Deck 45: Noninvasive Positive Pressure Ventilation

Question 1

Which of the following noninvasive positive-pressure ventilation (NPPV) settings are adequate for a patient with cardiogenic pulmonary edema?

A)continuous positive airway pressure (CPAP) at 10 to 15 cm H₂O with 100% oxygen
B)CPAP at 10 to 15 cm H₂O with 50% oxygen
C)CPAP at 8 to 12 cm H₂O with 100% oxygen
D)CPAP at 8 to 12 cm H₂O with 50% oxygen

Answer 1

C

Question 2

Which of the following groups of patients is NOT considered at risk for reintubation?

A)patients with APACHE II score greater than 12 on the day of extubation
B)patients older than 45 years
C)patients with congestive heart failure (CHF)
D)patients with one or more weaning failure

Answer 2

B

Question 3

Why did the use of intermittent positive-pressure breathing declined in the 1980s?

A)due to a lack of scientific evidence to support its use for delivering aerosolized medication
B)due to its cost of implementation
C)due to its complexity
D)replaced by newer technology

Answer 3

A

Question 4

Which of the following findings is NOT an exclusion criterion for using noninvasive positive-pressure ventilation (NPPV) in the patient with acute respiratory failure?

A)apnea
B)hemodynamic or cardiac instability
C)low risk of aspiration
D)lack of cooperation by the patient

Question 5

Which of the following are indications to use noninvasive positive-pressure ventilation (NPPV) in patients who have chronic obstructive pulmonary disease (COPD) with nocturnal hypoventilation?
I)PaCO₂ greater than 55 mm Hg
II)more than two hospitalizations related to hypercapnic respiratory failure
III)PaCO₂ greater than 65 mm Hg
IV)PaCO₂ between 50 and 54 mm Hg with nocturnal desaturation

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

Question 6

Which of the following therapies should be considered as first line of therapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD)?

A)noninvasive positive-pressure ventilation (NPPV)
B)mechanical ventilation
C)high-flow nasal cannula
D)systemic steroids

Question 7

Which of the following devices is considered to be the first electrically powered negative pressure ventilator?

A)the Bird
B)the iron lung
C)the chest cuirass
D)the rocking bed

Question 8

Which of the following are contraindications for the use of noninvasive positive-pressure ventilation (NPPV)?
I)nonsupportive family
II)lack of financial resources
III)copious amounts of secretions
IV)uncooperative behavior on the part of the patient

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

Question 9

Your patient has acute pulmonary edema from left heart failure. Which therapy should be tried first?

A)noninvasive positive-pressure ventilation (NPPV)
B)continuous positive airway pressure (CPAP)
C)mechanical ventilation
D)positive end-expiratory pressure

Question 10

Which of the following is least likely to indicate the need for noninvasive positive-pressure ventilation (NPPV) in the acute care setting?

A)paradoxical breathing
B)jugular venous distention
C)respiratory rate more than 25/min
D)use of accessory muscles

Question 11

Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of chronic obstructive pulmonary disease and hypercarbia. What is the goal of noninvasive positive-pressure ventilation in this setting with regard to the ABGs?

A)Return the PaCO₂ to 40 to 45 mm Hg.
B)Return the pH to near normal.
C)Return the PaCO₂ to less than 60 mm Hg.
D)Return the bicarbonate level to near normal.

Question 12

Which of the following indications for noninvasive positive-pressure ventilation (NPPV) is where the greatest controversy exists?

A)chronic obstructive pulmonary disease
B)pneumonia
C)hypoxemic respiratory failure
D)nocturnal hypoventilation

Question 13

Which of the following is NOT a goal of noninvasive positive-pressure ventilation (NPPV) in the acute care setting?

A)avoid intubation
B)decrease incidence of ventilation-associated pneumonia
C)decrease length of stay
D)improve mobility

Question 14

Which of the following does not predict successful use of noninvasive positive-pressure ventilation (NPPV) in the respiratory failure patient?

A)minimal air leak
B)low severity of illness
C)improvement in gas exchange within 30 minutes
D)pH = 7.20

Question 15

Which of the following is NOT a benefit of continuous positive airway pressure (CPAP) in postoperative major abdominal surgery?

A)lower mortality
B)lower intubation rate
C)lower incidence of pneumonia
D)lower rate of sepsis

Question 16

Which of the following restrictive thoracic diseases are successfully managed with noninvasive positive-pressure ventilation (NPPV)?
I)postpolio syndrome
II)neuromuscular disease
III)spinal cord injuries
IV)severe kyphoscoliosis

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

Question 17

Which of the following groups of patients with nocturnal hypoventilation respond to noninvasive positive-pressure ventilation (NPPV)?

A)hypoxic
B)hypercarbic
C)acidotic
D)hypocarbic

Question 18

How does noninvasive positive-pressure ventilation (NPPV) benefit the patient with restrictive thoracic disease?
I)rests the respiratory muscles
II)lowers the PaCO₂
III)improves lung compliance
IV)improves pulmonary function testing

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

Question 19

The use of noninvasive positive-pressure ventilation (NPPV) in the long-term care of patients with chronic obstructive pulmonary disease (COPD) will benefit the patient in all the following ways except:

A)better gas exchange
B)improved sleep quality
C)resetting the respiratory center to better respond to hypoxemia
D)unloading the respiratory muscles

Question 20

All of the following are potential benefits of using noninvasive positive-pressure ventilation (NPPV) during weaning except reduced:

A)length of intensive care unit (ICU) stay
B)incidence of nosocomial pneumonia
C)mortality rate
D)incidence of pulmonary embolism

Question 21

What strategy should be used when the patient complains of nasal congestion during the use of a nasal mask for noninvasive positive-pressure ventilation (NPPV)?

A)Switch to an oral mask.
B)Switch to a face mask.
C)Add a heated humidifier.
D)Reduce the inspiratory flow.

Question 22

Which of the following interfaces should be used in greater than 90% of the patients with hypoventilation?

A)full face mask
B)nasal mask
C)nasal pillows
D)oral mask

Question 23

Which of the following is NOT a required ventilator alarm for noninvasive positive-pressure ventilation (NPPV)?

A)loss of power
B)circuit disconnect
C)battery failure
D)blender alarm

Question 24

Which of the following interfaces that improve ventilation appears to be more tolerated?

A)nasal pillows
B)full face mask
C)nasal mask
D)oral mask

Question 25

Which level of positive end-expiratory pressure (PEEP) is necessary to prevent rebreathing of carbon dioxide?

A)1 to 3 cm H₂O
B)3 to 5 cm H₂O
C)5 to 7 cm H₂O
D)7 to 9 cm H₂O

Question 26

Which of the following is a potential risk of overtightening the straps of the mask?

A)absence of an air leak
B)tissue necrosis
C)eye irritation
D)claustrophobia

Question 27

Which of the following is the current recommendation for adding humidity while using noninvasive positive-pressure ventilation (NPPV)?

A)It is never recommended.
B)It is recommended for short-term application (less than 1 day).
C)It is recommended for long-term application (longer than 1 day).
D)It is always recommended.

Question 28

Which of the following interfaces is most commonly used to apply noninvasive positive-pressure ventilation (NPPV) in the acute setting?
I)nasal or full face mask
II)mouthpiece
III)endotracheal tube
IV)nasal pillows

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

Question 29

Which of the following ventilators is not used for noninvasive positive-pressure ventilation (NPPV)?

A)critical care
B)portable
C)noninvasive
D)negative pressure

Question 30

What mode of ventilation is most often used for noninvasive positive-pressure ventilation (NPPV) when a critical care ventilator is in use?

A)pressure support ventilation (PSV)
B)continuous positive airway pressure
C)synchronized intermittent mandatory ventilation
D)control

Question 31

Which of the following ventilators is generally only used for chronic noninvasive positive-pressure ventilation (NPPV)?

A)critical care
B)portable
C)noninvasive
D)negative pressure

Question 32

Which of the following modes is NOT commonly seen on noninvasive ventilators?

A)continuous positive airway pressure (CPAP)
B)spontaneous (pressure assist)
C)pressure assist
D)volume control

Question 33

Which of the following is the most important advantage of noninvasive ventilators over other types of ventilators?

A)cost
B)ability to trigger and cycle appropriately when small to moderate air leaks are present
C)ability to remove CO₂
D)ability to oxygenate

Question 34

Which of the following is required for noninvasive ventilators to work properly?

A)exhalation valve
B)pressure alarm
C)leak
D)blender

Question 35

Which of the following are characteristics of most noninvasive ventilators?
I)electrically powered
II)blower driven
III)microprocessor controlled
IV)double-circuit design

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

Question 36

Which of the following interfaces appear to be more efficient to improve ventilation?
I)nasal pillows
II)full face mask
III)nasal mask
IV)oral mask

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

Question 37

Compared with nasal masks, full-face masks are associated with all of the following, except:

A)increase in dead space
B)risk of aspiration
C)claustrophobia
D)hypocapnia

Question 38

Which of the following statements is NOT true about the use of home care ventilators for delivering noninvasive positive-pressure ventilation (NPPV)?

A)They operate only with pressure triggering.
B)They can operate on AC or DC power sources.
C)They can have a single-limb ventilator circuit.
D)Flow delivery pattern can be adjusted.

Question 39

Which of the following are the minimum performing characteristics of most noninvasive ventilators?
I)mandatory rate of 50 breaths/min or less
II)inspiratory pressure of 30 cm H₂O or less
III)PEEP of 15 cm H₂O or less
IV)inspiratory flow of 180 L/min or less at 20 cm H₂O

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

Question 40

Your patient is being ventilated with a common critical care ventilator using pressure support ventilation (flow cycled) with a nasal mask. A leak is present that is preventing the appropriate termination of the inspiratory cycle. What is the best response?

A)Switch to volume control mode.
B)Switch to time- cycled mode.
C)Switch to nasal pillows.
D)Switch to full face mask.

Question 41

What complication associated with noninvasive positive-pressure ventilation (NPPV) is most common?

A)aspiration
B)hypotension
C)nasal congestion
D)air leaks

Question 42

What is the best option for the patient in respiratory failure who continues to deteriorate 30 minutes after the initiation of noninvasive positive-pressure ventilation?

A)Wait another 30 minutes and monitor the patient.
B)Begin continuous positive airway pressure.
C)Intubate and begin mechanical ventilation.
D)Ventilate the patient using a bag-valve-mask.

Question 43

Initiating noninvasive positive-pressure ventilation (NPPV) can be done in the following settings, except:

A)emergency department
B)intensive care unit
C)hospital ward
D)nursing home

Question 44

Which of the following is likely to occur when decreasing the expiratory positive airway pressure in the patient being ventilated using noninvasive positive-pressure ventilation?

A)improved PaO₂
B)increased functional residual capacity
C)increased tidal volume
D)increased inspiratory positive airway pressure

Question 45

Which of the following define successful application of noninvasive positive-pressure ventilation (NPPV)?
I)overall improvement of patient's blood gas
II)normal blood gas
III)PaO₂ increased
IV)PaCO₂ decreased

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

Question 46

Which of the following techniques is NOT useful to avoid claustrophobia in the patient being ventilated by face mask?

A)Allow patient to hold the mask.
B)Increase the inspiratory flow.
C)Use sedation.
D)Use a larger mask.

Question 47

What physiologic effect will raising the expiratory positive airway pressure have in the patient receiving noninvasive positive-pressure ventilation?

A)increase the functional residual capacity
B)increase the tidal volume
C)decrease the PCO₂
D)lower the mean airway pressure

Question 48

What patient population is the only group currently accepted for the use of noninvasive positive-pressure ventilation (NPPV) in the hospital ward?

A)chronic obstructive pulmonary disease (COPD) patients with near normal pH
B)postoperative patients without pneumonia
C)no-code patients
D)asthma patients with normal SpO₂

Question 49

What is the recommended initial setting for ventilating pressure when delivering noninvasive positive-pressure ventilation in the pressure triggered timed mode?

A)2 to 5 cm H₂O
B)5 to 8 cm H₂O
C)8 to 12 cm H₂O
D)12 to 20 cm H₂O

Question 50

What is the recommended initial setting for positive end-expiratory pressure (PEEP) when delivering noninvasive positive-pressure ventilation in the pressure triggered timed mode?

A)2 to 5 cm H₂O
B)5 to 8 cm H₂O
C)8 to 12 cm H₂O
D)12 to 20 cm H₂O