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NBRC STYLE ATMV TEST Q’S
NBRC STYLE ATMV TEST Q’S WITH GUARANTEED ACCURATE ANSWERS |VERIFIED ·The cause of a mechanically ventilated patient's PIP increasing from 20 to 40 cm H20 while the static compliance remains relatively unchanged is due to? - ACCURATE ANSWERS✔✔ o Increased Raw An increase in PIP and Pplat with a stable PTA may be caused by? - ACCURATE ANSWERS✔✔ o ARDS What will occur when a patient's lung-thoracic compliance improves? - ACCURATE ANSWERS✔✔ o Pplat decreases o PIP decreases
Over the course of several hours, a respiratory therapist has detected an increase in PTA of a mechanically ventilated patient. The patient's Pplat has remained stable. What may be the cause of this increase? - ACCURATE ANSWERS✔✔ o Increase of airway secretions A patient's PTA is rising, while the Pplat is constant. What should be done to correct this problem? - ACCURATE ANSWERS✔✔ o Administer a bronchodilator o Suction airway secretions What will demonstrate the highest airway resistance? - ACCURATE ANSWERS✔✔ o PIP is 52 cm H2O, Pplat is 18 cm H2O, flow rate is 45 L/min What is associated with an increase in airway resistance? - ACCURATE ANSWERS✔✔ o Decreasing the flow rate of gas into the airway What is true regarding negative pressure ventilation? - ACCURATE ANSWERS✔✔ o These ventilators mimic normal breathing mechanics PEEP is best defined as: - ACCURATE ANSWERS✔✔ o Positive pressure at the end of exhalation on a mechanical ventilator
o Flow-time curve When both pressure and volume waveforms are affected by changes in lung characteristics, which variable is being controlled? - ACCURATE ANSWERS✔✔ o Time A high-frequency oscillator controls which variable? - ACCURATE ANSWERS✔✔ o Time When the ventilator is time triggering and the rate is set at 20 breaths/min, the time interval between breaths is? - ACCURATE ANSWERS✔✔ o 3 seconds During flow triggering the base flow is set at 5 L/min and the ventilator triggers when it senses 3 L/min returning to its flow measuring device. What is the flow sensitivity setting? - ACCURATE ANSWERS✔✔ o 2 L/min During pressure-support ventilation the patient triggers the ventilator, the set pressure is reached, and the ventilator cycles at 5 seconds. What is the cause of this time cycle? - ACCURATE ANSWERS✔✔ o A leak in the system The most common cycling mechanism used for a pressure-support ventilation is? - ACCURATE ANSWERS✔✔ o Flow
The maneuver used to measure plateau pressure is? - ACCURATE ANSWERS✔✔ o Inspiratory hold What flow is needed to deliver 850 mL of volume to a patient in 0. second with a constant gas flow? - ACCURATE ANSWERS✔✔ o 68 L/min What phase variable is responsible for beginning inspiration? - ACCURATE ANSWERS✔✔ o Trigger variable What variable will remain constant if airway resistance varies during a pressure-controlled breath? - ACCURATE ANSWERS✔✔ o Pressure What happens in most ICU ventilators if the pressure alarm is activated?
- ACCURATE ANSWERS✔✔ o Inspiration ends, and tidal volume is reduced o An alarm sounds Flow triggering gained widespread use by clinician's because? - ACCURATE ANSWERS✔✔ o It required less work of breathing for the patient
What suggests the presence of respiratory insufficiency and the need for ventilatory support? - ACCURATE ANSWERS✔✔ o MIP of -17 cm H2O o PaCO2of 81 mm Hg and pH of 7. Blood gas results on RA from an unconscious patient brought to the ED are as follows: pH = 7.23, PaCO2 = 81 mm Hg, HCO3 = 33 mEq/L, PaO2 = 43 mm Hg, and SaO2 = 71%. With no other data available, what form of therapy is indicated? - ACCURATE ANSWERS✔✔ o Mechanical ventilatory support A 30-year-old woman is seen in the ED. She demonstrates paralysis of the lower extremities that is progressively worsening. After several hours, during which she was monitored frequently, her VC has decreased to 12 mL/kg and MIP is - 30 cm H2O. The result of blood gas evaluations are not yet available. What type of therapy is most likely needed? - ACCURATE ANSWERS✔✔ o Mechanical ventilatory support A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis. The respiratory therapist has been monitoring patient's MIP and VC every 2 hours. The most recent results show that the patient continues to deteriorate: MIP = -27 cm H2O, VC = 32 mL/kg. What could be appropriately recommended? - ACCURATE ANSWERS✔✔ o Mechanical ventilatory support
A 34-year-old man is taken to the ED after a MVA. He is unconscious and unresponsive. ABG's obtained while patient is receiving oxygen via NRB mask show the following: PaO2 = 47 mmHg, pH = 7.09, and HCO3 = 27 mEq/L. What should the therapist do? - ACCURATE ANSWERS✔✔ o Intubate and ventilate A 68-year-old man with a history of COPD and CO2 retention is brought to the ED by ambulance. He is receiving oxygen through a nasal cannula (2 L/min). He is conscious and cooperative but in distress. He is leaning forward and using accessory muscles to breathe. His vital signs are as follows: HR = 100 beats/min, BP = 128/78 mm Hg, temp = 37.8F C, RR = 20 breaths/min with prolonged expiration through pursed lips. Breath sounds reveal bilateral crackles and wheezes. What is most appropriate?
- ACCURATE ANSWERS✔✔ o Evaluate for NIV A 43-year-old man who weighs 165 lbs (75 kg) and has MG is beginning to develop progressive weakness of the muscles. The RCP has been monitoring MIP and VC every 4 hours. The most recent results show that the patient continues to deteriorate despite treatment with anticholinesterase drugs: MIP = - 35 cm H2O, VC = 23 mL/kg. What would be appropriate to recommend? - ACCURATE ANSWERS✔✔ o Mechanical ventilatory support A 48-year-old woman admitted to the ED demonstrates tachypnea, tachycardia, and appears pale. Breath sounds reveal bilateral crackles. ABG results with the patient using a NRB mask are as follows: PaO2 = 32 mm Hg, pH = 7.49, and HCO3 = 24 mEq/L. What is the most
A 14-year-old boy who previously had been diagnosed with mild persistent asthma has a PEF of 100 L/min. What does this indicate? - ACCURATE ANSWERS✔✔ o Increase airway resistance After oxygen is administered, a patient's heart rate changes from 110 beats/min to 85 beats/min. the initial tachycardia was most likely caused by? - ACCURATE ANSWERS✔✔ o Hypoxemia A 34-year-old patient who was in a MVC is admitted to the hospital with crushed chest injuries and a fractured tibia. Two days later, the PaO2 is 56 mm Hg while he is breathing 80% oxygen, and the respiratory is 30 to 34 breaths/min. based on the history and these findings, what does this patient most likely need? - ACCURATE ANSWERS✔✔ o Invasive ventilation Which ABG parameter is considered the best indicator of a patient's ventilatory status? - ACCURATE ANSWERS✔✔ o PaCO A 43-year-old male was admitted last night with a stab wound to the right anterior thorax. The wound was repaired in surgery. Currently the patient is alert and continuously tries to remove his oxygen mask. He is in ICU and has a chest tube in his right hemithorax. Vital signs show pulse 120 beats/min, respirations 36 breaths/min and shallow, BP 148/ mm Hg, and oral temperaure of 38 C. Breath sounds are decreased over the right base, and chest expansion is decreased over the side. The patient is not coughing. ABG results reveal pH = 7.48, PaCO2 = 26 mm
Hg, PaO2 = 66 mm Hg, SaO2 94%, HCO3 = 19 mEq/L, FiO2 0.55 (via air entrainment mask), and Hb = 11.4. What is the most appropriate action to take at this time? - ACCURATE ANSWERS✔✔ o Intubate and mechanically ventilate with an FiO2 of 1. What characterizes hypercapnic respiratory failure? - ACCURATE ANSWERS✔✔ o Alveolar hypoventilation o Higher than normal PaCO The underlying physiological process leading to pure hypercapnic respiratory failure is? - ACCURATE ANSWERS✔✔ o Alveolar hypoventilation A 65-year-old male presents to the ED complaining of increasing shortness of breath over the past 3 days and appears to be in moderate respiratory distress. He is a 100-pack-year smoking history. Vital signs are: HR 115 beats/min, RR 32 breaths/min, BP 170/95 mm Hg, mild expiratory wheezing in his bases, and temperature 100F F oral. His ABG values on nasal cannula 3 L/min are pH = 7.30, PaCO2 = 70 mm Hg, PaO2 = 48 mm Hg, SaO2 = 67%, and HCO2 = 35 mEq/L. The most appropriate treatment at this time is to initiate what? - ACCURATE ANSWERS✔✔ o NIV positive-pressure ventilation A 55-year-old female with a history of chronic congestive heart failure and extreme obesity presents to the ED. She is alert but disoriented. Vital signs show pulse 143 beats/min, BP 145/94 mm Hg, oral temperature 37F
= 7.35, PaCO2= 31 mm Hg, PaO2 = 72 mm Hg, SaO2 = 88%, and HCO3 = 24 mEq/L. What should the respiratory therapist recommend? - ACCURATE ANSWERS✔✔ o Continuous aerosol with 30% oxygen Which condition demonstrates the need for intubation and mechanical ventilation? - ACCURATE ANSWERS✔✔ o ARF A disorder that may cause hypercapnic respiratory failure because of increased work of breathing is? - ACCURATE ANSWERS✔✔ o Asthma When switching from the CMV mode to the IMV mode to facilitate weaning from mechanical ventilation, what could be used, in addition to IMV (IMV), to assist in this process? - ACCURATE ANSWERS✔✔ o PSV A post-thoracic surgery patient currently receiving mechanical ventilation on VC - CMV with 60% oxygen has the following ABG: pH = 7.45, PaCO2 = 36 mm Hg. The patient's PIP are averaging 55 cm H2O. The ventilator mode that is most appropriate at this time is? - ACCURATE ANSWERS✔✔ o PC-CMV with PEEP A 38-year-old female suffered a deceleration injury in an MVC. She is alert and oriented but in respiratory distress. A portion of the patient's right anterior chest wall is moving in a paradoxical motion. Breath
sounds are decreased on the right and the trachea is midline and no pneumothorax was detected. ABG data reveal pH = 7.48, PaCO2 = 31 mm Hg, PaO2 = 63 mm Hg, and HCO3 = 24 mEq/L. The respiratory therapist should recommend what therapies for this patient at this time? - ACCURATE ANSWERS✔✔ o Mask CPAP with supplemental oxygen The physician requests that the RT make a recommendation for a patient with postpolio complaints of increasing daytime weakness. Her VC is mL/kg and MIP is -32 cm H2O. Her ABG on RA reveals pH = 7.38, PaCO2 = 46 mm Hg, PaO2 = 74 mm Hg, and HCO3= 24 mEq/L. The therapist should suggest what? - ACCURATE ANSWERS✔✔ o BiPAP via nasal mask at night During a pressure-triggered breath in VC - CMV the pressure-time curve on the graph display does no rise smoothly and appears to be somewhat concave in appearance. What does this indicate? - ACCURATE ANSWERS✔✔ o Flow rate is inadequate Every breath from the ventilator is time or patient triggered, pressure targeted (limited), and time cycled. What ventilator mode does this describe? - ACCURATE ANSWERS✔✔ o PAug Pressure augmentation (PAug) may be beneficial for mechanically ventilated patients with what? - ACCURATE ANSWERS✔✔ o Noncardiogenic pulmonary edema o Postoperative upper abdominal surgery
A patient with severe tetanus needs ventilatory support. What mode would you recommend? - ACCURATE ANSWERS✔✔ o Paralyze and sedate the patient; control ventilation using volume control (VC-CMV) When is it appropriate to use PSV? - ACCURATE ANSWERS✔✔ o As a method of weaning o To overcome the WOB through the ET tube and the circuit o For patient's using the IMV mode o For long-term patient support A patient on PC-CMV has widely fluctuating changes in Raw because of secretions and bronchospasm. The low tidal volume alarm is activated every few hours; the set pressure is 18 cm H2O. The physician is concerned about consistency in ventilation. What would you recommend? - ACCURATE ANSWERS✔✔ o Switch to VC-CMV A patient with ARDS has a plateau pressure of 30 cm H2O and a PIP of 39 cm H2O. VT is 0.7 on VC - CMV. The decision is made to switch the patient PC - CMV (PCV) to keep pressures at a safe level. What pressure would you set and why? - ACCURATE ANSWERS✔✔ o A pressure of 30 cm H2O to start would provide approximately the same VT delivery in VC - CMV and would be a safe starting point. This patient requires high pressures for delivery of VT. Palv should be kept below 30 cm H2O.
A patient receiving VC - CMV is actively triggering every breath. The respiratory therapist notices that the patient is using accessory muscles (sternocleidomastoid muscles) during the entire inspiratory phase. The therapist also sees that the pressure-time curve has a negative deflection before inspiration and has a concave appearance during inspiration. What is the apparent problem with this situation? - ACCURATE ANSWERS✔✔ o Apparently the ventilator has a fixed flow and pattern during inspiration that is not adequate for the patient's needs. The therapist should increase the inspiratory flow and see if this solves the problem. Another possible solution is to switch to another ventilator that allows additional flow on demand during VC - CMV. A patient has recovered from a severe pneumonia that required 8 days of PC-CMV ventilation. The patient is now conscious and responsive. She is triggering every breath and has a strong cough. What should the therapist suggest to the physician? - ACCURATE ANSWERS✔✔ o There are several options: (1) switch the patient to PC-IMV with a lower mandatory rate; (2) switch the patient to PSV; (3) switch to VS. Although any of these options would all for more spontaneous ventilation, it is important to monitor the SpO2, VT, and VE closely. A physician is concerned about the high pressures required to perform ventilation for a patient with terminal cancer and severe lung scarring. The lungs are very stiff and fibrous. The physician is also concerned about maintaining a normal CO2 in this patient. What mode might be appropriate for this patient and why? - ACCURATE ANSWERS✔✔ o A dual control mode that limits pressure (e.g., PRVC) may be appropriate
The flow waveform that is most appropriate for a patient with a high Raw is? - ACCURATE ANSWERS✔✔ o Descending What flow rate is necessary to deliver a VT 500 mL at a rate of 15 breaths/min with an I:E ratio of 1:3? - ACCURATE ANSWERS✔✔ o 30 L/min The appropriate minute ventilation for a male with a BSA of 2.3m(2) and a body temperature of 40F C is? - ACCURATE ANSWERS✔✔ o 11.7 L/min A 5-foot 1-inch tall female patient receiving PSV 6 cm H2O is showing signs of accessory muscle use and is exhaling a VT of 220 mL, at a rate of 28 breaths/min. The most appropriate action at this time is? - ACCURATE ANSWERS✔✔ o Increase PSV to 10 cm H2O A 5-foot 7-inch tall female multiple trauma patient was being managed on VC - CMV , ƒ 12 breaths/min, VT 640 mL, PEEP + 5 cm H2O, FiO 60%, and a constant waveform for the past 24 hours. Currently, PIP is 45 cm H2O, Pplat is 38 cm H2O, and the patient has been diagnosed with acute respiratory distress syndrome. The RT wants to switch the patient to PC-CMV. The initial pressure setting to target the appropriate VT for this patient would be? - ACCURATE ANSWERS✔✔ o 20 cm H2O
How is pressure support ventilation cycled? - ACCURATE ANSWERS✔✔ o Flow cycled What is true concerning the use of permissive hypercapnia in the management of ARDS? - ACCURATE ANSWERS✔✔ o Keep Pplat below 30 cm H2O by lowering VT to 4 to 6 mL/kg o High PEEP-E levels greater than 15 cm H2O may be required A 75-year-old female, admitted through emergency department earlier, today is increasingly distress and unable to breathe comfortably expect in the upright position. She has a history of coronary artery disease, and on admission, she was complaining of chest pain. She is becoming increasingly short of breath and appears cyanotic. Vital signs are reveal pulse 142 beats/min and labored. The ABG on nasal cannula 3 L/min is pH = 7.18, PaCO2 = 81 mm Hg, PaO2 = 35 mm Hg, SaO2 = 97%, and HCO3 = 29 mEq/L. What should the RT recommend? - ACCURATE ANSWERS✔✔ o Intubation and mechanical ventilation with PC-CMV Appropriate ventilatory parameters for an otherwise health 185-lb, 6- foot 1-inch, 26-year-old male patient who was brought to the ED because of a drug overdose includes what? - ACCURATE ANSWERS✔✔ o VC-CMV, VT 600 mL, set rate 12 breaths/min Before intubation, a patient's PaO2 was 78 mm Hg, while receiving a FiO2 of 0.60. What FiO2 setting on the ventilator will bring the PaO2 up
