Chapter 5; Selecting the Ventilator and the Mode

Chapter 5; Selecting the Ventilator and the Mode

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A 68-year-old female admitted for congestive heart failure is in respiratory distress and is being seen by the hospital’s medical emergency team in her regular room. The patient is in obvious respiratory distress and is immediately placed on a nonrebreathing mask. Physical assessment reveals: pulse 138 and thready; respiratory rate 30, shallow and labored; temperature 37° C; blood pressure 110/68. Breath sounds are bilaterally decreased with coarse crackles on inspiration. EKG shows normal sinus rhythm with widened cardiac output (QT) interval and an occasional irregular beat. No coughing is noted. The arterial blood gas on the nonrebreathing mask is: pH 7.34; PCO₂ 46 mm Hg; partial pressure of oxygen in the arteries (PO₂) is 52 mm Hg; oxygen saturation is 86%; bicarbonate (HCO₃^–) is 24 mEq/L. The patient is diaphoretic. The most appropriate ventilator mode to manage this patient initially is which of the following?

a.	Noninvasive Positive Pressure Ventilation (NPPV)
b.	Airway Pressure Release Ventilation (APRV)
c.	Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV)
d.	Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV)

 

 

ANS:   A

This patient is in impending respiratory failure due to a congestive heart failure (CHF) exacerbation. The arterial blood gas (ABG) also reveals mild hypercapnia and severe hypoxemia. With the proper treatment this exacerbation could be reversed fairly quickly. Non-invasive positive pressure ventilation (NPPV), in the form of bilevel positive airway pressure, is appropriate because of this. All the other choices require intubation. If the NPPV doesn’t work to decrease the patient’s respiratory failure then intubation would be the next step.

 

DIF:    3                      REF:    pg. 65| pg. 66

 

2. A patient has recently been diagnosed with obstructive sleep apnea. The most appropriate treatment includes which of the following?

a.	Pressure Support Ventilation (PSV)
b.	Noninvasive Positive Pressure Ventilation (NPPV)
c.	Continuous Positive Airway Pressure (CPAP)
d.	Pressure Controlled Continuous Mandatory Ventilation (PC-CMV)

 

 

ANS:   C

Continuous positive airway pressure (CPAP) is an accepted method used to treat obstructive sleep apnea. Noninvasive positive pressure ventilation (NPPV) would be appropriate if the patient had central sleep apnea, since there would be no respiratory efforts during the apnea periods. Pressure support ventilation (PSV) and Pressure controlled continuous mandatory ventilation (PC-CMV) would require the patient to be intubated.

 

DIF:    1                      REF:    pg. 65

 

3. Which of the following is the minimum ventilator rate that is considered full ventilatory support?

a.	4 breaths/minute
b.	6 breaths/minute
c.	8 breaths/minute
d.	10 breaths/minute

 

 

ANS:   C

Full ventilatory support is provided when the ventilator initiated rates are 8 breaths/minute or more.

 

DIF:    1                      REF:    pg. 70

 

4. Partial ventilatory support can be provided by which of the following ventilator modes?
5. Pressure Controlled Continuous Mandatory Ventilation (PC-CMV) set rate 8 breaths/minute
6. Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) set rate 4 breaths/minute
7. Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) set rate 10 breaths/minute
8. VC- MMV set V_e8 L/minute

a.	1 and 2 only
b.	2 and 3 only
c.	2 and 4 only
d.	3 and 4 only

 

 

ANS:   C

Continuous mandatory ventilation (CMV) is a full ventilatory support mode. Therefore, Pressure Controlled Continuous Mandatory Ventilation (PC-CMV) rate 8 breaths/minute is not partial ventilatory support. A ventilator rate setting of 8 breaths/minute or more is also considered full support. Therefore, even though Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) could be partial ventilatory support, it is full support because of the set rate of 10 breaths/minute. Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) with a set rate of 4 breaths/minute is partial ventilatory support and MMV can be partial ventilatory support when the patient is participating in the work of breathing (WOB) to maintain effective alveolar ventilation.

 

DIF:    2                      REF:    pg. 70

 

5. Of the following breath descriptions, which one is considered spontaneous?

a.	Flow triggered, pressure limited, flow cycled
b.	Time triggered, volume limited, volume cycled
c.	Pressure triggered, pressure limited, time cycled
d.	Patient triggered, patient cycled, baseline pressure +5 cm H2O

 

 

ANS:   D

Flow triggered and pressure triggered mean that the patient has initiated the breath. Pressure limited and volume limited mean that either one of these variables is not allowed to be exceeded during a breath. This occurs with either ventilator or assisted breaths. Patient triggered could either be pressure or flow and could be part of a spontaneous breath as long as the pressure during inspiration does not rise above the baseline setting. During spontaneous breathing the patient will control both the beginning and the ending of the breath.

 

DIF:    2                      REF:    pg. 70