Deck 11: Weaning From Mechanical Ventilation

Question 1

Which of the following would likely delay the start weaning a patient from mechanical ventilation?

A) Frequent dysrhythmias, ventilator failure, use of 5 cm H₂O PEEP
B) Severe acidosis, ventilator failure, use of 5 cm H₂O PEEP
C) Frequent dysrhythmias, severe acidosis, ventilator failure
D) Frequent dysrhythmias, severe acidosis, use of 5 cm H₂O PEEP

Answer 1

C

Question 2

Which of the following values would be satisfactory for considering a ventilator weaning attempt on a 38-year-old patient with no history of chronic lung disease?

A) Spontaneous frequency (f) = 38/min
B) Spontaneous V_T = 6 mL/kg PBW
C) Minute ventilation = 13 L/min
D) PaCO₂ = 53 mm Hg

Answer 2

B

Question 3

The oxygenation status of a 29-year-old postoperative patient shows: PaO₂= 58 mm Hg, SaO₂ = 85%, Qs/Qt = 25%, PaO₂/F_IO₂ = 105 mm Hg, F_IO₂ = 0.55. Based on these data, the therapist should recommend to the physician that weaning:

A) should begin because three of the measurements presented are within recommended thresholds.
B) should not begin because none of the measurements presented are within recommended thresholds.
C) should begin because all of the measurements presented are within recommended thresholds.
D) should not begin because only two of the five measurements presented are within recommended thresholds.

Answer 3

B

Question 4

Which of the following sets of pulmonary measurements suggest readiness for a weaning attempt?

A) MIP = −15 cm H₂O, V_D /V_T = 44%, f/V_T = 80 breaths/min/L
B) MIP = −15 cm H₂O, V_D /V_T = 44%, static compliance = 36 mL/cm H₂O
C) MIP = −15 cm H₂O, static compliance = 36 mL/cm H₂O, f/V_T = 80 breaths/min/L
D) V_D /V_T = 44%, static compliance = 36 mL/cm H₂O, f/V_T = 80 breaths/min/L

Question 5

A mechanically ventilated patient has the following oxygen content measurements: CcO₂ = 19.8 vol%, CaO₂ = 17.9 vol %, CvO₂ = 13.7 vol%. Which one of the following is the best description of the calculated shunt?

A) 17%, mild
B) 22%, moderate
C) 31%, severe
D) 38%, significant

Question 6

The PaO₂ of a mechanically ventilated patient is 150 mm Hg on 100% oxygen. If the PAO₂ is 675 mm Hg, what is the alveolar-arterial oxygen tension gradient? What is the estimated shunt if every 50 mm Hg difference approximates 2% shunt?

A) 410 mm Hg, 12%
B) 410 mm Hg, 16%
C) 525 mm Hg, 21%
D) 525 mm Hg, 33%

Question 7

A mechanically ventilated patient has a PaO₂ of 77 mm Hg on 30% oxygen. What is the PaO₂/F_IO₂ (P/F) ratio value for this patient, and is it acceptable or unacceptable for the oxygenation criteria for ventilator weaning?

A) 25.6, acceptable
B) 25.6, unacceptable
C) 256, acceptable
D) 256, unacceptable

Question 8

The following patients were recorded from a patient receiving mechanical ventilation: corrected tidal volume = 520 mL, peak inspiratory pressure = 42 cm H₂O, plateau pressure = 29 cm H₂O, PEEP = 10 cm H₂O. What is the calculated static compliance, and is it acceptable based on the criteria for weaning?

A) 16 mL/cm H₂O, acceptable
B) 16 mL/cm H₂O, unacceptable
C) 27 mL/cm H₂O, acceptable
D) 27 mL/cm H₂O, unacceptable

Question 9

Rapid shallow breathing would most likely cause:

A) an increase static compliance.
B) a decrease of Qs/Qt.
C) an increase of V_D/V_T.
D) a decrease in PAOP.

Question 10

What would be the calculated RSBI (f/V_T) for a patient who has an average spontaneous frequency of 23/min and tidal volume of 380 mL?

A) 17 breaths /min/L
B) 61 breaths/min/L
C) 87 breaths /min/L
D) 102 breaths/min/L

Question 11

An RSBI of 91 breaths/min/L would best be interpreted by which of the following?

A) Borderline acceptable for meeting the RSBI weaning criteria threshold.
B) Easily meets the RSBI weaning criteria threshold by a comfortable margin.
C) Borderline unacceptable for meeting the RSBI weaning criteria threshold.
D) Clearly unacceptable for meeting the RSBI weaning criteria threshold by a wide margin.

Question 12

Which of the following options would be able to provide "partial" ventilatory support via providing part of a patient's minute volume requirement?

A) SIMV mode, PAV mode, ASV mode
B) SIMV mode, assist/control mode, PAV mode, ASV mode
C) SIMV mode, T-piece system, assist/control mode, PAV mode
D) T-piece system, assist/control mode, ASV mode

Question 13

A diagnostic spontaneous breathing trial should be at least _____ in duration but may go as long as ______, and this is largely determined by the clinician's evaluation of how well the patient is tolerating the SBT using objective and subjective assessments.

A) 30 minutes, 60 minutes
B) 30 minutes, 120 minutes
C) 2 hours, 3 hours
D) 2 hours, 4 hours

Question 14

Which of the following trends may be used as indicators of weaning failure?

A) Increasing V_T, decreasing PaCO₂, decreasing static compliance
B) Increasing PaCO₂, decreasing PaCO₂, decreasing static compliance
C) Increasing V_T, increasing PaCO₂, decreasing static compliance
D) Increasing V_T, increasing PaCO₂, decreasing PaCO₂

Question 15

Terminal weaning is best defined as withholding of mechanical ventilation:

A) in patients who are in a vegetative state (brain death).
B) in patients who then die as a result.
C) in patients who terminally ill.
D) that likely results in death of the patient.

Question 16

Which of the following is the best definition of success for discontinuing mechanical ventilation?

A) A successful SBT and extubation for at least 48 hours
B) Discontinuation of ventilator support with or without extubation
C) Removal from mechanical ventilation followed by extubation for at least 12 hours
D) Discontinuation of ventilator breaths for 24 hours, with or without CPAP of 5 cm H₂O

Question 17

Which of the following best describes prolonged weaning from mechanical ventilation?

A) Patients who wean from mechanical ventilation in one to two SBT attempts.
B) Patients who wean from mechanical ventilation in one to three SBT attempts.
C) Patients who fail at least three SBT attempts and require a more gradual approach.
D) Patients who wean within one to three SBT attempts but require more than a week of weaning from the first SBT attempt.

Question 18

All of the following are important actions to consider when preparing patients for a successful weaning outcome. What is the first item to consider when assessing for readiness to start the weaning process?

A) Treat any infection that may exist.
B) Achieve acceptable fluid balance.
C) Ensure hemodynamic function and stability.
D) Ensure that the reason for initiating mechanical ventilation has been adequately resolved.

Question 19

Which of the following would be options to consider to reduce the risk for reintubation during the weaning process for COPD patients and others at greater risk?

A) High-flow nasal cannula, noninvasive ventilation
B) High-flow nasal cannula, subcutaneous epinephrine injection, nebulized antibiotics
C) Noninvasive ventilation, subcutaneous epinephrine injection
D) High-flow nasal cannula, noninvasive ventilation, nebulized antibiotics

Question 20

Of the choices provided, which one is the leading cause of failure for attempts to liberate patients from mechanical ventilation?

A) Cardiomyopathy
B) Bronchospasm
C) Pulmonary edema
D) Respiratory muscle weakness

Question 21

Which of the following are potential benefits from a tracheostomy tube to enhance the weaning process?

A) Reduced mechanical dead space volume, reduced airway edema, less work of breathing, increased V̇/Q̇ matching
B) Reduced mechanical dead space volume, less work of breathing, increased V̇/Q̇ matching
C) Reduced airway edema, increased V̇/Q̇ matching
D) Reduced mechanical dead space volume, less work of breathing