question

A pulse oximeter differentiates oxyhemoglobin from deoxygenated hemoglobin by which of the following methods?

answer

b. Shining and comparing two wavelengths of light through the sampling site

question

An arterial blood gas should be done to confirm pulse oximetry findings less than a minimum of _____________.

answer

80%

question

A pulse oximeter reading will be most accurate when used with a patient in which of the following situations?

answer

An intensive care unit patient with hyperbilirubinemia

question

A patient arrives in the emergency department via ambulance following rescue from a house fire. The instrument that would be most appropriate to assist the respiratory therapist in assessing this patient's oxygenation status is which of the following?

answer

CO-Oximeter

question

While trying to use a finger probe to assess a patient's oxygenation status, the respiratory therapist finds that the pulse rate and the ECG monitor heart rate are not consistent and the oxygen saturation measured by pulse oximeter (SpO2) reading is blank. The patient is awake, alert, and in no obvious respiratory distress. The respiratory therapist should first take which of the following actions?

answer

3. Adjust the probe position on the finger. 4. Remove probe, perform a capillary refill test.

question

A patient receiving mechanical ventilation is being continuously monitored for oxygen saturation measured by pulse oximeter (SpO2) for the last 48 hours. When initially applied, the SpO2 and the arterial oxygen saturation (SaO2), as well as the pulse on the pulse oximeter, ECG, and manual pulse, were consistent. During clinical rounds, the respiratory therapist notices that although the probe is appropriately placed and capillary refill is normal, the SpO2 reading is down to 90% from 95%. The most appropriate immediate action is to do which of the following?

answer

Draw an arterial blood gas.

question

A patient in the intensive care unit is receiving mechanical ventilation, has a pulmonary artery catheter in place, and is being monitored continuously with a capnometer. The patient's arterial partial pressure of carbon dioxide (PaCO2) is 41 mm Hg and the partial pressure of end-tidal carbon dioxide (PetCO2) is 36 mm Hg. There is a sudden decrease in the PetCO2 to 18 mm Hg causing an alarm to sound. The most likely cause of this development is which of the following?

answer

Pulmonary embolism

question

For a given minute ventilation, partial pressure of end-tidal carbon dioxide (PetCO2) is a function of which of the following?

answer

1. Metabolic rate 2. Cardiac output 3. Alveolar deadspace

question

Exhaled nitric oxide is used to monitor the effectiveness of which drug used in the treatment of asthma?

answer

Corticosteroids

question

What type of electrode is used by a transcutaneous partial pressure of oxygen (PtcO2) device?

answer

Polarographic

question

To properly operate, the transcutaneous partial pressure of oxygen electrode needs to be at what temperature range?

answer

42° C to 45° C

question

A transcutaneous partial pressure of oxygen (PtcO2) reading is inaccurate in all of the following situations EXCEPT:

answer

Infant Respiratory Distress Syndrome

question

What type of electrode is used by a transcutaneous partial pressure of carbon dioxide (PtcCO2) device?

answer

Stow-Severinghaus

question

How often should the respiratory therapist reposition the sensor of a transcutaneous monitor?

answer

4 to 6 hours

question

The clinical data that should be recorded when making transcutaneous measurements include which of the following?

answer

1. Electrode temperature 2. Skin temperature 3. Probe placement 4. Fractional Inspired Oxygen (FiO2)

question

An energy expenditure (EE) of 60 kcal/hr/m2 for an adult is indicative of which of the following conditions?

answer

Burns

question

An energy expenditure (EE) of 20 kcal/hr/m2 for an adult is indicative of which of the following conditions?

answer

Starvation

question

The respiratory quotient (RQ) value associated with substrate utilization patterns in normal, healthy individuals is which of the following?

answer

0.8

question

A mechanically ventilated patient with chronic obstructive pulmonary disease is in the process of being weaned from mechanical ventilation. A diet containing which of the following will be most beneficial to this process?

answer

Low carbohydrate with increased fats and proteins

question

The newest types of mechanical ventilators use which of the following devices to measure airway pressures?

answer

Electromechanical transducers

question

A strain gauge transducer is being used to measure airway pressures during mechanical ventilation. The transducer measures 18 mm Hg. However, you are required to document pressures in cm H2O. What should you document?

answer

24.5 cm H2O To convert mm Hg to cm H2O multiply the pressure in mm Hg by 1.36. Therefore, 18 multiplied by 1.36 is 24.5 cm H2O.

question

To measure plateau pressure, inspiration should be held for how many seconds?

answer

1 - 2 Plateau pressure requires the establishment of a period of no-flow for 1 to 2 seconds to allow pressure equilibration by the redistribution of the tidal volume and stress relaxation. This maneuver increases inspiratory time and if held longer than 2 seconds may cause barotrauma.

question

Select the ventilator flowmeter that will read accurately when used with heliox.

answer

Vortex ultrasonic Vortex ultrasonic flowmeters are not affected by the viscosity, density, or temperature of the gas being measured. The turbine and variable orifice pneumotachometer will not be accurate when using heliox because of its decreased density. A variable capacitance device is a transducer used to measure airway pressure.

question

During the application of positive-end-expiratory pressure (PEEP), the monitoring of which pressure will alert the respiratory therapist specifically to alveolar overdistention?

answer

Plateau pressure (Pplateau)

question

The energy required to move gas through the airways and expand the thorax is known as which of the following?

answer

Intrinsic work of breathing

question

An increase in intrinsic work of breathing due to a decrease in static compliance is caused by which of the following?

answer

Pulmonary fibrosis

question

The respiratory therapist preparing to insert an arterial line in the right radial artery performs an Allen's test. The result of the Allen's test is 20 seconds. The respiratory therapist should do which of the following?

answer

Perform an Allen's test on the left hand.

question

If the heart rate is 80 beats per minute, how long is one beat?

answer

1.3 seconds Cardiac cycle time = heart rate (HR)/60

question

An intubated patient with no known history of congestive heart failure is in the ICU. The patient is comatose and currently receiving mechanical ventilation via volume-controlled continuous mandatory ventilation (VC-CMV), set rate 12 bpm, set tidal volume (VT) 400 mL, positive-end-expiratory pressure (PEEP) 18 cm H2O, fractional inspired oxygen (FIO2) 0.35, and the patient is not assisting. Hemodynamic measurements show the following: central venous pressure (CVP) 5 mm Hg, pulmonary artery pressure (PAP) 33/20 mm Hg, and pulmonary artery occlusion pressure (PAOP) 16 mm Hg. Arterial blood gas (ABG) results are: pH 7.43, arterial partial pressure of carbon dioxide (PaCO2) 38 mm Hg, arterial partial pressure of oxygen (PaO2) 90 mm Hg. The physician asks for recommendations to improve this patient's hemodynamics. The most appropriate recommendation for this patient is which of the following?

answer

Decrease the PEEP incrementally and recheck hemodynamic measurements.

question

A patient in the ICU has a chest x-ray that shows bilateral infiltrates and has the following hemodynamic measurements: central venous pressure (CVP) 5 mm Hg, pulmonary artery pressure (PAP) 24/13 mm Hg, and pulmonary artery occlusion pressure (PAOP) 21 mm Hg. These findings are consistent with which of the following?

answer

Cardiogenic pulmonary edema

question

A patient in the ICU has a chest x-ray that shows bilateral infiltrates and has the following hemodynamic measurements: central venous pressure (CVP) 3 mm Hg, pulmonary artery pressure (PAP) 21/10 mm Hg, and pulmonary artery occlusion pressure (PAOP) 8 mm Hg. These findings are consistent with which of the following?

answer

Acute respiratory distress syndrome

question

PEEP therapy is indicated for patients with which of the following?

answer

PaO2 of 100 mm Hg while receiving an FIO2 of 0.8 The PaO2/FIO2 for answer A is 317, which shows no ALI or ARDS. The PaO2/FIO2 for answer B is 125; this is an indication for PEEP therapy (PaO2/FIO2 <200 for ARDS). The compliance for answers C and D is 50 mL/cm H2O and 53 mL/cm H2O, respectively. These compliances are normal for intubated patients.

question

Patients with which of the following clinical disorders may benefit from PEEP?

answer

ARDS

question

How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?

answer

15 min

question

Assessing the outcome of PEEP at levels set above 15 to 20 cm H2O is best done using which of the following?

answer

Pulmonary artery occlusion pressure

question

An absolute contraindication to PEEP is which of the following?

answer

Untreated tension pneumothorax

question

A patient is being ventilated with a PEEP of 10 cm H2O and an FIO2 of 0.4. The arterial blood gas results show that the patient remains hypoxemic, and the respiratory therapist increases the PEEP to 18 cm H2O, maintaining the FIO2 at 0.4. The patient's static compliance changes from 28 mL/cm H2O to 22 mL/cm H2O just after this change. The respiratory therapist should do which of the following?

answer

Decrease PEEP to 15 cm H2O and measure static compliance.

question

During a patient case study, increasing increments of PEEP showed no significant effects until 15 cm H2O was used, at which time the PaO2 improved markedly. This represents the point at which _______________.

answer

alveolar recruitment probably occurred

question

A pneumonia that was not incubating at the time of admission is one that develops a minimum of how many hours after admission?

answer

48 hrs

question

The type of organism that most often causes ventilator-acquired pneumonia is which of the following?

answer

bacteria

question

The mortality rate for VAP associated with prolonged hospital stays is which of the following?

answer

25%-50%

question

Sixty percent of all VAP infections are caused by which of the following?

answer

Aerobic gram-negative bacilli Aerobic gram-negative bacilli have accounted for nearly 60% of all VAP infections. The most common of these are Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp.

question

The most common gram-positive bacterium that causes ventilator-associated pneumonia is which of the following?

answer

Methicillin-resistant Staphylococcus aureus The predominant gram-positive bacterium that causes VAP is methicillin-resistant Staphylococcus aureus (MRSA). P. aeruginosa is a gram-negative bacterium.

question

Patients with chronic obstructive pulmonary disease (COPD) are at higher risk for infection with which of the following organisms?

answer

Haemophilus influenzae, Moraxella catarrhalis Patients with COPD have an increased risk for infection with H. influenzae, S. pneumoniae, and M. catarrhalis, whereas patients with cystic fibrosis are susceptible to P. aeruginosa and S. aureus infections.

question

The incidence of ventilator-associated pneumonia for all intubated patients is

answer

8% to 28%

question

The mortality rate for VAP depends on which of the following?

answer

2. Presence of underlying disease 3. Prior antimicrobial therapy

question

Healthy individuals usually have which of the following bacteria in their upper airways?

answer

Haemophilus sp. The upper airways of healthy individuals typically contain nonpathogenic bacteria, such as the viridans group of streptococci, Haemophilus sp., and anaerobes.

question

Critically ill patients receiving invasive mechanical ventilation have been found to have which of the following microorganisms not typically present in healthy individuals?

answer

Gram-negative bacilli

question

Reasons for the shift in oropharyngeal flora in patients receiving invasive mechanical ventilation with endotracheal tubes include which of the following?

answer

Decreased mucosal immunoglobulin A

question

Which of the following is not a method to reduce the risk of VAP?

answer

Nasally intubate whenever possible. Nasal intubation increases the risk of sinusitis, which is associated with ventilator-associated pneumonia. Intermittent nasogastric tube feedings, keeping the patient in a semirecumbent position, and using heat/moisture exchangers (HME) whenever possible are all methods to decrease the occurrence of VAP.

question

To avoid ventilator-associated pneumonia, how often should ventilator circuits be changed?

answer

Not unless visibly dirty

question

A "ventilator bundle" may include which of the following?

answer

1. Keeping the head of the bed at 30 degrees from the horizontal. 4. Using noninvasive positive pressure ventilation (NPPV) whenever possible. Ventilator bundles" are evidence-based practices that can significantly reduce the incidence of VAP. Keeping the patient in a semirecumbent position decreases the risk of aspiration. Using NPPV when possible can significantly lower the rate of nosocomial pneumonia. Ventilator circuits should be changed only when they are visibly dirty, and HMEs should be used whenever possible, because most can filter and all can eliminate condensation in the ventilator circuit.

question

What ends inspiration in pressure support ventilation?

answer

Flow

question

At what pressure is pressure support not high enough to contribute significantly to ventilatory support but is sufficient to overcome the work imposed by the ventilator system?

answer

5 cm H2O

question

Which mode of ventilation delivers the exact amount of pressure required to overcome the resistive load imposed by the ET tube for the flow measured at the time?

answer

Automatic tube compensation ATC reduces the work of breathing associated with increased ET tube resistance. ATC is designed to deliver exactly the amount of pressure required to overcome the resistive load imposed by the ET tube for the flow measured at the time. In a sense, this is providing variable PSV with variable inspiratory flow compensation. Volume-targeted PSV maintains a target volume by varying the pressure support level. PSV provides an operator-selected set pressure for every spontaneous breath. The automode can switch between time-triggered mandatory breaths and patient-triggered, volume-targeted, pressure-limited breaths as long as the patient is breathing spontaneously.

question

The mode of ventilation that maintains a minimum VE by increasing or decreasing the amount of support (VT or respiratory rate) given to the patient is

answer

mandatory minute ventilation

question

A postoperative patient, still under anesthesia, is being ventilated with VC-CMV with Automode. After 2 hours the patient is waking up and beginning to breathe spontaneously. The ventilator will respond by

answer

switching to the volume support mode.

question

The ACCP/SCCM/AARC task force recommends that a search for all possible causes that may be contributing to ventilator dependence be undertaken in patients who require mechanical ventilation for longer than ______ hours.

answer

24 hours

question

Spontaneous Breathing Trials

answer

Calculate the f/VT and PaO2/FIO2 for each patient. The patient with acceptable criteria has an f/VT of 23 and a PaO2/FIO2 of 325.

question

An SBT should not continue for longer than _____ minutes.

answer

120 typically last 30 mins

question

If a patient who has failed an SBT still meets the criteria for discontinuation of ventilation, an SBT should be performed every _______ hours to determine weanability.

answer

24 hrs

question

Extubation Failure

answer

Patients who do well for 30 to 60 minutes after extubation and then fail weaning because of acute respiratory acidosis, hypoxemia, hypotension, and chest pain are likely to have acute left ventricular failure. This occurs because of increased preload, which is due to the decreased pulmonary capillary compression that occurs when intrathoracic pressure is reduced as a result of being off the ventilator.

question

How long does a tracheostomy site typically take to mature?

answer

7 to 12 days

question

A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until ________ month(s) has/have passed and all weaning attempts during that time have failed.

answer

3

question

The American College of Chest Physicians (ACCP) considers long-term ventilator (LTV)-assisted patients to be those who require mechanical ventilation for at least _______ hours per day for _______ days or more.

answer

6;21

question

Which site for mechanical ventilation of patients provides the least patient independence and quality of life?

answer

ICU

question

A minimum of _______ days should be allowed to obtain insurance verification and authorization and to procure equipment before a ventilated patient is transferred home from the acute care hospital.

answer

7-14

question

In-hospital evaluation of ventilator-assisted infants should be performed how often for the first 2 years of life?

answer

2-3 months

question

Glossopharyngeal breathing is beneficial for patients with which condition?

answer

Patients who may benefit from learning glossopharyngeal breathing include those with a spinal cord injury or post-polio syndrome.

question

Ramsay Sedation Scale

answer

a graduated, single-category scale that is easy to perform and provides a numerical value that can be used as a target for achieving adequate sedation.

question

Ramsay Adequate sedation

answer

2 to 4

question

Exert their effects through a nonspecific depression of the central nervous system. This is accomplished when these drugs bind to benzodiazepine sites on the gamma-aminobutyric acid (GABA) receptor complex on neurons in the brain.

answer

Benzodiazepines

question

Has minimal effects on the cardiovascular system and does not cause histamine release, minimal effects on the renal system compared with other opioids

answer

Fentanyl

question

opioid of choice for patients with unstable hemodynamic status and renal insufficiency

answer

Fentanyl

question

have hemodynamic effects that may worsen this patient's hypovolemia

answer

Morphine and propofol

question

Paralyzing agents should not be given without

answer

sedatives

question

Paralyzing Agent

answer

Succ

question

prevents the sedative effects of benzodiazepines by competitively binding to benzodiazepine receptors

answer

Flumazenil

question

opioid antagonist used to facilitate opioid withdrawal

answer

Naloxone/Narcan

question

synthetic opioid that is more potent than morphine

answer

fentanyl

question

nondepolarizing paralyzing agent.

answer

Vecuronium

question

drug of choice for sedating mechanically ventilated patients in the ICU for longer than 24 hours.

answer

Lorazepam (Ativan)

question

are routinely used to treat patients demonstrating extreme agitation and delirium

answer

Neuroleptics, such as haloperidol

question

general anesthetic used for sedation

answer

Propofol

question

administered simultaneously, allow for greater control of the ICP than morphine alone

answer

Propofol and morphine

question

reduces cerebral blood flow and intracranial pressure, making it a useful sedative for neurosurgical patients, has been shown to be more effective than fentanyl in reducing ICP in patients with traumatic brain injury.

answer

Propofol

question

increases serum histamine levels and is associated with bronchospasm in patients with asthma and those with hypersensitive airways.

answer

morphine

question

are used for patient-ventilator dyssynchrony that cannot be corrected by adjusting ventilator settings.

answer

Paralytics or neuromuscular blocking agents

question

used to facilitate less conventional mechanical ventilation strategies

answer

NM blocks

question

Mode that results in the greatest reduction in venous return and thus cardiac output.

answer

VC-CMV W/ PEEP

question

HIGH VT/HIGH LEVELS OF PEEP

answer

result in increased resistance to blood flow through the pulmonary circulation; this increases right ventricular afterload. In addition, the right ventricle becomes overdistended, causing a decrease in RV output. Dilation of the RV can also force the interventricular septum to move to the left. Left ventricular output may also be decreased because of the expanding lungs. This plus the decreased venous return lowers cardiac output and decreases the amount of blood perfusing the myocardium.

question

Decreases in cardiac output can occur in normovolemic patients with levels of PEEP ____ cm H2O.

answer

>15 cmh2o

question

MAP

answer

MAP = 1/2 (PIP PEEP) × (Inspiratory time/Total cycle time) + PEEP

question

different types of hormones may influence urine output during mechanical ventilation.

answer

ADH, atrial natriuretic factor, and the renin-angiotensin-aldosterone cascade. Increases in the release of ADH, also called arginine vasopressin, from the posterior pituitary can reduce urine production by inhibiting free water excretion.

question

High distending volumes result in overdistention of the alveoli, leading to the release of inflammatory mediators from the lungs, which can result in multiorgan failure

answer

biotrauma

question

Repeated opening and closing of lung units, also called recruitment/derecruitment, generates

answer

shear stress

question

is lung injury caused by high pressure

answer

barotrauma

question

is the cause of biotrauma.

answer

over distention

question

lung injury that occurs at the level of the acinus. It is the microscopic level of injury that includes biotrauma, shear stress, and surfactant depletion (atelectrauma).

answer

VILI

question

lung injury identified as being a consequence of mechanical ventilation. The most common forms are ventilator-associated pneumonia (VAP), air trapping, patient-ventilator asynchrony, and extra-alveolar gas (barotrauma), such as pneumothorax and pneumomediastinum

answer

VALI

question

lung areas receive a higher portion of ventilation and perfusion.

answer

dependent

question

Anxiety and hypertension (mild to moderate acidosis) are clinical signs of ____, along with elevated T waves on an ECG.

answer

hypoventilation

question

Patients are cool to the touch, have twitchy muscles from hypokalemia, and have low, rounded T waves, atrial flutter, or negative T waves on the ECG.

answer

hyperventilation

question

lower limits of permissive hypercapnia

answer

PaO2 = 60 mm Hg and SpO2 = 90% are acceptable lower limits.

question

the pressure-time scalar takes a concave shape during inspiration

answer

inadequate flow

question

A volume curve dropping below baseline is indicative of

answer

active exhalation

question

A volume curve that ends above baseline indicates

answer

leak

question

An exhaled flow curve that takes the entire expiratory time to rise back to zero baseline is indicative

answer

increased airway resistance

question

When the loop on a pressure-volume loop does not return to zero during exhalation,

answer

leak in circuit

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