Chapter 8; Initial Patient Assessment

Chapter 8; Initial Patient Assessment

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The first step in the assessment and documentation of patient-ventilator interaction following the placement of a patient on a mechanical ventilator is which of the following?

ANS:   A

The first step in the process of assessment and documentation of patient-ventilator interaction after a patient has been placed on a mechanical ventilator involves the respiratory therapist verifying the physician’s orders. The second step is to verify that the ventilator passed an operational verification procedure (OVP). The OVP involves checking the integrity of the ventilator circuit and the humidification system. The patient assessment is performed during the patient-ventilator system check.

DIF:    1                      REF:    pg. 125

2. The operational verification procedure (OVP) involves checking the ventilator circuit for leaks. Ventilator settings that could be used to perform this procedure include which of the following?

ANS:   C

To check for leaks in the ventilator circuit the operator should set the tidal volume to 500 mL, the gas flow low (e.g., 20 L/min), the maximum pressure limit high (e.g., 100 to 120 cm H₂O), and an inspiratory pause of 1 to 2 seconds.

DIF:    1                      REF:    pg. 125

3. How often should the fractional inspired oxygen (F_IO₂) of an adult be measured with an oxygen analyzer?

ANS:   C

The fractional inspired oxygen (F_IO₂) for a ventilated adult should be measured during each patient-ventilator system check.

DIF:    1                      REF:    pg. 125

4. How long after beginning mechanical ventilation on a patient should an arterial blood gas sample be drawn?

ANS:   C

An arterial blood gas sample should be obtained about 15 minutes following the initiation of mechanical ventilation. This is vital for the evaluation of the effectiveness of ventilation and oxygenation.

DIF:    1                      REF:    pg. 126

5. A female patient who is 5’7” tall and weighs 68 kg is being mechanically ventilated with volume-controlled continuous mandatory ventilation (VC-CMV), set rate 12, patient trigger rate 25 bpm, tidal volume (V_T) 500 mL, set flow rate 60 L/min, fractional inspired oxygen (F_IO₂) 40%, positive-end-expiratory pressure (PEEP) 5 cm H₂O. The patient is currently in distress using accessory muscles of inspiration. A patient-ventilator system check is performed by the respiratory therapist. The flow-time waveform shows a failure of the expiratory flow to return to zero before the next breath is triggered. The most appropriate action for the respiratory therapist to take includes which of the following?

ANS:   D

There are two clues to the fact that this patient is having problems because of unintended positive-end-expiratory pressure (auto-PEEP): the patient’s trigger rate of 25 bpm and the flow-time curve not returning to zero before the next breath is triggered. Sedating the patient is not the most appropriate action to take in this situation. Sedating and paralyzing the patient is reserved as a last resort for respiratory distress from patient-ventilator asynchrony. Switching to pressure-controlled continuous mandatory ventilation (PC-CMV) will most likely not change the situation too much, unless the pressure is markedly reduced to reduce the tidal volume. Decreasing the set rate to 8 bpm will not affect the patient’s trigger rate and therefore will not change the situation. Switching to a mode where there is more spontaneous breathing is an acceptable strategy for dealing with auto-PEEP.

DIF:    3          REF:    pg. 128| pg. 129