Deck 5: Initiation of Mechanical Ventilation

Question 1

Which of the following breathing patterns is the most common sign of ventilatory failure associated with increased work of breathing and fatigue of respiratory muscles?

A) Increased respiratory frequency with an increased tidal volume
B) Increased respiratory frequency with a decreased tidal volume
C) Decreased respiratory frequency with an increased tidal volume
D) Cheyne-Stokes breathing with a variable tidal volume

Answer 1

B

Question 2

Which of the following is the absolute contraindication to mechanical ventilation?

A) Cardiogenic shock
B) Smoke inhalation
C) Tension pneumothorax
D) Near drowning.

Answer 2

C

Question 3

Which of the following suggests the presence of acute respiratory failure and the need for ventilatory support?
I) MIP of −16 cm H₂O
II) VC of 2.2 L for a 70-kg man
III) PaCO₂ of 80 mm Hg and pH of 7.19
IV) PaO₂ of 65 mm Hg on room air

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

Answer 3

A

Question 4

A patient admitted to the emergency department with unknown history has the following blood gas results on room air: pH = 7.23, PaCO₂ = 80 mm Hg, HCO₃⁻ = 33 mEq/L, PaO₂ = 43 mm Hg, and SaO₂ = 72%. With no other data available, which of the following forms of therapy is indicated?

A) Oxygen with a nonrebreathing mask
B) CPAP mask
C) IPPB treatment with albuterol
D) Mechanical ventilatory support

Question 5

A 32-year-old woman is seen in the emergency department. She demonstrates paralysis of the lower extremities that is progressively worsening. After several hours, during which she was monitored frequently, her VC has decreased to 12 mL/kg and MIP is −29 cm H₂O. The results of blood gas evaluations are not yet available. What type of therapy is most likely needed?

A) Bronchodilator via metered-dose inhaler
B) Mechanical ventilatory support
C) Incentive spirometry to improve muscle strength
D) Opioid reversal agent

Question 6

A 27-year-old man with food poisoning is beginning to develop progressive paralysis. The respiratory therapist has been monitoring the patient's MIP and VC every 2 hours. The most recent results show that the patient continues to deteriorate: MIP = −17 cm H₂O, VC = 31 mL/kg. Which of the following could be appropriately recommended?

A) Gastric lavage
B) Oxygen therapy
C) Medication to reverse the paralysis
D) Mechanical ventilatory support

Question 7

A 36-year-old man is taken to the emergency department after a motorcycle accident. He is unconscious and unresponsive. ABGs obtained while the patient is receiving oxygen via a nonrebreathing mask show the following: PaO₂ = 48 mm Hg, PaCO₂ = 90 mm Hg, pH = 7.10, and HCO₃⁻ = 27 mEq/L. Which of the following would the therapist recommend?

A) Recheck vital signs
B) Intubate and ventilate
C) Change to a Venturi mask and coach the patient to breathe
D) Begin cardiopulmonary resuscitation (CPR)

Question 8

A 66-year-old man in the emergency department has a history of COPD and CO₂ retention. He is conscious and cooperative but in distress, and receiving oxygen by nasal cannula at 2 L/min. He is breathing in a tripod position and using accessory muscles. His vitals are: heart rate = 102 beats/min, blood pressure = 127/77 mm Hg, temperature = 37.5°C, respiratory frequency = 20 breaths/min with prolonged expiration and using pursed lip-breathing. Bilateral sounds with crackles and wheezing. Which of the following is most appropriate?

A) Change to a Venturi mask and coach the patient to breathe.
B) Intubate and ventilate.
C) Change to a nonrebreather mask.
D) Evaluate for NIV.

Question 9

A 45-year-old man who weighs 166 lbs (75.5 kg) and has myasthenia gravis is beginning to develop progressive weakness of the muscles. The respiratory care practitioner has been monitoring MIP and VC every 4 hours. The most recent results show that the patient continues to deteriorate despite treatment with anticholinesterase drugs: MIP = −35 cm H₂O, VC = 23 mL/kg. Which of the following would be appropriate to recommend?

A) Incentive spirometry to improve muscle strength
B) Oxygen therapy
C) Mechanical ventilatory support
D) Administer a neuromuscular blocking agent

Question 10

A 50-year-old woman admitted to the emergency department demonstrates tachypnea, tachycardia, and appears pale. Breath sounds reveal bilateral crackles. ABG results with the patient using a nonrebreathing mask are as follows: PaO₂ = 48 mm Hg, PaCO₂ = 32 mm Hg, pH = 7.49, and HCO₃⁻ = 23 mEq/L. Which of the following is the most appropriate initial treatment for this patient?

A) Increase the oxygen mask flow rate.
B) Begin mechanical ventilation.
C) Provide CPAP by mask.
D) Administer inhaled steroid therapy.

Question 11

A 62-year-old man was admitted for a suspected myocardial infarction. Current ABG values on room air are as follows: PaO₂ = 56 mm Hg, PaCO₂ = 34 mm Hg, pH = 7.47, and HCO₃⁻ = 26 mEq/L. Which of the following is the most appropriate form of respiratory therapy for this patient?

A) Oxygen therapy
B) Noninvasive mechanical ventilation
C) He/O₂ therapy (80/20)
D) CPAP by mask

Question 12

Which of the following are goals of mechanical ventilation?
I) Provide breaths to maintain an adequate level of alveolar ventilation
II) Reduce patient work of breathing until the cause of respiratory failure can be remedied.
III) Restore arterial blood gas levels to normal
IV) Increase immune response

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

Question 13

A 72-year-old patient with COPD who has acute-on-chronic respiratory failure is supported with noninvasive ventilation. The patient is becoming more confused. Blood gas values are as follows: PaO₂ = 46 mm Hg, PaCO₂ = 57 mm Hg, pH = 7.22, and HCO₃⁻ = 22 mEq/L. Which of the following would be appropriate treatment for this patient?

A) Increase oxygen delivery.
B) Ask the patient if he is comfortable with the mask.
C) Ask the physician for a sedative.
D) Intubate and switch to invasive ventilation.

Question 14

Acute ventilatory failure is specifically _________, whereas respiratory insufficiency could be inadequate lung function with either hypoxia or hypercapnia.

A) inadequate CO₂ removal
B) abnormally low CO₂
C) inadequate oxygen delivery
D) oxygen toxicity

Question 15

A patient with sudden onset of hypoxemia, hypercapnia, and a normal bicarbonate value also has a normal P_(A-a)O₂ value. This would most likely be due to which one of the following?

A) Hypoxemic respiratory failure
B) Hypercapnic respiratory failure
C) Intrapulmonary shunting
D) Both hypoxemic and hypercapnic respiratory failure

Question 16

A 31-year-old motor vehicle accident victim is admitted to the hospital with crushed chest injuries and a fractured leg. Two days later the patient's PaO₂ is 55 mm Hg while breathing 85% oxygen, and the respiratory rate is 34 breaths/min. Based on the history and these findings, which of the following does the patient most likely need?

A) Invasive ventilation
B) Noninvasive ventilation
C) 100% oxygen
D) CPAP with oxygen

Question 17

Which of the following arterial blood gas parameters is considered the best indicator of a patient's ventilatory status?

A) Arterial pH
B) PaCO₂
C) PaO₂
D) SaO₂

Question 18

A sudden increase in the PaCO₂ to 53 mm Hg accompanied by a pH of 7.24 is best described as which of the following?

A) Acute respiratory failure
B) Chronic respiratory failure
C) Acute on chronic respiratory failure
D) Increased work of breathing

Question 19

The critical care team for patient safety and quality improvement wants to ensure that newly published national guidelines for initiating mechanical ventilation are implemented as quickly as possible by staff on all shifts. Which of the following would likely yield the best results?

A) Mandatory in-service attendance
B) Updated evidence-based ventilator protocol
C) Online training with continuing education credit
D) Pocket-sized summaries of the new guidelines

Question 20

A combination of pressure-limited breaths with a volume target is called:

A) BiPAP
B) Bilevel
C) Dual mode
D) Pressure-control ventilation with pressure support breaths