Deck 6: Monitoring in Mechanical Ventilation

Question 1

An increase in peak pressure without a corresponding increase in plateau pressure signals which of the following?

A) Increased compliance
B) Increased airway resistance
C) Increased consolidation
D) Increased bronchodilation

Answer 1

B

Question 2

Calculate the static compliance given the following information: P_peak 42 cm H₂O, P_plat 37 cm H₂O, V_T 550 mL, PEEP +10 cm H₂O, F_IO₂ 1.0, rate 22.

A) 17.2
B) 14.9
C) 13.1
D) 20.4

Answer 2

D

Question 3

Graphical analysis shows a spike at the beginning of the pressure scalar. Adjustment of which setting will eliminate the overshoot?

A) Inspiratory time decrease
B) Peak flow increase
C) Rise time increase
D) Cycle percent decrease

Answer 3

C

Question 4

A patient in the assist-control mode has a set rate of 15 with a total rate of 26. The inspiratory volume is 450 mL and the expiratory tidal volume is 375 mL with a PEEP of +6 cm H₂O and an F_IO₂ of 0.65. The inspiratory time is set on 1.25 seconds. Which of the following is most likely to be noted upon assessment when performing ventilator monitoring?

A) Crackles at mid-inspiration
B) A 1:2 inspiratory:expiratory ratio
C) Plateau pressure exceeds peak pressure
D) Auto-PEEP present with expiratory pause

Question 5

The goal of mechanical ventilation is to:

A) normalize the pH.
B) keep the PaCO₂ at 40 mm Hg.
C) maintain the SpO₂ > 80%.
D) keep the peak pressure < 30 cm H₂O.

Question 6

A patient on mechanical ventilation with a fever has an acidotic pH with a CO₂ production of 300 mL/min. Normal CO₂ production is 200 mL/min. Which of the following should occur physiologically as CO₂ production increases?

A) The peripheral chemoreceptors induce bradypnea.
B) The kidneys eliminate more bicarbonate.
C) The minute ventilation increases.
D) The GI tract releases bicarbonate into the bloodstream.

Question 7

A 5 foot, 2 inch female patient on mechanical ventilation has an ABG that shows a pH 7.52, PaCO₂ 30 mm Hg, PaO₂ 147 mm Hg, and HCO₃⁻ 23 mEq/L on assist-control ventilation with a rate of 18/min, V_T 500 mL, F_IO₂ 0.40, and PEEP +8 cm H₂O. The total rate is 22/min. Which change will help normalize the pH?

A) Decrease the rate to 14/min.
B) Decrease V_T to 8 mL/kg.
C) Administer 1 ampule bicarbonate.
D) Administer a paralytic medication.

Question 8

ABGs on a patient show a pH 7.28, PaCO₂ 31 mm Hg, HCO₃⁻ 17 mEq/L, and PaO₂ 47 mm Hg on a nonrebreather mask. Blood sugar is 105 mg/dL and the anion gap is 16. The most likely cause of the acidosis is:

A) emesis.
B) diarrhea.
C) ketoacidosis.
D) lactic acidosis.

Question 9

A patient receiving mechanical ventilation who was initially responsive now shows no response to stimuli. The intracranial pressure is 22 mm Hg. What is the consequence of the intracranial pressure?

A) Increased cerebral perfusion
B) Enlarged cranium
C) Brain anoxia
D) Herniation of mastoids

Question 10

What hormone is released with low cardiac output that may exacerbate kidney dysfunction by decreasing urine output further?

A) Erythropoietin
B) ADH
C) TSH
D) AST

Question 11

What is the greatest concern if mechanical ventilation causes liver dysfunction?

A) Decreased drug metabolism
B) Increased first-pass effect
C) Hepatomegaly
D) Hepatitis

Question 12

If the caloric needs of a patient are not met, what is the body's protein source?

A) Conversion of glucose
B) Lipopolysaccharide
C) Skeletal muscle
D) Ketogenesis

Question 13

End-tidal capnometry following an intubation attempt is 5%. The best interpretation of this data is that the:

A) endotracheal tube cuff is not inflated.
B) endotracheal tube is in the esophagus.
C) endotracheal tube is in the mainstem bronchus.
D) endotracheal tube in the trachea.

Question 14

What is the expected capnography waveform if a beta-agonist medication has successfully reversed an airway obstruction?

A) Loss of plateau
B) Normal waveform
C) Reduced end-tidal CO₂ level
D) Gradual increase in the end-tidal CO₂ level

Question 15

A patient in the cardiovascular recovery unit has an initial capnometry reading of 22 mm Hg. Two hours later, on the same ventilator settings, the capnometer readout has increased to 38 mm Hg. What is the significance of this change?

A) Patient recovery is complete.
B) CO₂ production has increased.
C) The capnometer has warmed up.
D) The equipment is defective.

Question 16

The balloon has ruptured on a pulmonary artery catheter. Which of the following can be used to estimate the left ventricular end diastolic pressure?

A) Pulmonary artery systolic
B) Pulmonary artery diastolic
C) Systemic diastolic
D) Central venous pressure

Question 17

A patient on the ventilator remains hypoxemic despite the application of PEEP and a high F_IO₂. Which assessment finding would you expect if a hemodynamic profile were performed?

A) Decreased pulmonary vascular resistance
B) Decreased cardiac output
C) Increased right ventricular stroke work
D) Increased saturation of venous oxygen