Deck 21: Long Term Ventilation

Question 1

One of the goals of long-term mechanical ventilation (LTMV)in the home or alternative care site is which of the following?

A) Permit lung healing
B) Reduce hospitalizations
C) Relieve respiratory distress
D) Improve pulmonary gas exchange

Answer 1

Reduce hospitalizations

Question 2

Which of the following ventilator requirements for a ventilator-assisted individual demonstrates clinical stability and indicates that the patient most likely is ready for discharge home from an acute care hospital?

A) PC-CMV,f = 14 breaths/min,PIP = 30 cm H₂O,PEEP = 10 cm H₂O,F_IO₂ = 0.5
B) VC-SIMV,f = 8 breaths/min,V_T = 400 mL,PS = 5 cm H₂O,PEEP = 5 cm H₂O,FIO₂ = 0.3
C) VC-CMV,f = 12 breaths/min,V_T = 600 mL,PEEP = 8 cm H₂O,F_IO₂ = 0.6
D) PC-IMV,f = 10 breaths/min,PIP = 25 cm H₂O,PS = 10 cm H₂O,PEEP = 10 cm H₂O,F_IO₂ = 0.8

Answer 2

VC-SIMV,f = 8 breaths/min,V_T = 400 mL,PS = 5 cm H₂O,PEEP = 5 cm H₂O,FIO₂ = 0.3

Question 3

The appropriate power source for a wheelchair-mounted ventilator is which of the following?

A) AC current
B) Pneumatic
C) Internal DC battery
D) External DC battery

Answer 3

External DC battery

Question 4

The preferred location for ventilator-dependent patients is ________________________.

A) a skilled nursing facility
B) a subacute care unit
C) their own homes
D) a long-term acute care hospital

Question 5

A VAI with amyotrophic lateral sclerosis and a TT is unable to develop clear secretions from his airway.Which of the following should be considered to manage this patient's airway clearance problem?
1)Manual chest compression and TT suctioning
2)Autogenic drainage and postural drainage
3)Positive expiratory pressure
4)Mechanical insufflation-exsufflation (MI-E)

A) 1 and 4
B) 1,2,and 3
C) 2 and 3
D) 1,2,and 4

Question 6

A patient using a negative pressure ventilator is assessed by the respiratory therapist and found to have a blood pressure of 85/40 mm Hg and a heart rate of 130 beats/min and thready.The physician orders compression stockings for the patient,but the clinical status is the same 24 hours after placement of the compression stockings.What is the most likely cause of this patient's hypotension?

A) Diarrhea
B) Dehydration
C) Septicemia
D) Abdominal blood pooling

Question 7

List the potential locations for patients requiring long-term ventilatory care in order of cost from most expensive to least expensive.
1)Patient's home
2)Long-term acute care facility
3)Intensive care or acute care unit
4)Extended care facility

A) 2,4,3,1
B) 4,1,3,2
C) 1,2,3,4
D) 3,2,4,1

Question 8

Glossopharyngeal breathing is beneficial for patients with which condition?

A) Tracheomalacia
B) Post-polio syndrome
C) Muscular dystrophy
D) Pierre-Robin syndrome

Question 9

Ventilator-associated pneumonia in VAIs is most often caused by which bacteria?

A) Staphylococcus aureus
B) Enterobacter spp.
C) Burkholderia cepacia
D) Streptococcus pneumoniae

Question 10

A patient with a TT is being discharged home with a ventilator,which he uses only during the night,without supplemental oxygen.During the day he uses a speaking valve.Which of the following equipment must he have in his home?
1)Suctioning equipment
2)Oxygen concentrator
3)Second mechanical ventilator
4)Manual resuscitator bag

A) 1 and 3
B) 1 and 4
C) 2,3,and 4
D) 1,2,3,and 4

Question 11

A patient with muscular dystrophy currently receiving ventilatory support with VC-IMV is being prepared for discharge home.The case manager asks the respiratory therapist to recommend a ventilator that will meet the patient's needs with the least complexity and at the lowest cost.The respiratory therapist should recommend which of the following ventilators?

A) PLV 102
B) LP-6 Plus
C) LTV 1000
D) Lifecare PLV 100

Question 12

The most important factors to consider when choosing a ventilator for home use include which of the following?
1)Sophistication
2)Reliability
3)Versatility
4)Cost

A) 1,2,and 4
B) 2,3,and 4
C) 1,2,and 3
D) 1 and 2

Question 13

What pressure range may be necessary to achieve a sufficient V_T using a chest cuirass?

A) -10 to -20 cm H₂O
B) -25 to -50 cm H₂O
C) -35 to -60 cm H₂O
D) -50 to -75 cm H₂O

Question 14

Which site for mechanical ventilation of patients provides the least patient independence and quality of life?

A) Intensive care unit
B) Skilled nursing facility
C) Long-term care hospital
D) Chronic assisted ventilator unit

Question 15

A patient with which condition is a suitable candidate for home care ventilation?

A) Flail chest due to trauma
B) Amyotrophic lateral sclerosis
C) Severe exacerbation of asthma
D) Acute respiratory distress syndrome

Question 16

Which of the following modes do the first-generation portable/home care ventilators use?
1)VC-CMV
2)PSV
3)VC-IMV
4)PC-IMV

A) 1 and 3
B) 2 and 4
C) 1 and 4
D) 1,2,3,and 4

Question 17

A minimum of _______ days should be allowed to obtain insurance verification and authorization and to procure equipment before a ventilated patient is transferred home from the acute care hospital.

A) 3 to 5
B) 7 to 14
C) 10 to 16
D) 21 to 30

Question 18

The American College of Chest Physicians (ACCP)considers long-term ventilator (LTV)-assisted patients to be those who require mechanical ventilation for at least _______ hours per day for _______ days or more.

A) 4;7
B) 6;14
C) 6;21
D) 8;21

Question 19

A quadriplegic patient is getting ready for discharge home from an acute care hospital.He has a TT and requires mechanical ventilation around-the-clock,but not supplemental oxygen.What equipment must he have in his home?
1)Transport ventilator
2)Manual resuscitator bag
3)E-cylinder of oxygen
4)Ventilator circuits

A) 1 and 2
B) 3 and 4
C) 1,2,and 4
D) 2 and 4

Question 20

In-hospital evaluation of ventilator-assisted infants should be performed how often for the first 2 years of life?

A) Once a month
B) Once every 2 to 3 months
C) Once every 4 to 6 months
D) Once a year

Question 21

What is the minimum pressure required to vibrate the vocal cords and produce a quality voice?

A) 1 cm H₂O
B) 2 cm H₂O
C) 3 cm H₂O
D) 4 cm H₂O

Question 22

Which of the following is an essential step the respiratory therapist must perform when setting up a speaking valve for a ventilator-assisted individual?

A) Turn up the required flow to 6 to 8 L/min.
B) Make sure the cuff is inflated before applying the valve.
C) Make sure the cuff is deflated before applying the valve
D) Place the speaking valve in a 22-mm corrugated tube.

Question 23

A VAI patient with a TT is having a trial of cuff deflation to allow for speech.The patient's voice is "weak," and he can speak only two or three words with each exhalation.The respiratory therapist could adjust which ventilator settings to improve the patient's speech?
1)Expiratory time
2)Inspiratory time
3)Volume
4)PEEP

A) 1 and 3
B) 2 and 4
C) 1 and 4
D) 2 and 3

Question 24

During an education session with the family of a ventilator-assisted individual who is being prepared for discharge home,the respiratory therapist explains ventilator circuit/suction equipment disinfection.Which of the following is an important instruction that should be part of this teaching?

A) "A white vinegar/distilled water mix can be reused as a disinfectant solution."
B) "Water for humidifiers can be taken directly from the tap."
C) "Suction catheters and plastic containers must be changed after 8 hours."
D) "Medicare will reimburse for all the disposable supplies needed for the ventilator."

Question 25

A VAI patient has expressed the desire to be able to speak.The most appropriate speaking device to use in-line with this ventilator patient is which of the following?

A) Voice TT
B) Passy-Muir
C) Portex Speaking TT
D) Pittsburgh Talking TT