Deck 24: Noninvasive Positive-Pressure Ventilation

Question 1

A physician orders a patient to be placed on NPPV.The physician wants the patient to breathe spontaneously with assistance,but since the patient has frequent apneic episodes,she also wants the patient to have a back-up rate.Which mode should the practitioner recommend to the physician?

A) Spontaneous mode
B) Spontaneous/timed mode
C) Timed mode
D) CPAP mode

Answer 1

Spontaneous/timed mode

Question 2

A patient on NPPV has an increase in lung compliance.If the set pressure remains the same what will happen to the delivered Vt?

A) It will remain the same.
B) It will increase.
C) It will decrease.
D) It will remain the same if the RAW decreases at the same time.

Answer 2

It will increase.

Question 3

The post-operative patient is placed on NPPV to increase alveolar ventilation.After 4 hours the patient has arterial blood gases drawn that reveal hypoxemia and hypercarbia.Which of the following could be the cause of these arterial blood gas abnormality?

A) A proper size fitting face mask
B) A leak in the NPPV circuitry
C) A pressure sore on the patient's face
D) Too much pressure being delivered

Answer 3

A leak in the NPPV circuitry

Question 4

Which of the following is NOT an advantage of a nasal mask for NPPV?

A) Improved verbal communication
B) Decreased risk of aspiration
C) Ability to eat and drink
D) Improved humidification

Question 5

A respiratory care practitioner is asked to evaluate a patient for impending ventilatory failure.The practitioner measures a Vt of 350 ml with respiratory rate of 25/min on the patient.What should the practitioner report to the physician as the patient's actual RSBI value?

A) 1.4
B) 0.07
C) 14
D) 71.4

Question 6

The respiratory care practitioner is called to the medical intensive care unit to evaluate a pneumonia patient for impending ventilatory failure.Arterial blood gases (ABGs)are drawn and the results are as follows: PaO₂ 49 mmHg,PaCO₂ 58 mmHg,pH 7.24,HCO₃ 23 mEq/L,FIO₂ 0.6.What do the patient's ABGs indicate?

A) The patient has impending ventilatory failure.
B) The patient has normal PaO₂ status for an increased FIO₂.
C) The patient has chronic ventilatory failure.
D) The patient's RSBI needs to be measured to determine ventilatory status.

Question 7

How do patients with chronic obstructive pulmonary disease (COPD)benefit the most from noninvasive positive-pressure ventilation?

A) By increasing PaO₂ levels
B) By avoiding intubation
C) By decreasing the patient's pH
D) By extending the patient's ventilatory muscle endurance

Question 8

If the patient's airway resistance increases during NPPV,what will happen to the patient's inspiratory time?

A) Inspiratory time will increase
B) Inspiratory time will decrease
C) The inspiratory time will not change
D) The inspiratory time will decrease if the compliance increases

Question 9

Noninvasive positive-pressure ventilation has been applied the most to patients with what diagnosis?

A) Acute hypoxemic respiratory failure
B) Severe acute asthma
C) Acute exacerbation of chronic obstructive pulmonary disease
D) Acute cardiogenic pulmonary edema

Question 10

A patient is admitted to the emergency department in respiratory distress.The respiratory care practitioner utilizes a full face mask to administer NPPV.After 20 minutes of NPPV the patient exhibits signs of gastric distention.The physician is concerned about the patient vomiting and aspirating.What should the practitioner recommend to decrease the gastric distention and decrease the possibility of aspiration?

A) The patient should be placed on his side to lessen the possibility of air swallowing.
B) The practitioner should place a little force on the mask harness to maintain a good seal.
C) Reduce the pressure on the face mask and allow the positive-pressure to seal the mask.
D) A nasogastric tube should be placed to decompress the stomach and reduce the risk of aspiration.

Question 11

A patient is set up on NPPV without humidification.Which of the following should the practitioner tell the nurse are potential hazards of inadequate humidification?

A) Drying of the respiratory mucosa
B) Mucous plugging
C) Gastric insufflation
D) a and b

Question 12

Which of the following is NOT an indication for noninvasive positive-pressure ventilation (NPPV)in acute respiratory failure?

A) Community-acquired pneumonia
B) Acute cardiogenic pulmonary edema
C) Postoperative respiratory failure
D) Chronic hypoxemic respiratory failure

Question 13

A patient develops a bronchospasm during NPPV.What will happen to the delivered Vt if the set pressure remains the same?

A) It will remain the same
B) It will decrease
C) It will increase
D) The set Vt will vary inversely with the delivered Vt

Question 14

What is defined as the application of positive pressure via the upper respiratory tract for the purpose of augmenting alveolar ventilation?

A) Noninvasive positive-pressure ventilation
B) Continuous positive airway pressure
C) Expiratory positive airway pressure
D) Pressure targeted ventilation

Question 15

In acute respiratory failure,NPPV tends to cause which of the following beneficial effects for the patient?
I.Increase the PaO₂
II.Decrease the pH
III.Increase the PaCO₂
IV.Decrease HCO₃

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

Question 16

A patient complains of eye irritation and dryness.Which of the following would the practitioner NOT use to correct this problem?

A) Increase the delivered pressure
B) Use of spacers
C) Proper mask fit,
D) Correct adjustment of the headgear

Question 17

Which of the following ventilatory parameters would indicate that a patient has impending ventilatory failure?

A) A 65-kg patient with a Vt of 273 ml
B) A 62-kg patient with a minute volume of 9.1 L/min
C) A 57-kg patient with a respiratory rate of 37/min
D) A RSBI of 54

Question 18

Which of the following is NOT a sign of increased ventilatory work?

A) Accessory muscle usage
B) Respiratory rate of 18/min
C) Retractions
D) Pursed lip breathing

Question 19

A patient with COPD is placed on NPPV.The patient develops sudden shortness of breath,asymmetrical chest movement,and tracheal shift away from the side of the chest with no movement.Which of the following is the most likely cause?

A) The patient has developed hypoxemia.
B) The patient has developed atelectasis.
C) A bleb has ruptured on the patient's lung.
D) The patient is experiencing O₂ induced hypoventilation.

Question 20

The respiratory care practitioner sets up NPPV on a patient with central sleep apnea.Which of the following modes would be the most dangerous for the patient during NPPV?

A) Spontaneous/timed mode
B) Timed mode
C) Spontaneous mode
D) Assist/control

Question 21

A patient on a full face mask on noninvasive positive-pressure ventilation (NPPV)is swallowing air and having trouble exhaling due to a leak around the naso-gastric (NG)tube.What can be done?

Question 22

What can be accomplished by blocking the mask interface and placing the ventilator into the timed mode with a set rate?

A) Setting the %IPAP time
B) Testing the circuit's integrity
C) Testing the oxygen percentage
D) Determining the set rate

Question 23

What should be monitored to determine whether NPPV is meeting the patient's oxygenation requirements?

A) Blood pressure
B) Cardiac arrhythmias
C) Oxygen percentage
D) Oximetry of arterial blood gases

Question 24

In the spontaneous mode of NPPV,how long is the EPAP pressure maintained during the expiratory phase?

A) Until the ventilator senses the next spontaneous breath
B) After a set amount of time
C) Until the % EPAP time has expired
D) Until a specific volume is delivered to the patient

Question 25

In the spontaneous mode of ventilation,how is the breath from the ventilator initiated?

A) Set time
B) Patient inspiratory flow
C) Inspiratory volume
D) Manually

Question 26

A COPD patient is being ventilated on a noninvasive positive-pressure ventilation (NPPV)in the spontaneous/timed mode of ventilation.The ventilator is not triggering each time the patient attempts to initiate a breath.What can be done?

Question 27

Which of the following is another name for the peak inspiratory pressure achieved during BiPAP ventilation?

A) Expiratory positive airway pressure (EPAP)
B) Inspiratory positive airway pressure (IPAP)
C) Continuous positive airway pressure (CPAP)
D) Baseline pressure

Question 28

The respiratory care practitioner sets up a patient on NPPV in the spontaneous/timed mode due to frequent apneic episodes.To ensure that the patient receives continuous ventilation,which of the following should be set on the ventilator?

A) EPAP pressure
B) Low pressure alarm
C) %IPAP time
D) Set rate

Question 29

A patient is placed on noninvasive positive-pressure ventilation (NPPV).The patient is on a nasal mask and is having trouble keeping his mouth closed due to tachypnea and dyspnea.Breath sounds are diminished bilaterally.The patient is also complaining of nasal dryness.What should be done to help the patient?