Question 1

Which of the following statements is NOT true regarding the use of controlled ventilation?

Accepted Answer

Controlled ventilation indeed allows the therapist significant control over inspiratory flow and pressure, contrary to the statement in option D. This control is essential for tailoring the ventilation to the patient's specific needs, such as adjusting the pressure to prevent lung injury or modifying the flow to ensure adequate oxygenation and carbon dioxide removal.

Question 2

Air-trapping is a major concern in patients with what diagnosis when using the assist-control mode?

Accepted Answer

Air-trapping is a major concern in patients with chronic obstructive pulmonary disease (COPD) when using the assist-control mode of mechanical ventilation. COPD patients have increased airway resistance and decreased lung compliance, which makes it difficult for them to exhale air properly, leading to air-trapping. The assist-control mode provides a set number of breaths and tidal volume, which can worsen air-trapping in COPD patients. Therefore, other modes such as pressure support ventilation or bi-level positive airway pressure (BiPAP) may be better options for COPD patients.

Question 3

A physician orders intubation and mechanical ventilation in the synchronized intermittent mandatory ventilation mode for a 170-lb adult man with neuromuscular disease. Which of the following initial settings would you recommend? $\quad\text { Rate } \quad\quad \underline{V_{T}}$
A. $ 8 / \mathrm{min} \quad 900 \mathrm{ml} $
B. $ 15 / \mathrm{min} \quad 1100 \mathrm{ml} $
C. $ 14 / \mathrm{min} \quad 700 \mathrm{ml} $
D. $ 16 / \mathrm{min} \quad 1000 \mathrm{ml} $

Accepted Answer

The answer of A physician orders intubation and mechanical ventilation...

Question 4

A ventilator has separate rate and V_T controls. If you set a V_T of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

Accepted Answer

The answer of A ventilator has separate rate and V_T...

Question 5

Which of the following remedies is NOT commonly used in patients ventilated in the assist-control mode with a high ventilatory drive to avoid hyperventilation?

Accepted Answer

Reducing inspiratory flow is not a common remedy for avoiding hyperventilation in patients with a high ventilatory drive in assist-control mode. Instead, other methods like using synchronized intermittent mandatory ventilation, tranquilizers, or analgesics are typically employed to manage the patient's ventilatory drive and prevent hyperventilation.

Question 6

What mode of ventilation may be most useful for ventilating a patient with a bronchopulmonary fistula?

Accepted Answer

Bronchopulmonary fistula is a condition where there is an abnormal connection between the bronchus and lung tissue, leading to air leakages. In such cases, high-frequency jet ventilation (HFJV) may be the most useful mode of ventilation. HFJV uses small tidal volumes and high respiratory rates, which may improve gas exchange and prevent further air leakage by minimizing the pressure changes in the lung during ventilation.

Question 7

In what scenario is pressure-controlled ventilation (PCV) most often used?

Accepted Answer

Pressure-controlled ventilation (PCV) is often used when there is a need to limit plateau pressure, such as in patients with acute respiratory distress syndrome (ARDS) or other conditions requiring lung protective ventilation strategies.

Question 8

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a V_T of 950 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

Accepted Answer

The answer of A ventilator has separate rate and minute...

Question 9

A physician orders intubation and mechanical ventilation in the synchronized intermittent mandatory ventilation mode for a 200-lb ideal body weight (IBW) adult man with normal lungs. Which of the following initial ventilator settings would you recommend? 
$\begin{array} { l l l } 
& \text { Rate } & V_{T}  \
\text { A. } & 8 / \min & 1100 \mathrm { ml } \
\text { B. } & 10 / \mathrm { min } & 900 \mathrm { ml } \
\text { C. } & 18 / \mathrm { min } & 800 \mathrm { ml } \
\text { D. } & 20 / \mathrm { min } & 800 \mathrm { ml }
\end{array}$

Accepted Answer

The answer of A physician orders intubation and mechanical ventilation...

Question 10

Which of the following statements is NOT true regarding the use of intermittent mandatory ventilation (IMV) or synchronized intermittent mandatory ventilation (SIMV)?

Accepted Answer

The answer of Which of the following statements is NOT...

Question 11

On a ventilator that has separate rate and minute ventilation (V_E) controls, the rate is set at 13/min and the V_E at 11 L/min. About what V_T is the patient receiving?

Accepted Answer

To calculate the minute ventilation (V_T), we can use the following formula: V_T = rate (breaths/min) x tidal volume (TV) We know that the rate is set at 13/min and we need to find TV. Using the given V_E control, we can assume that the desired minute ventilation is 11 L/min. Converting this to mL/min: 11 L/min x 1000 mL/L x 1 min/60 s = 183.3 mL/s Now, we can calculate the tidal volume: TV = minute ventilation / rate TV = 183.3 mL/s / 13/min TV = 14.1 mL/breath Rounded to the nearest 50 mL (as given in the answer choices), the patient is receiving about 850 mL/breath, which corresponds to choice letter B.

Question 12

A physician orders intubation and mechanical ventilation in the synchronized intermittent mandatory ventilation mode for a 160-lb adult man with a history of chronic obstructive pulmonary disease. Which of the following settings would you recommend? 
$\begin{array}{ll}&\text { Rate }& \underline{\mathrm{V_T}} \
A.&8 / \mathrm{min} & 700 \mathrm{ml} \
B.&10 / \mathrm{min} & 950 \mathrm{ml} \
C.&12 / \mathrm{min} & 1100 \mathrm{ml} \
D.&16 / \mathrm{min} & 700 \mathrm{ml}
\end{array}$

Accepted Answer

The answer of A physician orders intubation and mechanical ventilation...

Question 13

What mode of ventilation will automatically vary the pressure support provided as patient effort changes to maintain a "normal" work of breathing?

Accepted Answer

Proportional assist ventilation (PAV) is a mode of ventilation that uses sensors to detect changes in the patient's breathing effort and provides pressure support in proportion to that effort. This means that as the patient's effort increases, the ventilator will provide more support, and as their effort decreases, the support provided will also decrease. This helps to maintain a more "normal" work of breathing and can improve patient comfort and synchrony with the ventilator. Synchronized intermittent mandatory ventilation (A) delivers a set number of breaths at a set volume or pressure, with the option for the patient to trigger additional breaths. Volume-control continuous mandatory ventilation (C) delivers a set volume of air with each breath, regardless of the patient's effort. Assist-control volume ventilation (D) delivers a set volume of air with each breath but allows for patient-triggered breaths at that same volume.

Question 14

When a patient is initially started on mechanical ventilation common orders from the physician in the patient's chart include all the following except:

Accepted Answer

Sensitivity is not typically one of the initial settings ordered by a physician when starting a patient on mechanical ventilation. The initial orders usually include FIO2, mode, and tidal volume. Sensitivity settings are often adjusted by the respiratory therapist based on patient needs and response.

Question 15

Which of the following statements is NOT true regarding pressure-supported ventilation?

Accepted Answer

The answer of Which of the following statements is NOT...

Question 16

What mode of ventilation is most often applied to the intensive care unit patient needing mechanical ventilation?

Accepted Answer

Assist-control or synchronized intermittent mandatory ventilation (SIMV) is the most commonly used mode of ventilation in the intensive care unit (ICU) because it provides a preset volume or pressure for each breath and allows the patient to initiate breaths on their own. This means that the patient can breathe at their own rate while still receiving support when needed. Pressure-supported ventilation (A) is used for weaning patients off of mechanical ventilation, while pressure-controlled ventilation (B) is used in specific situations such as acute respiratory distress syndrome. Control mode (D) is not commonly used in the ICU as it requires constant adjustment based on patient response.

Question 17

Which of the following statements is NOT true regarding ventilation is the assist-control mode?

Accepted Answer

The statement "It is usually applied with a backup rate of 5 to 8 breaths/min" is not true for ventilation in the assist-control mode. Generally, the backup rate for this mode is set to the patient's spontaneous respiratory rate or 12-20 breaths/min, whichever is higher.

Question 18

What will most likely result if the patient ventilated in the assist-control mode develops a high ventilatory drive?

Accepted Answer

In assist-control ventilation mode, if a patient develops a high ventilatory drive, they will trigger the ventilator to deliver more breaths at the preset volume or pressure. This can lead to hyperventilation, which would cause a decrease in carbon dioxide levels in the blood, leading to respiratory alkalosis.

Question 19

A physician orders intubation and mechanical ventilation in the continuous mandatory ventilation assist-control mode for a 125-lb adult woman with normal lungs. Which of the following initial settings would you recommend? $\begin{array}{ll}&\text { Rate }&\underline{\mathrm{V}_{\mathrm{T}}}\
A.&10 / \mathrm{min} & 1000 \mathrm{ml} \
B.&12 / \mathrm{min} & 500 \mathrm{ml} \
C.&12 / \min & 1000 \mathrm{ml} \
D.&18 / \mathrm{min} & 800 \mathrm{ml}
\end{array}$

Accepted Answer

The answer of A physician orders intubation and mechanical ventilation...

Question 20

For adolescents in the 8- to 16-year-old age range, which of the following ranges of ventilator setting would you initially recommend? Rate
$\begin{array}{ll}&\text { Rate }&\underline{\mathrm{V}_{\mathrm{T}}}\
A.&8 \text { to } 12 / \mathrm{min} & 10 \text { to } 12 \mathrm{ml} / \mathrm{kg} \
B.&8 \text { to } 12 / \mathrm{min} & 8 \text { to } 10 \mathrm{ml} / \mathrm{kg} \
C.&20 \text { to } 30 / \mathrm{min} & 10 \text { to } 12 \mathrm{ml} / \mathrm{kg} \
D.&20 \text { to } 30 / \mathrm{min} & 8 \text { to } 10 \mathrm{ml} / \mathrm{kg}
\end{array}$

Accepted Answer

The answer of For adolescents in the 8- to 16-year-old...

Quiz 44: Initiating and Adjusting Ventilatory Support

Which of the following statements is NOT true regarding the use of controlled ventilation?

Air-trapping is a major concern in patients with what diagnosis when using the assist-control mode?

A ventilator has separate rate and V_T controls. If you set a V_T of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

Which of the following remedies is NOT commonly used in patients ventilated in the assist-control mode with a high ventilatory drive to avoid hyperventilation?

What mode of ventilation may be most useful for ventilating a patient with a bronchopulmonary fistula?

In what scenario is pressure-controlled ventilation (PCV) most often used?

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a V_T of 950 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

Which of the following statements is NOT true regarding the use of intermittent mandatory ventilation (IMV) or synchronized intermittent mandatory ventilation (SIMV) ?

On a ventilator that has separate rate and minute ventilation (V_E) controls, the rate is set at 13/min and the V_E at 11 L/min. About what V_T is the patient receiving?

What mode of ventilation will automatically vary the pressure support provided as patient effort changes to maintain a "normal" work of breathing?

When a patient is initially started on mechanical ventilation common orders from the physician in the patient's chart include all the following except:

Which of the following statements is NOT true regarding pressure-supported ventilation?

What mode of ventilation is most often applied to the intensive care unit patient needing mechanical ventilation?

Which of the following statements is NOT true regarding ventilation is the assist-control mode?

What will most likely result if the patient ventilated in the assist-control mode develops a high ventilatory drive?

Quiz 44: Initiating and Adjusting Ventilatory Support

Which of the following statements is NOT true regarding the use of controlled ventilation?

Air-trapping is a major concern in patients with what diagnosis when using the assist-control mode?

A ventilator has separate rate and VT controls. If you set a VT of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

Which of the following remedies is NOT commonly used in patients ventilated in the assist-control mode with a high ventilatory drive to avoid hyperventilation?

What mode of ventilation may be most useful for ventilating a patient with a bronchopulmonary fistula?

In what scenario is pressure-controlled ventilation (PCV) most often used?

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a VT of 950 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

Which of the following statements is NOT true regarding the use of intermittent mandatory ventilation (IMV) or synchronized intermittent mandatory ventilation (SIMV) ?

On a ventilator that has separate rate and minute ventilation (VE) controls, the rate is set at 13/min and the VE at 11 L/min. About what VT is the patient receiving?

What mode of ventilation will automatically vary the pressure support provided as patient effort changes to maintain a "normal" work of breathing?

When a patient is initially started on mechanical ventilation common orders from the physician in the patient's chart include all the following except:

Which of the following statements is NOT true regarding pressure-supported ventilation?

What mode of ventilation is most often applied to the intensive care unit patient needing mechanical ventilation?

Which of the following statements is NOT true regarding ventilation is the assist-control mode?

What will most likely result if the patient ventilated in the assist-control mode develops a high ventilatory drive?

A ventilator has separate rate and V_T controls. If you set a V_T of 850 ml and a respiratory rate of 12/min in the continuous mandatory ventilation mode, what will the minute ventilation be?

A ventilator has separate rate and minute ventilation controls. A physician orders continuous mandatory ventilation with a V_T of 950 ml at a respiratory rate of 12/min. What minute ventilation would you set on this ventilator?

On a ventilator that has separate rate and minute ventilation (V_E) controls, the rate is set at 13/min and the V_E at 11 L/min. About what V_T is the patient receiving?