Question 1

Which of the following would you assess immediately after a patient is placed on a ventilatory support device?
I.ABGs
II.patient's airway
III.patient's vital signs

Accepted Answer

After a patient is placed on a ventilatory support device, it is crucial to assess the patient's airway to ensure it is secure and not obstructed, check the arterial blood gases (ABGs) to evaluate the effectiveness of the ventilation and oxygenation, and monitor the patient's vital signs to detect any immediate adverse effects or complications from the ventilation support.

Question 2

Which of the following criteria should be met before considering use of a heat-moisture exchanger (HME) for a patient being placed on ventilatory support?
I.	There should be no problem with retained secretions.
II.	The patient should not have a fever (normothermic).
III.	The patient should be adequately hydrated.
IV.	The support should be short term (24 to 48 hours).

Accepted Answer

All the criteria listed (I, II, III, and IV) should be met before considering the use of a heat-moisture exchanger (HME) for a patient on ventilatory support. This ensures optimal function and minimizes complications.

Question 3

What limits should be initially set for high and low V_T values and/or minute volume alarms on a ventilatory support device?

Accepted Answer

Initially setting limits of ±10% to 15% for high and low V_T values and minute volume alarms allow for adequate monitoring and alerting for any significant changes in ventilation, while minimizing false alarms. Tighter limits may create too many false alarms while looser limits may not provide timely alerts for potentially dangerous changes in ventilation. However, actual limit settings may vary depending on the clinical situation and patient's needs.

Question 4

A patient receiving continuous mandatory ventilation in the assist-control mode develops auto-PEEP. Which of the following changes in ventilatory patterns would you consider to minimize the effects of auto-PEEP in this patient? I.decreasing the rate or increasing V_T II.using low-rate synchronized intermittent mandatory ventilation III.decreasing the peak inspiratory flow IV.lowering the V_T and letting the PaCO₂rise

Accepted Answer

To minimize the effects of auto-PEEP, strategies include decreasing the ventilatory rate or increasing the time for exhalation (I), using low-rate synchronized intermittent mandatory ventilation (SIMV) to allow more time for exhalation (II), and lowering the tidal volume to reduce the amount of air trapped in the lungs and allowing the partial pressure of carbon dioxide (PaCO2) to rise if necessary for patient safety (IV). Decreasing the peak inspiratory flow (III) does not directly address auto-PEEP, as it's more about the speed of delivery rather than the volume or time allowed for exhalation.

Question 5

A dehydrated, feverish patient suffering from acute bacterial pneumonia is being intubated in order to provide mechanical ventilatory support. Which of the following devices would you select to control humidification and airway temperature for this patient?

Accepted Answer

Heated wick humidifiers with servo-control are designed to accurately control the temperature and humidity of the air delivered to the patient, making them ideal for intubated patients requiring mechanical ventilation, especially when precise humidity and temperature control are necessary, such as in cases of acute bacterial pneumonia with fever and dehydration.

Question 6

A heat-moisture exchanger (HME) should be avoided in which of the following circumstances? I.patients with excessive secretions II.patients with a high FIO₂ III.patients with low body temperature

Accepted Answer

An HME should be avoided in patients with excessive secretions (I) and low body temperature (III) because it can increase the risk of airway obstruction and hypothermia, respectively.

Question 7

If available, the FIO₂ alarm should be set to what percentage?

Accepted Answer

The FIO₂ alarm should be set to ±5% to ensure proper monitoring and alerting for deviations within an acceptable range.

Question 8

A patient suffering from postoperative complications has been receiving mechanical ventilation for 6 days with a volume ventilator. A heat-moisture exchanger (HME) is providing control over humidification and airway temperature. Over the past 24 hours, the patient's secretions have decreased in quantity but are thicker and more purulent. Which of the following actions would you suggest at this time?

Accepted Answer

Switching to a heated wick humidifier is advisable because it can provide better humidification than an HME, which is important for managing thick and purulent secretions in mechanically ventilated patients.

Question 9

For which of the following patients requiring ventilatory support would you recommend against using a heat-moisture exchanger (HME) for airway humidification? I.patient whose expired V_Tis less than 70% of the delivered V_T II.patient with a spontaneous minute ventilation of 14 L/min III.patient with body temperature less than 32° C

Accepted Answer

Heat-moisture exchangers (HMEs) are contraindicated or not recommended for patients with certain conditions. These include patients whose expired tidal volume is less than 70% of the delivered tidal volume, indicating a significant leak in the system which would render HMEs ineffective. Patients with a high spontaneous minute ventilation (e.g., 14 L/min) may exceed the capacity of HMEs to adequately humidify and warm the inspired air. Lastly, patients with a body temperature less than 32°C may require active warming and humidification beyond what HMEs can provide, as maintaining body temperature and ensuring adequate humidification are critical in such hypothermic conditions.

Question 10

When using a heated humidifier during mechanical ventilation, the inspired gas temperature at the airway should be set to what level?

Accepted Answer

The inspired gas temperature at the airway should be set to 35° to 37° C when using a heated humidifier during mechanical ventilation to closely mimic the conditions of the human body's natural airway, ensuring optimal humidity and temperature for the patient's comfort and respiratory health.

Question 11

You have just placed a chronic obstructive pulmonary disease (COPD) patient on intermittent mandatory ventilation at a rate of 8/min, a V_T of 750 ml, and an FIO₂ of 0.40. To ensure proper equilibration between the alveolar and arterial gas tensions, how long should you wait before drawing a sample for measurement of the ABG?

Accepted Answer

The answer of You have just placed a chronic obstructive...

Question 12

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H₂O pressure is required to deliver the preset V_T of 950 ml. What high-pressure limit would you now set for this patient?

Accepted Answer

The high-pressure limit on a ventilator is typically set 10-20 cm H2O above the peak inspiratory pressure to allow for variation without causing frequent alarms. Since 55 cm H2O is required to deliver the preset volume, setting the high-pressure limit at 70 cm H2O provides a safe margin.

Question 13

After setting up a patient on a ventilatory support device, which of the following supplementary equipment would you require to be available at the bedside?
I.suction source and catheters
II.backup artificial airway
III.manual resuscitator with oxygen

Accepted Answer

All three options are important to have available at the bedside after setting up a patient on a ventilatory support device. A suction source and catheters are necessary for airway management and to clear secretions. A backup artificial airway is vital in case the patient's endotracheal tube or tracheostomy tube becomes dislodged or blocked. A manual resuscitator with oxygen is also necessary in case of possible ventilator failure or if the patient needs to be taken off the ventilator for a short period. Therefore, options I, II, and III are all necessary to have available.

Question 14

A patient receiving continuous mandatory ventilation in the assist-control mode develops auto-PEEP. Which of the following general approaches would you consider to minimize the effects of auto-PEEP in this patient?
I.increasing expiratory time
II.applying PEEP
III.switching ventilating mode to synchronized intermittent mandatory ventilation

Accepted Answer

The answer of A patient receiving continuous mandatory ventilation in...

Question 15

Which of the following would you initially verify in assessing the airway of a patient placed on ventilatory support?
I.cuff pressure
II.tube position
III.tube patency

Accepted Answer

In assessing the airway of a patient on ventilatory support, it is crucial to verify cuff pressure to ensure the endotracheal or tracheostomy tube is sealed properly, tube position to confirm it is placed correctly in the trachea and not dislodged, and tube patency to ensure there are no obstructions blocking air flow.

Question 16

When the therapist is initially setting the high-pressure alarm on the ventilator and the patient's plateau pressure is less than 30 cm H₂O, what should the high pressure alarm be set at?

Accepted Answer

If the plateau pressure is less than 30 cm H₂O, the high pressure limit can be adjusted to 10 to 20 cm H₂O above the peak inspiratory pressure.

Question 17

Which of the following factors influence patient-ventilator interaction?
I.artificial airway
II.trigger sensitivity
III.presence of auto-PEEP

Accepted Answer

All three factors (artificial airway, trigger sensitivity, presence of auto-PEEP) can affect patient-ventilator interaction. An artificial airway may cause discomfort and coughing, leading to asynchronous breathing patterns. Trigger sensitivity refers to the ability of the ventilator to detect the patient's respiratory effort, and if not set appropriately, it can cause delayed triggering or auto-triggering. Auto-PEEP can lead to breath stacking, increased work of breathing, and potential lung injury. Therefore, all three factors should be taken into consideration when managing mechanically ventilated patients.

Question 18

All of the following machine factors can have a major impact on adult patient-ventilator interaction except:

Accepted Answer

Tubing compliance is a machine factor that does not have a major impact on adult patient-ventilator interaction.

Question 19

Indications for delivering sigh breaths during mechanical ventilation include all of the following except which of the following?

Accepted Answer

Sigh breaths are additional breaths given at a higher volume than the regular ventilatory cycle to prevent or treat atelectasis (collapse of part of the lung). They are not specifically indicated for patients with stiff lungs, as in choice C, because in such cases, the primary concern is avoiding lung injury from overdistension, and sigh breaths could potentially exacerbate this by delivering higher volumes to already compromised lung tissue. Choices A, B, and D are situations where sigh breaths might be used to improve lung compliance and oxygenation or to counteract the effects of using small tidal volumes, which can lead to atelectasis.

Question 20

A chronic obstructive pulmonary disease (COPD) patient in respiratory failure is receiving ventilatory support in the volume-targeted intermittent mandatory ventilation mode at a rate of 6/min. You measure an auto-PEEP level of 9 cm H₂O. Which of the following would you recommend to decrease the effects of auto-PEEP in this patient?

Accepted Answer

Applying 4 to 6 cm H2O PEEP will help to decrease the effects of auto-PEEP by keeping the airways open and preventing alveolar collapse during expiration. Decreasing the rate or lowering the V_T may decrease air trapping, but it may also lead to inadequate ventilation and worsening respiratory failure. Letting the PaCO2 rise is also not recommended as this can lead to respiratory acidosis and further compromise the patient's respiratory function. Decreasing the peak inspiratory flow may also decrease air trapping, but it may also lead to inadequate ventilation and increased work of breathing for the patient.

Quiz 44: Initiating and Adjusting Ventilatory Support

Which of the following would you assess immediately after a patient is placed on a ventilatory support device? I.ABGs II.patient's airway III.patient's vital signs

What limits should be initially set for high and low VT values and/or minute volume alarms on a ventilatory support device?

A dehydrated, feverish patient suffering from acute bacterial pneumonia is being intubated in order to provide mechanical ventilatory support. Which of the following devices would you select to control humidification and airway temperature for this patient?

A heat-moisture exchanger (HME) should be avoided in which of the following circumstances? I.patients with excessive secretions II.patients with a high FIO2 III.patients with low body temperature

If available, the FIO2 alarm should be set to what percentage?

When using a heated humidifier during mechanical ventilation, the inspired gas temperature at the airway should be set to what level?

After placing a patient on a volume-cycled ventilator in the continuous mandatory ventilation assist-control mode, you note that 55 cm H2O pressure is required to deliver the preset VT of 950 ml. What high-pressure limit would you now set for this patient?

After setting up a patient on a ventilatory support device, which of the following supplementary equipment would you require to be available at the bedside? I.suction source and catheters II.backup artificial airway III.manual resuscitator with oxygen

Which of the following would you initially verify in assessing the airway of a patient placed on ventilatory support? I.cuff pressure II.tube position III.tube patency

When the therapist is initially setting the high-pressure alarm on the ventilator and the patient's plateau pressure is less than 30 cm H2O, what should the high pressure alarm be set at?

Which of the following factors influence patient-ventilator interaction? I.artificial airway II.trigger sensitivity III.presence of auto-PEEP