value below what value indicates significant muscle weakness?

A)10 to 15 ml/kg
B)20 to 25 ml/kg
C)30 to 40 ml/kg
D)50 to 60 ml/kg

Question 35

What is the normal mean pulmonary artery pressure?

A)5 mm Hg
B)10 mm Hg
C)15 mm Hg
D)20 mm Hg

Question 36

Which of the following is NOT a common purpose of using ventilator graphics?

A)to detect auto-PEEP
B)to assess effects of bronchodilators
C)to determine patient ventilator synchrony
D)to determine best FIO₂

Question 37

Which of the following is NOT associated with a decreased end-tidal PCO₂?

A)decreased metabolic rate
B)increase in lung perfusion
C)rapid and very shallow breathing
D)decreased CO₂ production

Question 38

Which of the following is NOT a cause of increased airway resistance?

A)small endotracheal tube
B)high gas flow
C)increased secretions
D)suctioning

Question 39

What is the average total work of breathing for healthy persons?

A)0.31 to 0.2 J/L
B)0.3 to 0.5 J/L
C)0.5 to 0.8 J/L
D)0.8 to 1.5 J/L

Question 40

What is the value of determining the lower inflection point during measurement of the pressure-volume curve?

A)best tidal volume
B)best PEEP level
C)to determine best airway size
D)to determine type of ventilator inspiratory flow pattern

Question 41

Which of the following should be considered first if medical and mechanical problems have been excluded and the patient continues to fight the ventilator or exhibit high levels of agitation or distress?

A)paralytics
B)sedatives
C)narcotics
D)anesthetics

Question 42

What parameter is best used to assess left ventricular afterload?

A)CVP
B)PCWP
C)SVR
D)PVR

Question 43

Which of the following is NOT a global monitoring index?

A)APACHE
B)APS
C)TISS
D)ATS

Question 44

Which of the following is NOT associated with an increase in central venous pressure?

A)right heart failure
B)pulmonary valvular stenosis
C)pulmonary embolism
D)dehydration

Question 45

At what level of intracranial pressure will venous drainage be impeded and cerebral edema develop in uninjured tissue?

A)10 to 15 mm Hg
B)20 to 30 mm Hg
C)30 to 35 mm Hg
D)40 to 45 mm Hg

Question 46

Which of the following levels of albumin are consistent with severe malnutrition?

A)less than 3.0 g/dl
B)less than 2.5 g/dl
C)less than 2.2 g/dl
D)less than 4.0 g/dl

Question 47

What is the Glasgow Coma Scale (GCS) score that requires intracranial pressure monitoring?

A)less than 8
B)less than 9
C)less than 10
D)less than 11

Question 48

Elevation of which of the following substances is consistent with hepatic inflammation?

A)aspartate aminotransferase
B)bilirubin
C)alkaline phosphatase
D)blood urea nitrogen

Question 49

What hemodynamic parameter is best useful for estimated left ventricular end-diastolic pressure?

A)CVP
B)pulmonary capillary wedge pressure (PCWP)
C)SVR
D)PVR

Question 50

What is the normal range for pulmonary capillary wedge pressure?

A)5 to 10 mm Hg
B)15 to 20 mm Hg
C)20 to 25 mm Hg
D)30 to 35 mm Hg

Question 51

What level of urine output is considered anuria?

A)less than 500 ml/day
B)less than 250 ml/day
C)less than 150 ml/day
D)less than 50 ml/day

Question 52

What medication is associated with dilated and fixed pupils in the intensive care unit patient?

A)atropine
B)lidocaine
C)vanceril
D)aminophylline

Question 53

What is the normal range for cardiac output?

A)2 to 4 L/min
B)4 to 8 L/min
C)5 to 10 L/min
D)depends on patient age

Question 54

Which of the following physical findings is NOT consistent with starvation?

A)temporal muscle wasting
B)sunken supraclavicular fossae
C)decreased adipose stores
D)less 50 ml/day

Question 55

What is the most common method of estimating GFR?

A)blood urea nitrogen
B)blood urea nitrogen and creatinine
C)plasma creatinine and creatinine clearance
D)urine output