Question 1

Which of the following restrictive thoracic diseases are successfully managed with noninvasive ventilation (NIV)?
1) Postpolio syndrome
2) Neuromuscular disease
3) Spinal cord injuries
4) Severe kyphoscoliosis

Accepted Answer

Noninvasive ventilation (NIV) is effectively used in managing restrictive thoracic diseases caused by conditions like postpolio syndrome, neuromuscular diseases, spinal cord injuries, and severe kyphoscoliosis, as these conditions impair the normal respiratory mechanics.

Question 2

Your patient has acute pulmonary edema from left heart failure. Which therapy should be tried first?

Accepted Answer

CPAP is considered by most first-line therapy for acute cardiogenic pulmonary edema.

Question 3

Which of the following are potential benefits of using noninvasive ventilation (NIV) during weaning?
1) Reduced length of intensive care unit (ICU) stay
2) Reduced incidence of nosocomial pneumonia
3) Reduced mortality rate
4) Reduced incidence of pulmonary embolism

Accepted Answer

Noninvasive ventilation (NIV) during weaning can lead to various benefits including reducing the length of intensive care unit (ICU) stay, reducing the incidence of nosocomial pneumonia, and reducing mortality rate. However, there is no evidence to suggest that it can reduce the incidence of pulmonary embolism. Therefore, options A, C, and D can be ruled out. Option B includes all the correct benefits of NIV during weaning, and thus it is the best choice.

Question 4

How does noninvasive ventilation (NIV) benefit the patient with restrictive thoracic disease? 1) It rests the respiratory muscles. 2) It lowers the PaCO_2. 3) It improves lung compliance. 4) It improves pulmonary function testing.

Accepted Answer

Noninvasive ventilation (NIV) benefits the patient with restrictive thoracic disease by resting the respiratory muscles, lowering the PaCO2, and improving lung compliance. It does not necessarily improve pulmonary function testing, therefore option D is incorrect. Option B is incorrect as it only includes lowering PaCO2 and improving pulmonary function testing but misses out on improving lung compliance and resting the respiratory muscles. Therefore, option A is the correct answer.

Question 5

Which of the following noninvasive ventilation (NIV) settings are adequate for a patient with cardiogenic pulmonary edema?

Accepted Answer

CPAP should be administered at 8 to 12 cm H₂O with 100% oxygen.

Question 6

Which of the following findings are exclusion criteria for using noninvasive ventilation (NIV) in the patient with acute respiratory failure?
1) Apnea
2) Hemodynamic or cardiac instability
3) Low risk of aspiration
4) Lack of cooperation by the patient

Accepted Answer

Apnea, hemodynamic or cardiac instability, and lack of cooperation by the patient are all exclusion criteria for using noninvasive ventilation (NIV) in the patient with acute respiratory failure. Low risk of aspiration is not an exclusion criteria for NIV. Therefore, options A, C, and D are incorrect. The best choice is B as it lists all the exclusion criteria.

Question 7

Which of the following are indications to use noninvasive ventilation (NIV) in patients who have chronic obstructive pulmonary disease (COPD) with nocturnal hypoventilation? 1) PaCO₂ greater than 55 mm Hg 2) More than two hospitalizations related to hypercapnic respiratory failure 3) PaCO₂ greater than 65 mm Hg 4) PaCO₂ between 50 and 54 mm Hg with nocturnal desaturation

Accepted Answer

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, NIV should be considered for patients with COPD and nocturnal hypoventilation if they have chronic hypercapnia (PaCO2 greater than 55 mm Hg) or a history of two or more hospitalizations for hypercapnic respiratory failure. NIV may also be considered if the patient has PaCO2 between 50 and 54 mm Hg with evidence of nocturnal desaturation. Therefore, options 1, 2, and 4 are all indications for NIV use in patients with COPD and nocturnal hypoventilation. Option 3 is incorrect because a PaCO2 greater than 65 mm Hg is not a specific indication for NIV use in this patient population.

Question 8

All of the following are goals of noninvasive ventilation (NIV) in the acute care setting, except:

Accepted Answer

Avoiding intubation and invasive positive-pressure ventilation, improving survival, decreasing the length of ventilatory support, decreasing the length of hospitalization, and decreasing the incidence of ventilator-associated pneumonia are major goals of NIV in the acute care setting (emergency department, intensive care unit, or hospital ward).

Question 9

The respiratory therapist has placed a patient on noninvasive ventilation. After 2 hr the patient showing significant improvement in her work of breathing but is experiencing nasal and oral dryness. Which of the following corrective action should be performed?

Accepted Answer

Heated humidity (approximately 30° C) should always be provided with NIV to avoid nasal symptoms, the accumulation of secretions in the back of the oral pharynx and enhance patient tolerance.

Question 10

The use of noninvasive ventilation (NIV) in the long-term care of patients with chronic obstructive pulmonary disease (COPD) will benefit the patient in which the following ways except:
1) better gas exchange.
2) improved sleep quality.
3) resetting the respiratory center to better respond to hypoxemia.
4) unloading the respiratory muscles.

Accepted Answer

NIV provides positive pressure ventilation, which helps to improve gas exchange, unload the respiratory muscles, and improve sleep quality. However, it does not reset the respiratory center to better respond to hypoxemia.

Question 11

Which of the following therapies should be considered as first line of therapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD)?

Accepted Answer

The differences in reported outcome between these studies suggest that NIV should be considered standard of care for COPD patients in an acute exacerbation and offered as first-line therapy to patients in all institutions treating the COPD patient.

Question 12

Why did the use of intermittent positive-pressure breathing decline in the 1980s?

Accepted Answer

The use of intermittent positive-pressure breathing declined significantly in the mid-1980s after a randomized, controlled trial revealed no benefit, compared to a simple small-volume nebulizer, in the treatment of patients with chronic obstructive pulmonary disease.

Question 13

Which of the following are benefits of continuous positive airway pressure (CPAP) in postoperative major abdominal surgery?
1) Lower mortality
2) Lower intubation rate
3) Lower incidence of pneumonia
4) Lower rate of sepsis

Accepted Answer

The answer of Which of the following are benefits of...

Question 14

Which of the following groups of patients with nocturnal hypoventilation respond to noninvasive ventilation (NIV)?

Accepted Answer

Patients with hypercapnic and nocturnal desaturation may be most likely to benefit from nocturnal NIV.

Question 15

Which of the following devices is considered to be the first electrically powered negative-pressure ventilator?

Accepted Answer

The first electrically powered, negative-pressure ventilator was known as the "iron lung."

Question 16

Which of the following are contraindications for the use of noninvasive ventilation (NIV)?
1) Nonsupportive family
2) Lack of financial resources
3) Copious amounts of secretions
4) Uncooperative behavior on the part of the patient

Accepted Answer

Noninvasive ventilation (NIV) contraindications include situations that compromise its effectiveness or patient safety, such as copious secretions (which can obstruct the airway or mask), and uncooperative behavior (which can prevent proper mask fitting or adherence to therapy). While nonsupportive family and lack of financial resources are not direct clinical contraindications, they can significantly impact the feasibility and successful implementation of NIV, affecting patient care and outcomes.

Question 17

Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of chronic obstructive pulmonary disease and hypercarbia. What is the goal of noninvasive ventilation in this setting with regard to the ABGs?

Accepted Answer

Noninvasive ventilation in this setting aims to reduce the PaCO2 to less than 60 mm Hg, thereby improving ventilation and reducing the risk of respiratory acidosis.

Question 18

Which of the following indications for noninvasive ventilation (NIV) is where the greatest controversy exists?

Accepted Answer

This is the indication for NIV where the greatest controversy exists.

Question 19

Which of the following is least likely to indicate the need for noninvasive ventilation (NIV) in the acute care setting?

Accepted Answer

Signs and symptoms of respiratory distress include use of accessory muscles, paradoxical breathing, a respiratory rate of 25 breaths/min or greater, and the presence of moderate to severe dyspnea.

Question 20

Which of the following groups of patients are considered at risk for reintubation?
1) Patients with APACHE 2 score greater than 12 on the day of extubation
2) Patients older than 45 years
3) Patients with congestive heart failure (CHF)
4) Patients with one or more weaning failure

Accepted Answer

Patients with higher APACHE 2 scores and CHF are known risk factors for reintubation. Patients who have previously failed a weaning attempt are also more likely to have difficulty with extubation and may require reintubation. Age alone is not a significant risk factor for reintubation.

Quiz 49: Noninvasive Ventilation

Which of the following restrictive thoracic diseases are successfully managed with noninvasive ventilation (NIV) ? 1) Postpolio syndrome 2) Neuromuscular disease 3) Spinal cord injuries 4) Severe kyphoscoliosis

Your patient has acute pulmonary edema from left heart failure. Which therapy should be tried first?

Which of the following are potential benefits of using noninvasive ventilation (NIV) during weaning? 1) Reduced length of intensive care unit (ICU) stay 2) Reduced incidence of nosocomial pneumonia 3) Reduced mortality rate 4) Reduced incidence of pulmonary embolism

How does noninvasive ventilation (NIV) benefit the patient with restrictive thoracic disease? 1) It rests the respiratory muscles. 2) It lowers the PaCO_2. 3) It improves lung compliance. 4) It improves pulmonary function testing.

Which of the following noninvasive ventilation (NIV) settings are adequate for a patient with cardiogenic pulmonary edema?

Which of the following findings are exclusion criteria for using noninvasive ventilation (NIV) in the patient with acute respiratory failure? 1) Apnea 2) Hemodynamic or cardiac instability 3) Low risk of aspiration 4) Lack of cooperation by the patient

All of the following are goals of noninvasive ventilation (NIV) in the acute care setting, except:

The respiratory therapist has placed a patient on noninvasive ventilation. After 2 hr the patient showing significant improvement in her work of breathing but is experiencing nasal and oral dryness. Which of the following corrective action should be performed?

Which of the following therapies should be considered as first line of therapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD) ?

Why did the use of intermittent positive-pressure breathing decline in the 1980s?

Which of the following are benefits of continuous positive airway pressure (CPAP) in postoperative major abdominal surgery? 1) Lower mortality 2) Lower intubation rate 3) Lower incidence of pneumonia 4) Lower rate of sepsis

Which of the following groups of patients with nocturnal hypoventilation respond to noninvasive ventilation (NIV) ?

Which of the following devices is considered to be the first electrically powered negative-pressure ventilator?

Which of the following are contraindications for the use of noninvasive ventilation (NIV) ? 1) Nonsupportive family 2) Lack of financial resources 3) Copious amounts of secretions 4) Uncooperative behavior on the part of the patient

Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of chronic obstructive pulmonary disease and hypercarbia. What is the goal of noninvasive ventilation in this setting with regard to the ABGs?

Which of the following indications for noninvasive ventilation (NIV) is where the greatest controversy exists?

Which of the following is least likely to indicate the need for noninvasive ventilation (NIV) in the acute care setting?

Which of the following groups of patients are considered at risk for reintubation? 1) Patients with APACHE 2 score greater than 12 on the day of extubation 2) Patients older than 45 years 3) Patients with congestive heart failure (CHF) 4) Patients with one or more weaning failure

Quiz 49: Noninvasive Ventilation

Which of the following restrictive thoracic diseases are successfully managed with noninvasive ventilation (NIV) ? 1) Postpolio syndrome 2) Neuromuscular disease 3) Spinal cord injuries 4) Severe kyphoscoliosis

Your patient has acute pulmonary edema from left heart failure. Which therapy should be tried first?

Which of the following are potential benefits of using noninvasive ventilation (NIV) during weaning? 1) Reduced length of intensive care unit (ICU) stay 2) Reduced incidence of nosocomial pneumonia 3) Reduced mortality rate 4) Reduced incidence of pulmonary embolism

How does noninvasive ventilation (NIV) benefit the patient with restrictive thoracic disease? 1) It rests the respiratory muscles. 2) It lowers the PaCO2. 3) It improves lung compliance. 4) It improves pulmonary function testing.

Which of the following noninvasive ventilation (NIV) settings are adequate for a patient with cardiogenic pulmonary edema?

Which of the following findings are exclusion criteria for using noninvasive ventilation (NIV) in the patient with acute respiratory failure? 1) Apnea 2) Hemodynamic or cardiac instability 3) Low risk of aspiration 4) Lack of cooperation by the patient

All of the following are goals of noninvasive ventilation (NIV) in the acute care setting, except:

The respiratory therapist has placed a patient on noninvasive ventilation. After 2 hr the patient showing significant improvement in her work of breathing but is experiencing nasal and oral dryness. Which of the following corrective action should be performed?

Which of the following therapies should be considered as first line of therapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD) ?

Why did the use of intermittent positive-pressure breathing decline in the 1980s?

Which of the following are benefits of continuous positive airway pressure (CPAP) in postoperative major abdominal surgery? 1) Lower mortality 2) Lower intubation rate 3) Lower incidence of pneumonia 4) Lower rate of sepsis

Which of the following groups of patients with nocturnal hypoventilation respond to noninvasive ventilation (NIV) ?

Which of the following devices is considered to be the first electrically powered negative-pressure ventilator?

Which of the following are contraindications for the use of noninvasive ventilation (NIV) ? 1) Nonsupportive family 2) Lack of financial resources 3) Copious amounts of secretions 4) Uncooperative behavior on the part of the patient

Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of chronic obstructive pulmonary disease and hypercarbia. What is the goal of noninvasive ventilation in this setting with regard to the ABGs?

Which of the following indications for noninvasive ventilation (NIV) is where the greatest controversy exists?

Which of the following is least likely to indicate the need for noninvasive ventilation (NIV) in the acute care setting?

Which of the following groups of patients are considered at risk for reintubation? 1) Patients with APACHE 2 score greater than 12 on the day of extubation 2) Patients older than 45 years 3) Patients with congestive heart failure (CHF) 4) Patients with one or more weaning failure

How does noninvasive ventilation (NIV) benefit the patient with restrictive thoracic disease? 1) It rests the respiratory muscles. 2) It lowers the PaCO_2. 3) It improves lung compliance. 4) It improves pulmonary function testing.