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RCP 500

ADVANCED RESPIRATORY THERAPY

TEST 2, UNITS 4 & 5            &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;         NAME___________= _________________

OCTOBER 13, 2008

 

ANSWER THE FOLLOWING MULITPLE CHOICE QUESTIONS ON THE = ANSWER SHEET PROVIDED.  (2 PTS)

 

1.         = You are ventilating a patient with a volume-targeted mode.  If the patient’s lung compli= ance would decrease you would see:

 

= I.      =              an increase in the peak pressure

= II.      =           an increase in the pause pressure

= III.      =        an increase in the airways resistance

= IV.      =        a decrease in the delivered tidal volume

 

= A)    II only

= B)    I and II

= C)    II and IV

= D)    I, II and III

 

2.         = You are ventilating a patient in a pressure-targeted mode.  If the patient’s airways resistance increased you would see;

 

= I.      =              an increase in peak pressure

= II.      =           a decrease in delivered tidal volume

= III.      =        an increase in inspiratory time

= IV.      =        a decrease in pause pressure

 

= A)    II only

= B)    II and III

= C)    I, II and IV

= D)    I, III and IV

 

3.         = You are asked to initiate mechanical ventilation on a post-surgical male patient who is 5’11” and weighs 180 pounds.  You decide to use volume-targeted ventilation.  What would you s= elect as an initial tidal volume?

 

= A)    200 ml

= B)    500 ml

= C)    800 ml

= D)    1200 ml

 

4.   &n= bsp;     For most adult patients peak inspiratory flow rates should be:

 

= A)    10-20 lpm

= B)    20-40 lpm

= C)    40-80 lpm

= D)    60-100 lpm

 

 

 

5.         = Patients with which of the following disease processes will typically need a longer expiratory time when being mechanically ventilated?

 

= I.      =              ARDS

= II.      =           Asthma

= III.      =        COPD

= IV.      =        Pulmonary fibrosis

 

= A)    I and II

= B)    II and III

= C)    I, III and IV

= D)    II, III and IV

 

6.   &n= bsp;     Which of the following ventilator changes will increase MAP?       

 

= I.      =              increase mechanical rate from 12 to 14

= II.      =           increase tidal volume from 700 ml to 900 ml

= III.      =        change oxygen percentage from 40% to 50%

= IV.      =        change from Assist Control rate of 12 to SIMV mode = rate of 10

 

= A)    I and II

= B)    I and IV

= C)    I, II and IV

= D)    II, III and IV

 

7.   &n= bsp;     A patient is changed from a CPAP of 6 cm H2O to a CPAP of 8 cm H2O.  The mean airway pressure:

 

= A)    would change from 6 to 8

= B)    would change from 8 to 6

= C)    would stay at 4

= D)    would change to 14

 

8.   &n= bsp;     Mechanical ventilation will:

 

= I.      =              increase ADH production

= II.      =           increase blood flow to the kidney

= III.      =        redistribute blood flow to areas of the kidneys that are least effective at removing fluid

 

= A)    I only

= B)    II only

= C)    I and III

= D)    II and III

 

 

 

 

 

 

 

 

 

9.         = A patient is currently being mechanically ventilated in a pressure-targeted mode.  The patient’s lung compliance decreases significantly.  What would you expect to happen to arterial blood gases?

 

= I.      =              PaCO2 would increase

= II.      =           PaCO2 would decrease

= III.      =        pH would increase

= IV.      =        pH would decrease

 

= A)    I and III

= B)    I and IV

= C)    II and III

= D)    II and IV

 

10.       You a= re asked to assist in the management of a mechanically ventilated patient who = has COPD.  The best way to manage = this patient is to maintain:

 

= A)    the PaCO2 between 40 and 50

= B)    the PaO2 between 60 and 70

= C)    the pH between 7.35 and 7.45

= D)    the breathing rate between 10 and 20

 

11.   &= nbsp;   Complications of respiratory alkalosis include:

 

= I.      =              decreased cardiac output

= II.      =           dysrhythmias

= III.      =        syncope

= IV.      =        seizures

 

= A)    I and IV

= B)    I, III and IV

= C)    II, III and IV

= D)    I, II, III and IV

 

12.       The w= ater in a Fisher-Paykel humidifier has run dry.=   Which of the following ventilator alarms would indicate this?

 

= A)    low exhaled minute volume

= B)    high peak pressure

= C)    apnea

= D)    none of the above

 

 

 

 

 

 

 

 

 

 

 

 

13.       The U= pper Pressure Limit alarm is sounding on a Servoi ventilator.  Which of the following might be ca= using this?

 

= I.      =              oxygen high pressure hose is disconnected

= II.      =           patient is biting on the endotracheal tube

= III.      =        patient has developed a tension pneumothorax

= IV.      =        electrical power cord has become unplugged

 

= A)    I and III

= B)    II and III

= C)    I, II and IV

= D)    II, III and IV

 

14.   &= nbsp;   Given the following data on a ventilator check:

 

 

   &nbs= p;            &= nbsp;       Tidal volume       =         600 ml

   &nbs= p;            &= nbsp;       Peak pressure      = ;        45 cm H2O

   &nbs= p;            &= nbsp;       Pause pressure      = ;       22 cm H2O

   &nbs= p;            &= nbsp;       PEEP        &= nbsp;           &nbs= p;      4 cm H2O

 

   &nbs= p;        Which of the following is most likely occurring in this patient?

 

= I.      =              excessive secretions in the airway

= II.      =           bronchospasm

= III.      =        pneumothorax

= IV.      =        tube has slipped into the right mainstem bronchus

 

= A)    I and II

= B)    II and III

= C)    III and IV

= D)    I, II and III

 

15.   &= nbsp;   You have just initiated mechanical ventilation on a patient.  Which of the f= ollowing is the best way to

   &nbs= p;        determine if these settings are appropriate for this patient?

 

= A)    look at pulse oximeter

= B)    get a chest x-ray

= C)    draw an arterial blood gas

= D)    look at chest excursion

 

16.   &= nbsp;   A patient is ordered to be started on a BiPAP of 15/8.  These numbers indicate:

 

= A)    an IPAP of 15 and a PEEP of 8

= B)    an EPAP of 15 and an IPAP of 8

= C)    a CPAP of 15 and a PEEP of 8

= D)    a PEEP of  15 and an IPAP of 8

 

 

 

 

 

17.   &= nbsp;   PEEP therapy should:

 

= I.      =              increase FRC

= II.      =           improve oxygenation

= III.      =        increase lung compliance

= IV.      =        decrease V/Q mismatch

 

= A)    I and III

= B)    I, II and III

= C)    II, III and IV

= D)    I, II, III and IV

 

18.   &= nbsp;   Which of the following diseases would LEAST likely benefit from PEEP therapy?

 

= A)    ARDS

= B)    Pulmonary fibrosis

= C)    COPD

= D)    Bilateral diffuse pneumonia

 

19.       You c= hange the PEEP level on a mechanical ventilator from 10 cm H2O to 15 c= m H2O.  Which of the following would indic= ate that the new PEEP level is too high?

 

= I.      =              Static compliance goes from 24 to 32

= II.      =           Static compliance goes from 24 to 20

= III.      =        Arterial-end tidal CO2 difference goes f= rom 3.5 to 4.5

= IV.      =        Arterial-end tidal CO2 difference goes f= rom 3.5 to 2.5

 

= A)    II only

= B)    I and III

= C)    II and IV

= D)    I, III and IV

 

20.   &= nbsp;   The proper level of PEEP should:  = ;   

 

= I.      =              increase A-a gradient

= II.      =           increase oxygen transport

= III.      =        increase intrapulmonary shunt

 

= A)    II only

= B)    III only

= C)    I and II

= D)    II and III

 

21.       Curre= ntly, during mechanical ventilation in a patient with ARDS it is strongly recomme= nded that the pause pressure not exceed:

 

= A)    20 cm H2O

= B)    25 cm H2O

= C)    30 cm H2O

= D)    35 cm H2O

 

 

22.   &= nbsp;   Currently the best predictor for a successful wean from mechanical ventilation is:

 

= A)    RSBI

= B)    MIP

= C)    P.100

= D)    CROP index

 

23.       You a= re asked to wean a 27-year-old trauma patient from the mechanical ventilator.<= span style=3D'mso-spacerun:yes'>  The patient is female and is 5’3” and weighs 120 pounds.&nb= sp; The patient is currently in SIMV + Pressure Support mode with an SIMV rate of 8 and a Pressure Support level of 20 cm H2O.  Her spontaneous tidal volumes are = 630 ml.

&nbs= p;

You would recommend:

 

= A)    increasing the SIMV rate to 10

= B)    adding a PEEP of 7

= C)    increasing the pressure support level to 25

= D)    switching to Pressure Support mode and decreasing pressure support level to 15

 

24.       You a= re asked to wean a patient from mechanical ventilation.  You are currently trying the patie= nt in a Pressure Support mode with a pressure support of 12 cm H2O.  The patient has been in Pressure S= upport for 20 minutes.  After 20 minu= tes you record the following data:

 

   &nbs= p;            &= nbsp;       Patient rate      &nb= sp;            =            32

   &nbs= p;            &= nbsp;       Average tidal volume     &= nbsp;        190 ml

   &nbs= p;            &= nbsp;      

   &nbs= p;        You would recommend:

 

= A)    increasing the oxygen percentage

= B)    decreasing the pressure support level

= C)    extubating the patient

= D)    place patient back in Assist Control mode

 

25.       You a= re asked to wean a patient from the mechanical ventilator.  You collect the following data aft= er the patient has been on a pressure support of 5 and a PEEP of 5 for one hour.  The patient is a 49-year-old male = who is 5’7” and weighs 175 pounds.

 

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      Patient rate      &nb= sp;            =            22

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      Average tidal volume     &= nbsp;        475 ml

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      pH   &n= bsp;            = ;            &n= bsp;            = ;  7.36

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      PaCO2        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;   44

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      PaO2        &= nbsp;           &nbs= p;            &= nbsp;      82

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      FiO2        &= nbsp;           &nbs= p;            &= nbsp;       0.30

 

   &nbs= p;        You would:

 

   &nbs= p;        A) extubate the patient

   &nbs= p;        B) place patient in MMV mode

   &nbs= p;        C) try patient on a t-piece trial

   &nbs= p;        D) increase pressure support to 10

 

 

ANSWER THE FOLLOWING QUESTIONS WITH A CONCISE ANSWER.<= /p>

 

26.   &= nbsp;   Discuss why mechanical ventilation might actually worsen V/Q relationships.  (3 pts)

 

 

 

 

 

 

 

 

 

 

27.   &= nbsp;   List and discuss FOUR physiologic effects of mechanical ventilation on the cardi= ovascular system. 

(4 pts)

 

 

 

 

 

 

 

 

 

 

 

28.   &= nbsp;   List and discuss five general reasons for doing ventilator checks.  (5 pts)

 

 

 

 

 

 

 

 

 

 

 

 

29.       You w= alk into a patient’s room to do a ventilator check and notice the ET tube= is now at 25 cm at the teeth when earlier it was at 22 cm.  What would you do?  (4 pts)

 

 

 

 

 

 

 

 

 

 

 

30.       You a= re managing a patient who has just come back from AAA surgery.  The patient is being mechanically ventilated in the Volume Control mode.&nbs= p; The patient is on a rate of 12 and a tidal volume of 800ml.  Patient’s peak pressure is 24.  The patient is not taking= any additional breaths. State the values you would use for the following alarms= .  (4 pts)

 

   &nbs= p;        High frequency-

 

   &nbs= p;        Low exhaled minute volume-

 

   &nbs= p;        Upper pressure limit-

 

   &nbs= p;        High tidal volume-

 

31.       You a= re paged by the ICU nurse to come attend to a ventilator that is alarming.  When you enter the room you notice= the Low Exhaled Minute Volume alarm sounding.&= nbsp; How would you proceed?  (4 pts)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

32.       Given= the pressure curve below identify the part of the curve that is due to airways resistance and the part that is due to lung and chest wall compliance.  (2 pts)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33.   &= nbsp;   List and describe three ways you can tell if the in-line bronchodilator therapy = is helping your patient. 

   &nbs= p;        (3 pts)

 

 

 

 

 

 

 

 

 

 

34.       Given= the following information, state which PEEP level would be best for this patient and defend your answer.  (4 pt= s)

 

PEEP            =    5        &= nbsp;           &nbs= p; 10        &= nbsp;           15=         &= nbsp;           20=

BP           &= nbsp;       127/81        &= nbsp;    122/78        &= nbsp;    119/74        &= nbsp;    115/73

PIP            =       28        &= nbsp;           33=         &= nbsp;           38=         &= nbsp;           43=

Pplateau        &= nbsp;           21        &= nbsp;           26=         &= nbsp;           31=         &= nbsp;           36=

CaO2            =    10.7                 11.2        &= nbsp;        12.6        &= nbsp;        13.2

CvO2            =   7.2        &= nbsp;          7.6        &= nbsp;          7.0        &= nbsp;          7.0

CO        &= nbsp;         4.1        &= nbsp;          4.1        &= nbsp;          3.9        &= nbsp;          3.8

 

 

 

 

 

 

 

 

 

 

 

 

35.       Given= the following information, calculate dynamic compliance, static compliance, and airways resistance.  (3 pts)

 

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      tidal volume &nbs= p;            &= nbsp;           &nbs= p; 600 ml

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      peak pressure &nb= sp;            =              37 cm H2O

   &nbs= p;            &= nbsp;               &= nbsp;           &nbs= p;   pause Pressure &n= bsp;            = ;           31 cm H2O

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      PEEP        &= nbsp;           &nbs= p;            &= nbsp;     7 cm H2O

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      Flow        &= nbsp;           &nbs= p;            &= nbsp;      40 lpm

 

 

 

 

 

 

 

 

 

 

36.       Given= the following information, calculate a rapid shallow breathing index (RSBI) and state whether the calculated value is acceptable for weaning.  (4 pts)

 

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      breathing rate  &= nbsp;           20=

   &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;      minute volume  &n= bsp;         6.8 liters

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37.       List = three ways to wean a patient.  List = the methods from most effective to least effective according to current data.  (3 pts)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

38.       For the next four problems y= ou will be given a patient situation and a set of ABG’s.  You are to

recomme= nd the SINGLE best ventilator change for each situation.  (2 pts each)

 

= A)    36 year-old male patient with bilateral pneumonia.  Patient is 5’8” and we= ighs 170 lbs.

 

Current settings:        &= nbsp; Assist Control      =             &nb= sp;      ABG’s        &= nbsp;    pH        &= nbsp;          7.43

           &nbs= p;            &= nbsp;           Ra= te        &= nbsp;        16        &= nbsp;           &nbs= p;            &= nbsp;          PaCO2        &= nbsp;    43

           &nbs= p;            &= nbsp;           Ti= dal Volume  700 ml            =             &nb= sp;            PaO2        &= nbsp;       49

           &nbs= p;            &= nbsp;           Fi= O2        &= nbsp;        .70

           &nbs= p;            &= nbsp;           PE= EP        &= nbsp;      8

           &nbs= p;            &= nbsp;           To= tal Rate       16

 

Ventilator Change:

 

= B)    56 year-old female post surgical patient.&nbs= p; Patient is 5’4” and weighs 190 lbs.

 

Current settings:        &= nbsp; SIMV        &= nbsp;           &nbs= p;            &= nbsp;    ABG’s        &= nbsp;    pH        &= nbsp;          7.22

           &nbs= p;            &= nbsp;           Ra= te        &= nbsp;        12        &= nbsp;           &nbs= p;            &= nbsp;          PaCO2        &= nbsp;    59

           &nbs= p;            &= nbsp;           Ti= dal Volume  700 ml            =             &nb= sp;            PaO2        &= nbsp;       59

           &nbs= p;            &= nbsp;           Fi= O2        &= nbsp;        .40

           &nbs= p;            &= nbsp;           PE= EP        &= nbsp;      5

           &nbs= p;            &= nbsp;           Pa= tient Rate    32

 

Ventilator Change:

 

= C)    57 year-old female COPD patient.  Patient is 5’7” and weighs 135 lbs.

 

Current settings:        &= nbsp; MMV        &= nbsp;           &nbs= p;     ABG’s        &= nbsp;           &nbs= p;    pH        &= nbsp;          7.61

           &nbs= p;            &= nbsp;           Ra= te        &= nbsp;        16        &= nbsp;           &nbs= p;            &= nbsp;          PaCO2        &= nbsp;    22

           &nbs= p;            &= nbsp;           Ti= dal Volume  650 ml            =             &nb= sp;            PaO2        &= nbsp;       92

           &nbs= p;            &= nbsp;           Fi= O2        &= nbsp;        .40

           &nbs= p;            &= nbsp;           PE= EP        &= nbsp;      3

           &nbs= p;            &= nbsp;           Pa= tient Rate    16, patient n= ot triggering any breaths

 

Ventilator Change:

 

= D)    22 year-old female trauma patient.  Patient is 5’6” and weighs 165 lbs.

 

Current settings:        &= nbsp; CMV        &= nbsp;           &nbs= p;      ABG’s  &nb= sp;            =           pH        &= nbsp;          7.59

           &nbs= p;            &= nbsp;           Ra= te        &= nbsp;        10        &= nbsp;           &nbs= p;                   &= nbsp;   PaCO2        &= nbsp;    21

           &nbs= p;            &= nbsp;           Ti= dal volume   600 ml        &= nbsp;           &nbs= p;            &= nbsp;   PaO2        &= nbsp;       127

           &nbs= p;            &= nbsp;           Fi= O2        &= nbsp;        .45

           &nbs= p;            &= nbsp;           PE= EP        &= nbsp;      5

           &nbs= p;            &= nbsp;           Pa= tient Rate    18

 

Ventilator Change:

 

 

 

 

 

 

 

 BONUS:

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