Mechanical Ventilation
Midterm Exam
Course Introduction
Mechanical Ventilation is a comprehensive course that explores the principles, settings, modes, and clinical applications of mechanical ventilators in the management of patients with respiratory failure. Students will learn about the indications for initiating ventilation, various types of ventilator support, monitoring techniques, troubleshooting common complications, and strategies for weaning patients. Emphasis is placed on integrating theory with clinical practice through case studies, evidence-based guidelines, and hands-on demonstrations, preparing healthcare professionals to optimize patient outcomes in both acute and chronic care settings.
Recommended Textbook
Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by J M Cairo
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Page 2
Chapter 1: Basic Terms and Concepts of Mechanical
Ventilation
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Sample Questions
Q1) Plateau pressure (P )is measured during which phase of the ventilatory cycle?
A) Inspiration
B) End-inspiration
C) Expiration
D) End-expiration
Answer: B
Q2) The pressure required to maintain alveolar inflation is known as which of the following?
A) Transairway pressure (P )
B) Transthoracic pressure (P )
C) Transrespiratory pressure ( P )
D) Transpulmonary pressure (P )
Answer: D
Q3) Which of the following are involved in external respiration?
A) Red blood cells and body cells
B) Scalenes and trapezius muscles
C) Alveoli and pulmonary capillaries
D) External oblique and transverse abdominal muscles
Answer: C
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Chapter 2: How Ventilators Work
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Q1) Which of the following is an example of a flow control valve?
A) Linear piston
B) Spring-loaded bellows
C) Solenoid
D) Rotary drive piston
Answer: C
Q2) The respiratory therapist enters modes and parameters into the ventilator with which of the following?
A) Control logic
B) Input power
C) User interface
D) Drive mechanism
Answer: C
Q3) Modern intensive care units' (ICU)ventilators regulate gas flow to the patient by using which of the following?
A) Rotary drive pistons
B) Linear drive pistons
C) Proportional solenoids
D) Spring-loaded bellows
Answer: C
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Chapter 3: How a Breath Is Delivered
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Sample Questions
Q1) The ventilator that can provide a negative pressure during the very beginning of the exhalation phase is which of the following?
A) Servo<sup>i</sup>
B) VIASYS Avea
C) Puritan Bennett 840
D) Cardiopulmonary Venturi
Answer: D
Q2) The respiratory therapist enters the room of a patient being mechanically ventilated with volume ventilation.The high pressure alarm is sounding and the measured exhaled tidal volume is significantly lower than what is set.The variable that is ending inspiration is which of the following?
A) Time
B) Flow
C) Pressure
D) Volume
Answer: C
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Chapter 4: Establishing the Need for Mechanical Ventilation
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Sample Questions
Q1) A patient seen in the emergency department exhibits paralysis of the lower extremities that is getting progressively worse.Vital capacity is 6 mL/kg,maximum inspiratory pressure (MIP)is -17 cm H O,and oxygen saturation measured by pulse oximeter (S O )is 89%.Arterial blood gases are pending.The physician suspects Guillain-Barré syndrome.The most appropriate action at this time is which of the following?
A) Intubate and mechanically ventilate.
B) Place patient on a nonrebreather mask.
C) Initiate continuous positive airway pressure.
D) Initiate noninvasive positive pressure ventilation.
Q2) Respiratory failure due to inadequate ventilation is known as which of the following?
A) Hypoxemic
B) Hypercapnic
C) Compensated
D) Chronic
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Chapter 5: Selecting the Ventilator and the Mode
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Sample Questions
Q1) The ventilator mode that allows the patient to breathe spontaneously between operator-selected time-triggered volume and pressure-targeted breaths is which of the following?
A) Pressure support ventilation (PSV)
B) Continuous mandatory ventilation (CMV)
C) Intermittent mandatory ventilation (IMV)
D) Airway pressure release ventilation (APRV)
Q2) An assisted breath in the pressure controlled continuous mandatory ventilation (PC-CMV)mode can be described by which of the following?
A) Time triggered, pressure limited, time cycled
B) Patient triggered, pressure limited, time cycled
C) Time triggered, pressure limited, pressure cycled
D) Patient triggered, volume limited, volume cycled
Q3) A home care patient diagnosed with central sleep apnea would benefit from which of the following modes of ventilation?
A) Pressure support ventilation (PSV)
B) Noninvasive positive pressure ventilation (NIV)
C) Continuous positive airway pressure (CPAP)
D) Pressure controlled intermittent mandatory ventilation (PC-IMV)
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Page 7
Chapter 6: Initial Ventilator Settings
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Sample Questions
Q1) Calculate the inspiratory time (T )when a ventilator is set at a tidal volume (V )of 500 mL and a constant flow rate of 30 L/min.
A) 0.6 second
B) 1 second
C) 1.5 second
D) 1.7 second
Q2) Calculate the inspiratory time (T )when a ventilator is set at a tidal volume (V )of 800 mL and a constant flow rate of 40 L/min.
A) 0.02 second
B) 0.5 second
C) 1.2 second
D) 3.2 seconds
Q3) With which flow waveform pattern will the mean airway pressure be the highest?
A) Sine
B) Square
C) Ascending ramp
D) Descending ramp
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8
Chapter 7: Final Considerations in Ventilator Setup
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Sample Questions
Q1) Sigh breaths could be beneficial during which of the following situations?
A) Continuous positive airway pressure (CPAP) used for the treatment of hypoxemia.
B) Mechanical ventilation with V s = 8-10 mL/kg.
C) Ventilating acute respiratory distress syndrome (ARDS) patient with plateau pressure P >30 cm H O.
D) Pressure-supported ventilation with tidal volume (V ) = 4-6 mL/kg
Q2) Identify the patient who could benefit from sigh breaths.
A) Patient on pressure-controlled continuous mandatory ventilation (PC-CMV) with peak inspiratory pressure (PIP) = 38 cm H O
B) Patient on volume-controlled continuous mandatory ventilation (VC-CMV) with a plateau pressure (P<sub>plateau</sub> ) = 36 cm H O
C) Spontaneously breathing patient receiving continuous positive airway pressure (CPAP)
D) 70 kg ideal body weight (IBW) patient on 400 mL with P<sub>plateau</sub> = 25 cm H O
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Chapter 8: Initial Patient Assessment
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Sample Questions
Q1) Following initiation of volume-controlled continuous mandatory ventilation (VC-CMV)ventilation,the patient's average peak inspiratory pressure (PIP)is 23 cm
H O.The high pressure limit alarm should be set at which of the following?
A) 28 cm H O
B) 33 cm H O
C) 38 cm H O
D) 43 cm H O
Q2) The respiratory therapist is performing a physical assessment of a patient receiving pressure support ventilation.The patient is short of breath,has a respiratory rate of 28 breaths/min,a dull percussion note over the right base that becomes resonant over the right upper lobe,and resonance over the left lung.Chest movement on the right side is decreased.The STAT chest X-ray reveals a blunting of the right costophrenic angle.The pulmonary disorder that is causing this clinical presentation is which of the following?
A) Acute respiratory distress syndrome (ARDS)
B) Emphysema
C) Pneumothorax
D) Pleural effusion
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Chapter 9: Ventilator Graphics
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Sample Questions
Q1) The term used to specify the flow,pressure,and volume waveforms that are graphed relative to time is called:
A) hysteresis.
B) loop.
C) waveform.
D) scalar.
Q2) An inadequate flow setting during volume ventilation will cause which of the following to occur?
A) The volume curve will drop below the zero baseline.
B) The volume curve will not drop to the zero baseline.
C) The exhaled flow will take longer to rise to the zero baseline.
D) The pressure-time curve will appear concave during inspiration.
Q3) The volume curve on a volume-time scalar is consistently dropping below the baseline during exhalation.The first action to take is which of the following?
A) Measure the plateau pressure.
B) Measure the endotracheal (ET) tube cuff pressure.
C) Check the ventilator circuit for a leak.
D) Assess the patient for active exhalation.
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11
Chapter 10: Assessment of Respiratory Function
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Sample Questions
Q1) A patient whose carbon dioxide (CO )production is 390 mL/min and oxygen (O )consumption is 375 mL/min is most likely experiencing which of the following?
A) Ketosis
B) Severe sepsis
C) Hyperventilation
D) Too much carbohydrate intake
Q2) During calibration of a transcutaneous monitor the respiratory therapist notices a signal drift.The respiratory therapist should do which of the following?
A) Increase the probe temperature.
B) Replace the monitor and call for repair.
C) Add more electrolyte gel to the patient's skin.
D) Change the electrolyte and sensor's membrane.
Q3) What type of electrode is used by a transcutaneous partial pressure of carbon dioxide (P O )device?
A) Galvanic
B) Polarographic
C) Paramagnetic
D) Stow-Severinghaus
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Chapter 11: Hemodynamic Monitoring
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Sample Questions
Q1) Calculate the cardiac index for a patient with the following data: heart rate = 80 beats/min,stroke volume = 55 mL,and body surface area = 2.8 m².
A) 0.57 L/min/m²
B) 1.6 L/min/m²
C) 7.2 L/min/m²
D) 19.6 L/min/m²
Q2) Calculate the ejection fraction of a female patient with a stroke volume of 40 mL and an end-diastolic volume of 125 mL.
A) 0.32
B) 3.1
C) 85
D) 165
Q3) A patient with an oxygen consumption of 340 mL/min,arterial oxygen content of 17.3 vol%,and mixed venous oxygen content of 12.8 vol% has a cardiac output of which of the following?
A) 2 mL/min
B) 2.6 mL/min
C) 7.6 mL/min
D) 11 mL/min
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Page 13
Chapter 12: Methods to Improve Ventilation in Patient-Ventilator Management
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Sample Questions
Q1) Advantages of closed suctioning include which of the following?
1)No need to prehyperoxygenate or posthyperoxygenate.
2)No need to prehyperventilate or posthyperventilate.
3)Decreased risk of infection for caregiver.
4)No loss of PEEP during the procedure.
A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 4 only
D) 2, 3, and 4 only
Q2) A patient with pneumonia and underlying COPD is being mechanically ventilated in the VC-CMV mode with V 650 mL.The resulting P CO is 62 mm Hg.What change should be made to the V to obtain a desired P CO of 50 mm Hg for this patient?
A) 400 mL
B) 800 mL
C) 1000 mL
D) 1200 mL
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14
Chapter 13: Improving Oxygenation and Management of ARDS
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Sample Questions
Q1) Which of the following patients may benefit from PEEP?
A) COPD
B) Asthma
C) ARDS
D) Cystic fibrosis
Q2) During a patient case study,increasing increments of PEEP showed no significant effects until 15 cm H O was used,at which time the P O improved markedly.This represents the point at which _______________.
A) cardiac output decreased
B) airway resistance decreased
C) hemoglobin saturation improved
D) alveolar recruitment probably occurred
Q3) During mechanical ventilation of a patient with CHF,the P O = 38 mm Hg and the F O = 0.6.If the desired P O is 60 mm Hg,the F O needs to be changed to which of the following?
A) 0.65
B) 0.75
C) 0.85
D) 0.95
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Chapter 14: Ventilator-Associated Pneumonia
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Q1) Which of the following is not a method to reduce the risk of VAP?
A) Nasally intubate whenever possible.
B) Provide intermittent nasogastric tube feedings.
C) Keep patient in a semirecumbent position.
D) Use heat/moisture exchangers when possible.
Q2) The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with early-onset VAP is which of the following?
A) Linezolid
B) Vancomycin
C) Gentamicin
D) Levofloxacin
Q3) A patient with which of the following CPIS criteria should be placed on empiric antibiotic therapy pending the outcome of a bronchial alveolar lavage?
A) CPIS = 4
B) CPIS = 5
C) CPIS = 6
D) CPIS = 7
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Chapter 15: Sedatives, Analgesics, and Paralytics
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Sample Questions
Q1) A patient with hypovolemic shock secondary to widespread second- and third-degree burns is being mechanically ventilated.The patient appears agitated,and the respiratory therapist is unable to synchronize the ventilator to the patient.Which drug can the respiratory therapist suggest to the ICU team to sedate this patient and synchronize ventilation?
A) Fentanyl
B) Morphine
C) Propofol
D) Succinylcholine
Q2) A patient who is receiving mechanical ventilation in the ICU is found to be wildly agitated.The most appropriate drug to control this delirium is which of the following?
A) Propofol
B) Fentanyl
C) Haloperidol
D) Lorazepam
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Chapter 16: Extrapulmonary Effects of Mechanical
Ventilation
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Sample Questions
Q1) Which of the following ventilator parameters would result in the highest mean airway pressure?
A) PIP = 30 cm H O; PEEP = 10 cm H O; TI = 0.5 sec; TCT = 5 sec
B) PIP = 50 cm H O; PEEP = 10 cm H O; TI = 0.5 sec; TCT = 5 sec
C) PIP = 30 cm H O; PEEP = 15 cm H O; TI = 0.5 sec; TCT = 5 sec
D) PIP = 50 cm H O; PEEP = 10 cm H O; TI = 0.5 sec; TCT = 5 sec..
Q2) Mechanical ventilation has an effect on the hormone _____________,which causes a decrease in urinary output.
A) cortisol
B) arginine vasopressin
C) parathyroid hormone
D) thyroid-stimulating hormone
Q3) During spontaneous breathing,the fall in intrapleural pressure that draws air into the lungs during inspiration also draws blood into the major thoracic vessels.This phenomenon increases which of the following?
A) Systemic vascular resistance
B) Right ventricular afterload
C) Right ventricular preload
D) Pulmonary capillary resistance
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Chapter 17: Effects of Positive Pressure Ventilation on the
Pulmonary System
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Sample Questions
Q1) The pressure-time scalar of a patient with COPD who is receiving PSV shows positive deflection toward the end of inspiration.The most appropriate way to alleviate this is to do which of the following?
A) Increase the PSV level.
B) Decrease the PSV level.
C) Increase the flow cycle percentage.
D) Decrease the flow cycle percentage.
Q2) The RT performs a patient-ventilator system check on a 24-year-old,5-foot,10-inch male patient who has been intubated because of a drug overdose.The RT notices what appears to be swelling around the patient's upper anterior chest and neck area.Palpation elicits a tissue paper feeling.The ventilator settings are: VC-CMV,rate 12/min with no patient assist,V 900 mL,PEEP 5 cm H O,F O 0.4,T 1.2 sec.The most appropriate action for the RT to take is which of the following?
A) Increase the set flow rate.
B) Decrease the set tidal volume.
C) Reduce the set respiratory rate.
D) Perform emergency needle decompression.
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Chapter 18: Troubleshooting and Problem Solving
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Q1) Which of the following can activate an apnea alarm?
A) Secretions
B) Auto-PEEP
C) Loss of PEEP
D) Active inhalation
Q2) The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the low pressure,low exhaled volume,and low V alarms active.The ventilator circuit is connected to the patient's endotracheal tube.This situation could be caused by which of the following?
A) Improper flow rate and flow pattern.
B) Poorly responsive internal demand valve.
C) Migration of the ET tube into the upper airway.
D) The patient is continuing to actively inhale.
Q3) An increased arterial-to-end-tidal partial pressure CO<sub>2</sub> gradient can help identify which of the following?
A) Pulmonary embolism
B) Dynamic hyperinflation
C) Cardiogenic pulmonary edema
D) Noncardiogenic pulmonary edema
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Page 20
Chapter 19: Basic Concepts of Noninvasive
Positive-Pressure Ventilation
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Sample Questions
Q1) To use CPAP successfully,a patient must have which of the following?
A) Adequate P CO
B) Secure artificial airway
C) P CO >40 mm Hg
D) Adequate spontaneous ventilation
Q2) The primary goal of NIV in the acute care setting is to do which of the following?
A) Improve sleep quality.
B) Decrease muscle fatigue.
C) Avoid invasive ventilation.
D) Eliminate nocturnal hypopnea.
Q3) Negative-pressure ventilators cause air to enter the lungs by increasing ______________ pressure.
A) transairway
B) transpulmonary
C) transrespiratory
D) transthoracic
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21
Chapter 20: Weaning and Discontinuation from Mechanical Ventilation
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Sample Questions
Q1) In which patient would continued use of an artificial airway be necessary?
A) A patient with upper airway burns and no peritubular leak
B) A patient who tests positive for a peritubular leak
C) A patient with bronchospasm and supplemental oxygen requirements
D) A patient with a strong cough who expectorates moderate amounts of sputum
Q2) Which parameter is used as the primary index of the drive to breathe?
A) Airway occlusion pressure
B) CROP index
C) Maximum inspiratory pressure
D) Rapid shallow breathing index
Q3) 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?
A) 2 cm H O
B) 5 cm H O
C) 8 cm H O
D) 10 cm H O
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Chapter 21: Long-Term Ventilation
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Sample Questions
Q1) A quadriplegic patient is getting ready for discharge home from an acute care hospital.He has a TT and requires mechanical ventilation around-the-clock,but does not need supplemental oxygen.What equipment must he have in his home?
1)Transport ventilator
2)Manual resuscitator bag
3)E-cylinder of oxygen
4)Ventilator circuits
A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 4 only
D) 2 and 4 only
Q2) Glossopharyngeal breathing is beneficial for patients with which condition?
A) Tracheomalacia
B) Postpolio syndrome
C) Muscular dystrophy
D) Pierre-Robin syndrome
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23
Chapter 22: Neonatal and Pediatric Ventilation
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Q1) The pressure manometer in-line with a bubble CPAP setup is reading higher than the depth of the expiratory limb in the liquid-filled bottle.This is most likely caused by which of the following?
A) Set flow rate above 5 L/min
B) Set flow rate below 5 L/min
C) Fluid in the inspiratory line
D) Improperly placed manometer
Q2) Oxygen delivery and tissue perfusion may be evaluated clinically by which of the following?
A) Mucous membrane color
B) Skin color and tone
C) Capillary refill
D) Chest X-ray
Q3) The mode of ventilation that allows a neonate to breathe at a high and a low CPAP setting is which of the following?
A) SiPAP
B) HFOV
C) Nasal IMV
D) Nasal HFV
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Page 24
Chapter 23: Special Techniques in Ventilatory Support
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Q1) When T<sub>high</sub> is set at 5.5 seconds,and the T is set at 0.5 second,what is the set ventilator rate?
A) 8
B) 10
C) 14
D) 16
Q2) Weaning from APRV includes which of the following?
A) Increasing the P and decreasing the T<sub>high</sub>
B) Decreasing the P and increasing the T<sub>high</sub>
C) Increasing the P and decreasing the T<sub>low</sub>
D) Decreasing the P and increasing the T<sub>low</sub>
Q3) The NAVA mode can be used in which of the following situations?
A) Paralysis
B) Heavy sedation
C) Injury to the respiratory brain centers
D) Spontaneous breathing
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