Question 1

A patient is intubated due to an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD).The patient is now breathing with pressure support ventilation 5 cm H₂O and continuous positive airway pressure (CPAP)5 cm H₂O.The patient is unable to flow trigger every inspiration.Unintended positive-end-expiratory pressure (auto-PEEP)is measured at 10 cm H₂O.The most appropriate action is to take is which of the following?

Accepted Answer

Patients may have trouble triggering a breath when unintended positive-end-expiratory pressure (auto-PEEP)is present.When this occurs,adjusting the sensitivity may not alleviate the patient's inability to trigger the ventilator.When auto-PEEP occurs in mechanically ventilated,spontaneously breathing patients with airflow obstruction,setting extrinsic PEEP to a level equal to about 80% of the patient's auto-PEEP level may allow the ventilator to sense the patient's inspiratory efforts.Decreasing the extrinsic PEEP level will not alleviate this problem.Altering the pressure support or the flow trigger will not alleviate this problem.

Question 2

The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges?

Accepted Answer

The goal of selecting a specific fractional inspired oxygen (F_IO₂)for a patient is to achieve a clinically acceptable arterial oxygen tension (e.g. ,60-100 mm Hg).

Question 3

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV),a patient's average peak inspiratory pressure (PIP)is 26 cm H₂O following suctioning.The appropriate settings for the low and high pressure alarms are which of the following?

Accepted Answer

Low-pressure alarms are usually set about 5 to 10 cm H₂O below peak inspiratory pressure (PIP).High-pressure alarms are set about 10 cm H₂O above PIP.The only answer that fits both of these criteria is answer "C."

Question 4

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H₂O of unintended positive-end-expiratory pressure (auto-PEEP)and a pressure trigger setting of 2 cm H₂O?

Accepted Answer

The effort required to trigger a breath equals the sum of the auto-PEEP and the pressure trigger setting.

Question 5

A patient set up on pressure support ventilation (PSV)has an average minute volume of 5.8 L.What should the low exhaled minute volume alarm be set at?

Accepted Answer

The low exhaled minute volume alarm should be set between 10% and 15% below the average minute volume.

Question 6

The mechanical ventilator event that is considered potentially life-threatening or a level 2 event is which of the following?

Accepted Answer

Intrinsic PEEP = level 3;High respiratory rate = level 3;Humidification malfunction = level 2;Exhalation valve failure = level 1.

Question 7

Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (F_IO₂)settings?

Accepted Answer

Using a high oxygen concentration following a cardiac arrest can provide a way of restoring normal oxygenation and replacing tissue oxygen storage when oxygen debt and lactic acid accumulations occur,as with this patient.

Question 8

The ventilator volume is set at 575 mL.The low exhaled tidal volume (V_T)alarm should be set at which of the following?

Accepted Answer

The low exhaled tidal volume (V_T)alarm should be set at 10% to 15% below the set V_T.

Question 9

A patient's baseline arterial blood gas (ABG)reveals a partial pressure of oxygen (P_aO₂)of 78 mm Hg while receiving 35% supplemental oxygen.What should the ventilator fractional inspired oxygen (F_IO₂)be set at to obtain a target P_aO₂ of 95mm Hg?

Accepted Answer

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Question 10

A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity?

Accepted Answer

The humidification system used during mechanical ventilation should provide at least 30 mg H₂O/L of absolute humidity at a range of about 31° C to 35° C for all available flows up to 20 to 30 L/min.

Question 11

The respiratory therapist in the intensive care unit (ICU)responds to a patient's room because the ventilator is alarming.The most appropriate immediate action is which of the following?

Accepted Answer

When a ventilator alarm rings,the respiratory therapist must first ensure that the patient is being ventilated.If the RT doubts this,the patient should be disconnected from the ventilator and ventilated using a manual resuscitation bag.The RT should silence the alarms at that time and call for help.

Question 12

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (P_aO₂)of 45 mm Hg.The patient is being intubated and the ventilator set up.What is the appropriate fractional inspired oxygen (F_IO₂)to achieve a P_aO₂ of 60 mm Hg?

Accepted Answer

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Question 13

Identify the patient that could benefit from sigh breaths.

Accepted Answer

Mechanical ventilator sigh breaths are not recommended with higher tidal volumes (VTs > 7 mL/kg IBW)or in the presence of plateau pressures P_plateau >30 cm H₂O.Sigh breaths may be harmful to spontaneously breathing patients receiving continuous positive airway pressure (CPAP)for the treatment of hypoxemia.Therefore,only the 70 kg ideal body weight (IBW)patient on 400 mL (5.7 mL/kg)with the plateau pressure of 25 cm H₂O could benefit from sigh breaths.

Question 14

A patient is being ventilated with pressure controlled-synchronized intermittent mandatory ventilation (PC-SIMV)of 12 breaths/minute.The apnea alarm time setting should be which of the following?

Accepted Answer

Apnea alarms are usually set so the patient will not miss two consecutive machine breaths (apnea time > total cycle time [TCT] and < [TCT F1F1F1S1F1F1F10 2]).The TCT would be 5 sec/cycle [60 sec/12 breaths/min = 5 sec.] Considering that the alarm should be activated after two missed mandatory breaths,then that would be 10 seconds or 2 x TCT.

Question 15

How much pressure and time is necessary during a lung recruitment maneuver?

Accepted Answer

The recruitment maneuver used to expand collapsed areas of the lung involves using a sustained high pressure of 35 to 45 cm H₂O for 40 to 60 seconds.

Question 16

What is the range for setting flow triggering?

Accepted Answer

Flow triggering is set in a range of 1 to 10 L/min below the base flow depending on the selected ventilator.

Question 17

In which situation should the heat moisture exchanger (HME)be replaced with a heated humidification system?

Accepted Answer

If secretions appear thick after two consecutive suctioning procedures,the heat moisture exchanger (HME)should be removed and the patient switched to a heated humidification system.

Question 18

What fractional inspired oxygen (F_IO₂)setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (P_aO₂)of 53 mm Hg while receiving 50% oxygen and the desired P_aO₂ is 90 mm Hg?

Accepted Answer

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Question 19

All of the following are appropriate situations for the use of sigh or deep breaths except which?

Accepted Answer

Sigh breaths may be harmful to spontaneously breathing patients receiving continuous positive airway pressure (CPAP)for the treatment of hypoxemia.Sigh breaths are appropriate during chest physical therapy (CPT),extubation,and before and after suctioning

Question 20

Calculate the humidity deficit when a heat moisture exchanger (HME)provided 14 mg/L of water to the set tidal volume.

Accepted Answer

Humidity deficit = 44 mg/L - absolute humidity

Quiz 7: Final Considerations in Ventilator Setup

The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges?

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV) ,a patient's average peak inspiratory pressure (PIP) is 26 cm H₂O following suctioning.The appropriate settings for the low and high pressure alarms are which of the following?

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H₂O of unintended positive-end-expiratory pressure (auto-PEEP) and a pressure trigger setting of 2 cm H₂O?

A patient set up on pressure support ventilation (PSV) has an average minute volume of 5.8 L.What should the low exhaled minute volume alarm be set at?

The mechanical ventilator event that is considered potentially life-threatening or a level 2 event is which of the following?

Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (F_IO₂) settings?

The ventilator volume is set at 575 mL.The low exhaled tidal volume (V_T) alarm should be set at which of the following?

A patient's baseline arterial blood gas (ABG) reveals a partial pressure of oxygen (P_aO₂) of 78 mm Hg while receiving 35% supplemental oxygen.What should the ventilator fractional inspired oxygen (F_IO₂) be set at to obtain a target P_aO₂ of 95mm Hg?

A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity?

The respiratory therapist in the intensive care unit (ICU) responds to a patient's room because the ventilator is alarming.The most appropriate immediate action is which of the following?

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (P_aO₂) of 45 mm Hg.The patient is being intubated and the ventilator set up.What is the appropriate fractional inspired oxygen (F_IO₂) to achieve a P_aO₂ of 60 mm Hg?

Identify the patient that could benefit from sigh breaths.

A patient is being ventilated with pressure controlled-synchronized intermittent mandatory ventilation (PC-SIMV) of 12 breaths/minute.The apnea alarm time setting should be which of the following?

How much pressure and time is necessary during a lung recruitment maneuver?

What is the range for setting flow triggering?

In which situation should the heat moisture exchanger (HME) be replaced with a heated humidification system?

What fractional inspired oxygen (F_IO₂) setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (P_aO₂) of 53 mm Hg while receiving 50% oxygen and the desired P_aO₂ is 90 mm Hg?

All of the following are appropriate situations for the use of sigh or deep breaths except which?

Calculate the humidity deficit when a heat moisture exchanger (HME) provided 14 mg/L of water to the set tidal volume.

Quiz 7: Final Considerations in Ventilator Setup

The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which of the following ranges?

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV) ,a patient's average peak inspiratory pressure (PIP) is 26 cm H2O following suctioning.The appropriate settings for the low and high pressure alarms are which of the following?

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H2O of unintended positive-end-expiratory pressure (auto-PEEP) and a pressure trigger setting of 2 cm H2O?

A patient set up on pressure support ventilation (PSV) has an average minute volume of 5.8 L.What should the low exhaled minute volume alarm be set at?

The mechanical ventilator event that is considered potentially life-threatening or a level 2 event is which of the following?

Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (FIO2) settings?

The ventilator volume is set at 575 mL.The low exhaled tidal volume (VT) alarm should be set at which of the following?

A patient's baseline arterial blood gas (ABG) reveals a partial pressure of oxygen (PaO2) of 78 mm Hg while receiving 35% supplemental oxygen.What should the ventilator fractional inspired oxygen (FIO2) be set at to obtain a target PaO2 of 95mm Hg?

A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity?

The respiratory therapist in the intensive care unit (ICU) responds to a patient's room because the ventilator is alarming.The most appropriate immediate action is which of the following?

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (PaO2) of 45 mm Hg.The patient is being intubated and the ventilator set up.What is the appropriate fractional inspired oxygen (FIO2) to achieve a PaO2 of 60 mm Hg?

Identify the patient that could benefit from sigh breaths.

A patient is being ventilated with pressure controlled-synchronized intermittent mandatory ventilation (PC-SIMV) of 12 breaths/minute.The apnea alarm time setting should be which of the following?

How much pressure and time is necessary during a lung recruitment maneuver?

What is the range for setting flow triggering?

In which situation should the heat moisture exchanger (HME) be replaced with a heated humidification system?

What fractional inspired oxygen (FIO2) setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (PaO2) of 53 mm Hg while receiving 50% oxygen and the desired PaO2 is 90 mm Hg?

All of the following are appropriate situations for the use of sigh or deep breaths except which?

Calculate the humidity deficit when a heat moisture exchanger (HME) provided 14 mg/L of water to the set tidal volume.

Following intubation and placement on volume-controlled continuous mandatory ventilation (VC-CMV) ,a patient's average peak inspiratory pressure (PIP) is 26 cm H₂O following suctioning.The appropriate settings for the low and high pressure alarms are which of the following?

How much patient effort is needed to trigger a ventilator breath when there is 8 cm H₂O of unintended positive-end-expiratory pressure (auto-PEEP) and a pressure trigger setting of 2 cm H₂O?

Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (F_IO₂) settings?

The ventilator volume is set at 575 mL.The low exhaled tidal volume (V_T) alarm should be set at which of the following?

A patient's baseline arterial blood gas (ABG) reveals a partial pressure of oxygen (P_aO₂) of 78 mm Hg while receiving 35% supplemental oxygen.What should the ventilator fractional inspired oxygen (F_IO₂) be set at to obtain a target P_aO₂ of 95mm Hg?

A patient receiving 60% oxygen from an air entrainment mask has a partial pressure of oxygen (P_aO₂) of 45 mm Hg.The patient is being intubated and the ventilator set up.What is the appropriate fractional inspired oxygen (F_IO₂) to achieve a P_aO₂ of 60 mm Hg?

What fractional inspired oxygen (F_IO₂) setting should be set on the ventilator when the patient currently has a partial pressure of oxygen (P_aO₂) of 53 mm Hg while receiving 50% oxygen and the desired P_aO₂ is 90 mm Hg?