Question 1

What patients are at high risk for postextubation upper airway obstruction?
1) Those with neuromuscular disorders
2) Those who have had major neck surgery
3) Those with infectious masses or abscesses
A)2 and 3 only
B)1 and 2 only
C)1 and 3 only
D)1, 2, and 3

Accepted Answer

Patients with neuromuscular disorders, those who have had major neck surgery, and those with infectious masses or abscesses are all at high risk for postextubation upper airway obstruction due to potential airway compromise or weakened airway structures.

Question 2

Which of the following cardiovascular changes would you consider a bad sign during weaning a patient from ventilatory support?
A) Development of chest pain
B) Increase in both stroke volume and cardiac index
C) Increase in heart rate from 95 to 110/min
D) Fall in blood pressure from 143/95 to 126/88 mm Hg

Accepted Answer

The development of chest pain during weaning from ventilatory support indicates a possible ischemia or angina, which is a bad sign that the patient may not be ready to wean from the ventilator. All other options can be normal or expected during weaning.

Question 3

While monitoring a patient during a T tube weaning trial, you notice the following: increased patient agitation; increased heart rate (from 90 to 118/min); increased respiratory rate (from 17 to 33/min with some paradoxical motion); and premature ventricular contractions (PVCs) increasing to an average of 5/min. Which of the following actions would be appropriate at this time?
A) Reconnect the patient to the ventilator with prior settings.
B) Encourage the patient to relax, and continue careful monitoring.
C) Request that the patient be given a stat (immediate) bolus of lidocaine.
D) Request that the patient be given a strong sedative or hypnotic.

Accepted Answer

The patient is showing signs of respiratory distress and cardiac compromise, with an increase in heart rate and respiratory rate, as well as PVCs. These symptoms may indicate that the patient is not ready for T tube weaning and needs to be reconnected to the ventilator with prior settings to support their breathing and prevent further complications. Encouraging the patient to relax and careful monitoring may not be enough to address the worsening symptoms. Requesting a bolus of lidocaine or strong sedative/hypnotic is not appropriate without further assessment and consultation with a physician.

Question 4

In considering a patient for endotracheal tube extubation, which of the following procedures would you recommend to determine the risk of postextubation upper airway obstruction?
A) Methylene blue test
B) Pre- and postbronchodilator
C) Cuff leak test
D) Forced vital capacity

Accepted Answer

The cuff leak test is recommended to detect airway obstruction before extubation.

Question 5

What is the best way to decrease the work of breathing imposed by an artificial airway on a patient receiving ventilatory support?
A) Provide pressure support.
B) Decrease inspiratory flow.
C) Lower the minute ventilation.
D) Use low rates of breathing.

Accepted Answer

Pressure support ventilation can be very effective in overcoming this imposed work.

Question 6

While monitoring a patient being weaned through a T tube protocol, signs indicating that mechanical ventilation should be restored include which of the following?
1) Development of cardiac arrhythmias
2) Asynchronous or paradoxical breathing
3) Development of severe hypotension
4) Moderate rise in respiratory rate
A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Accepted Answer

Signs indicating the need to restore mechanical ventilation during a T tube weaning trial include the development of cardiac arrhythmias, asynchronous or paradoxical breathing, and severe hypotension. These conditions suggest the patient is not tolerating the weaning process well and requires additional respiratory support.

Question 7

Which of the following are useful strategies in managing the psychological problems encountered in weaning some patients from ventilator support?
1) Secure a psychiatric consult.
2) Decrease environmental stress.
3) Avoid mental stimulation.
4) Teach relaxation methods.
A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2 and 3 only

Accepted Answer

Securing a psychiatric consult can be helpful in managing psychological problems encountered during weaning from ventilator support. Decreasing environmental stress, such as providing a quiet and peaceful environment, can also be beneficial. Teaching relaxation methods like deep breathing and progressive muscle relaxation can help reduce anxiety and promote calmness. Avoiding mental stimulation, however, may not be a useful strategy as patients may benefit from activities that promote cognitive stimulation and engagement. Therefore, options 2 and 4 are useful strategies while option 3 is not.

Question 8

Which of the following are advantages of using pressure-supported ventilation for weaning? 1) Guaranteed V_T 2) Reduced work of breathing 3) Respiratory muscle fatigue prevented 4) Better patient comfort and synchrony A)1 and 3 only B)1, 2, and 3 only C)3 and 4 only D)2, 3, and 4 only

Accepted Answer

Pressure-supported ventilation provides support during the inspiratory phase of breathing, reducing the work of breathing and preventing respiratory muscle fatigue. This improves patient comfort and synchrony. However, it does not guarantee V_T as other factors such as oxygenation and hemodynamics should also be considered during weaning. Therefore, options 1 and 4 are not correct. Option 2 is correct, as it reduces the work of breathing. Option 3 is correct, as it prevents respiratory muscle fatigue. Option D includes all correct options.

Question 9

Which of the following is false about artificial tracheal airways and weaning? A) There are decreases in tube inner diameter (ID) and increases in V_E increase the work of breathing. B) The added work due to artificial airways can increase ventilator dependence. C) Artificial airways can increase the work of breathing nearly three-fold. D) Tracheostomy tubes increase the work of breathing more than can endotracheal tubes.

Accepted Answer

The presence of an artificial airway may increase airway resistance nearly three-fold, although some evidence calls into question the assumption that breathing through an endotracheal tube offers a greater work of breathing than does breathing through a natural airway postextubation. In a study with 14 successfully extubated patients, at the end of a 2-hr spontaneous breathing trial, there was no difference in work of breathing before and after extubation.

Question 10

In an effort to determine a patient's need for ventilatory support, which of the following factors increase(s) ventilatory workload?
1) Decreased lung compliance
2) Decreased thoracic compliance
3) Increased airway resistance
4) Artificial airways
A)1 only
B)1 and 2 only
C)1, 2, and 3 only
D)1, 2, 3, and 4

Accepted Answer

Decreased lung compliance, decreased thoracic compliance, and increased airway resistance all increase the effort required for breathing, thus increasing ventilatory workload. Artificial airways can also increase the workload by adding resistance or by being improperly sized or positioned.

Question 11

Which of the following are disadvantages of using the T tube method for weaning?
1) More staff time required
2) Abrupt transition sometimes difficult
3) High imposed work of breathing
4) Lack of alarm systems
A)1 and 3 only
B)1, 2, and 4 only
C)3 and 4 only
D)2 and 4 only

Accepted Answer

The T tube method for weaning from mechanical ventilation has several disadvantages, including requiring more staff time due to the need for close monitoring, the potential difficulty of an abrupt transition for some patients, and the lack of alarm systems which can alert staff to patient distress or equipment malfunction.

Question 12

While monitoring a patient during a T tube weaning trial, you notice the following: an increase in heart rate from 86 to 100/min; an increase in respiratory rate from 12 to 23/min; an increase in PaCO₂from 39 to 45 mm Hg; and a decrease in PaO₂from 82 to 73 mm Hg. Which of the following actions would be appropriate at this time? A) Reconnect the patient to the ventilator with prior settings. B) Request that the patient be administered a mild sedative. C) Suction the patient after manual hyperinflation or oxygenation. D) Encourage the patient to relax, and continue careful monitoring.

Accepted Answer

The patient is experiencing respiratory distress, as evidenced by the increase in heart rate, respiratory rate, PaCO2, and decrease in PaO2. The appropriate action at this time is to encourage the patient to relax and continue careful monitoring.

Question 13

Which of the following are disadvantages of using intermittent mandatory ventilation for weaning?
1) Potentially high work of breathing
2) Weaning time possibly prolonged
3) Patient-ventilator asynchrony
4) Higher mean airway pressures
A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Accepted Answer

1) Potentially high work of breathing: In intermittent mandatory ventilation, patients have to initiate their own breaths during the weaning process. If the patient has a high work of breathing, they may struggle to initiate these breaths, leading to respiratory distress.
2) Weaning time possibly prolonged: Due to the patient having to initiate their own breaths, weaning may take longer as the patient's respiratory muscles may tire.
3) Patient-ventilator asynchrony: When the patient initiates a breath, it may not coincide with the ventilator's next mandatory breath, leading to asynchrony, which can cause patient discomfort and prolong weaning.
Therefore, options 1, 2, and 3 are all disadvantages of using intermittent mandatory ventilation for weaning, making option B the correct answer.

Question 14

Which of the following patients are at high risk for severe laryngeal edema after an endotracheal tube extubation?
1) Pediatric burn victim
2) Patient with epiglottitis
3) Smoke inhalation patient
4) Pulmonary fibrosis patient
A)2 and 4 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Accepted Answer

Pediatric burn victims, patients with epiglottitis, and smoke inhalation patients are at high risk for severe laryngeal edema after an endotracheal tube extubation. Pulmonary fibrosis patients are not specifically at high risk for this complication.

Question 15

A patient whom you are trying to wean below 5 cm H₂O pressure support develops respiratory muscle fatigue. Which of the following would you recommend to overcome this problem? 1) Make sure there is adequate O₂ transport or cardiac output. 2) Make sure that the patient is adequately nourished. 3) Check and replace any depleted electrolytes. 4) Clear secretions and provide bronchodilation. A)2 and 4 only B)1, 2, and 3 only C)3 and 4 only D)1, 2, 3, and 4

Accepted Answer

All of the options listed are important in addressing respiratory muscle fatigue. Ensuring adequate oxygen transport or cardiac output (1), adequate nutrition (2), and checking/replacing depleted electrolytes (3) are all supportive measures that can help improve the overall status of the patient's respiratory muscles. Additionally, clearing secretions and providing bronchodilation (4) can directly improve the work of breathing and reduce the demand on the respiratory muscles. Therefore, the best choice is D - all of the above options.

Question 16

Which of the following changes can be expected when weaning a patient through a T tube trial? 1) Increase in respiratory rate of 10/min 2) Increase in heart rate of 15 to 20/min 3) 5 to 10 mm Hg rise in the arterial PCO₂ 4) Doubling of the minute ventilation A)2 and 4 only B)1, 2, and 3 only C)3 and 4 only D)1, 2, 3, and 4

Accepted Answer

During a T tube trial, the patient's spontaneous breathing efforts are evaluated in preparation for weaning off mechanical ventilation. The increase in respiratory rate (option 1) and heart rate (option 2) are common changes due to the increased work of breathing. A slight increase in arterial PCO2 (option 3) may occur as the patient adjusts to the new respiratory effort. However, a doubling of the minute ventilation (option 4) is not expected and may indicate failure of the T tube trial. Therefore, options 1, 2, and 3 are expected changes during a T tube trial, while option 4 is not. The correct answer is B.

Question 17

What are some factors that indicate a patient's readiness for extubation?
1) Adequate oxygenation or ventilation with spontaneous breathing
2) Minimal risk for upper airway obstruction
3) Adequate airway protection or minimal aspiration risk
4) Adequate clearance of pulmonary secretions
A)2 and 4 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Accepted Answer

All of the factors listed are important in determining a patient's readiness for extubation. Adequate oxygenation and ventilation with spontaneous breathing means the patient is able to maintain their airway without the support of the ventilator. Minimal risk for upper airway obstruction means the patient's airway is patent and not at risk for obstruction. Adequate airway protection or minimal aspiration risk means the patient is able to protect their airway and reduce the risk of aspirating. Adequate clearance of pulmonary secretions means the patient is able to clear their lungs of secretions which reduces the risk of respiratory complications post-extubation.

Question 18

Who should make the decisions related to terminal weaning?
A) Patient
B) Patient's family and patient's physician
C) Nurse
D) Respiratory therapist

Accepted Answer

The decision should be made by the family in consultation with the patient's physician and in accordance with established ethical and legal guidelines.

Question 19

Which factors lead to the development of computer-based weaning protocols?
1) Respiratory therapists are unable to successfully wean most patients using protocols.
2) Computer-based weaning protocols are relatively easy to develop.
3) Weaning is time-consuming.
4) Weaning is a labor-intensive process.
A)3 only
B)1, 2, and 3 only
C)2, 3, and 4 only
D)1, 2, 3, and 4

Accepted Answer

The answer of Which factors lead to the development of...

Question 20

The physician has requested that the respiratory therapist determine a patient's rapid shallow breathing index (RSBI) before placing the patient on PSV. The patient has a respiratory rate of 32/min and VT of 300 ml. What is the patient's RSBI?
A) 107
B) 110
C) 112
D) 114

Accepted Answer

The answer of The physician has requested that the respiratory...

Quiz 52: Discontinuing Ventilatory Support

What patients are at high risk for postextubation upper airway obstruction? 1) Those with neuromuscular disorders 2) Those who have had major neck surgery 3) Those with infectious masses or abscesses

Which of the following cardiovascular changes would you consider a bad sign during weaning a patient from ventilatory support?

In considering a patient for endotracheal tube extubation, which of the following procedures would you recommend to determine the risk of postextubation upper airway obstruction?

What is the best way to decrease the work of breathing imposed by an artificial airway on a patient receiving ventilatory support?

Which of the following are useful strategies in managing the psychological problems encountered in weaning some patients from ventilator support? 1) Secure a psychiatric consult. 2) Decrease environmental stress. 3) Avoid mental stimulation. 4) Teach relaxation methods.

Which of the following are advantages of using pressure-supported ventilation for weaning? 1) Guaranteed VT 2) Reduced work of breathing 3) Respiratory muscle fatigue prevented 4) Better patient comfort and synchrony

Which of the following is false about artificial tracheal airways and weaning?

In an effort to determine a patient's need for ventilatory support, which of the following factors increase(s) ventilatory workload? 1) Decreased lung compliance 2) Decreased thoracic compliance 3) Increased airway resistance 4) Artificial airways

Which of the following are disadvantages of using the T tube method for weaning? 1) More staff time required 2) Abrupt transition sometimes difficult 3) High imposed work of breathing 4) Lack of alarm systems

Which of the following are disadvantages of using intermittent mandatory ventilation for weaning? 1) Potentially high work of breathing 2) Weaning time possibly prolonged 3) Patient-ventilator asynchrony 4) Higher mean airway pressures

Which of the following patients are at high risk for severe laryngeal edema after an endotracheal tube extubation? 1) Pediatric burn victim 2) Patient with epiglottitis 3) Smoke inhalation patient 4) Pulmonary fibrosis patient

Which of the following changes can be expected when weaning a patient through a T tube trial? 1) Increase in respiratory rate of 10/min 2) Increase in heart rate of 15 to 20/min 3) 5 to 10 mm Hg rise in the arterial PCO2 4) Doubling of the minute ventilation

What are some factors that indicate a patient's readiness for extubation? 1) Adequate oxygenation or ventilation with spontaneous breathing 2) Minimal risk for upper airway obstruction 3) Adequate airway protection or minimal aspiration risk 4) Adequate clearance of pulmonary secretions

Who should make the decisions related to terminal weaning?

The physician has requested that the respiratory therapist determine a patient's rapid shallow breathing index (RSBI) before placing the patient on PSV. The patient has a respiratory rate of 32/min and VT of 300 ml. What is the patient's RSBI?

Which of the following are advantages of using pressure-supported ventilation for weaning? 1) Guaranteed V_T 2) Reduced work of breathing 3) Respiratory muscle fatigue prevented 4) Better patient comfort and synchrony

Which of the following changes can be expected when weaning a patient through a T tube trial? 1) Increase in respiratory rate of 10/min 2) Increase in heart rate of 15 to 20/min 3) 5 to 10 mm Hg rise in the arterial PCO₂ 4) Doubling of the minute ventilation