Pulmonary Physiology
Final Test Solutions
Course Introduction
Pulmonary Physiology explores the fundamental principles of respiratory system function, emphasizing the mechanics of breathing, gas exchange, regulation of respiration, and acid-base balance. The course delves into the structural and functional organization of the lungs, transport of oxygen and carbon dioxide, control of ventilation, and the physiological adaptations to varying oxygen demands. Students will also examine pathophysiological changes seen in respiratory diseases, laboratory methods for assessing pulmonary function, and the integration of pulmonary processes with overall homeostasis.
Recommended Textbook
Pilbeams Mechanical Ventilation Physiological and Clinical Applications 6th Edition by J M Cairo
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23 Chapters
707 Verified Questions
707 Flashcards
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Chapter 1: Basic Terms and Concepts of Mechanical
Ventilation
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36 Verified Questions
36 Flashcards
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Sample Questions
Q1) The patient-ventilator data over the past few hours demonstrates an increased peak inspiratory pressure (PIP)with a constant transairway pressure (P ).The respiratory therapist should conclude which of the following?
A) Static compliance (C )has increased.
B) Static compliance (C )has decreased.
C) Airway resistance (R ) has increased.
D) Airway resistance (R ) has decreased.
Answer: B
Q2) The formula used for the calculation of static compliance (Cs)is which of the following?
A) (Peak inspiratory pressure (PIP) - EEP)/tidal volume (V )
B) (Plateau pressure (P ) - EEP)/tidal volume (V )
C) Tidal volume/(plateau pressure - EEP)
D) Tidal volume/(peak pressure (PIP) - plateau pressure (P ))
Answer: C
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3
Chapter 2: How Ventilators Work
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Sample Questions
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 internal circuit of a ventilator allows the gas to go directly from its power source into the patient.This is known as which of the following?
A) Single-circuit
B) Open loop
C) Closed loop
D) Double-circuit
Answer: A
Q3) The function of the exhalation valve is to do which of the following?
A) Adjust the flow going to the patient.
B) Close during exhalation to vent patient gas.
C) Seal the external circuit during inspiration.
D) Determine the volume being delivered.
Answer: C
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Page 4
Chapter 3: How a Breath Is Delivered
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Sample Questions
Q1) The trigger variable in the controlled mode is which of the following?
A) Flow
B) Time
C) Pressure
D) Volume Answer: B
Q2) How many variables can a ventilator control at one time?
A) One
B) Two
C) Three
D) Four Answer: A
Q3) The limit variable set on a mechanical ventilator will do which of the following?
A) End inspiration
B) Begin inspiration
C) Control the maximum value allowed
D) Control the minimum value allowed
Answer: C
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Chapter 4: Establishing the Need for Mechanical Ventilation
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Sample Questions
Q1) A 64-year-old female patient having an acute exacerbation of chronic obstructive pulmonary disease (COPD)was admitted to the hospital yesterday.During rounds today the respiratory therapist finds the patient to be difficult to arouse and has the following physical findings: heart rate 102 beats/min,respiratory rate 23 breaths/min shallow and slightly labored,breath sounds are bilaterally decreased with rhonchi in both bases.The patient has a frequent butweak cough. The respiratory therapist draws an ABG with the following results on a 2 L/min nasal cannula: pH 7.52, P<sub>a</sub>CO<sub>2</sub> 30 mm Hg, P<sub>a</sub>O<sub>2</sub> 45 mm Hg, S<sub>a</sub>O<sub>2</sub> 86%, HCO<sub>3</sub><sup>-</sup> 24 m Eq/L. The most appropriate action is which of the following?
A) Intubate and mechanically ventilate.
B) Increase the nasal cannula to 4 L/min.
C) Administer incentive spirometry.
D) Begin noninvasive positive pressure ventilation.
Q2) Acute hypercapnic respiratory failure may be caused by which of the following?
A) Decreased fractional inspired oxygen (F O )
B) Pulmonary shunt
C) Respiratory muscle fatigue
D) Perfusion/diffusion impairment
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Chapter 5: Selecting the Ventilator and the Mode
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Sample Questions
Q1) In which of the following situations would NIV be tried?
A) Patient in whom blood pressure is 65/35, heart rate is 150 beats/min, and respiratory frequency is 34 breaths/min
B) Patient who nearly drowned who has copious amounts of white, frothy secretions
C) Patient with chronic obstructive pulmonary disease (COPD) and right lower-lobe pneumonia with respiratory acidosis and increased work of breathing (WOB)
D) A 5-year-old child who has aspirated a piece of chicken and is having trouble breathing
Q2) The ventilator mode that would be most appropriate to iatrogenically induce hyperventilation to manage a closed head injury patient with severely elevated intracranial pressure (ICP)is which of the following?
A) Volume support ventilation (VSV)
B) Airway pressure release ventilation (APRV)
C) Pressure-controlled continuous mandatory ventilation (PC-CMV)
D) Volume-controlled intermittent mandatory ventilation (VC-IMV)
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Chapter 6: Initial Ventilator Settings
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Sample Questions
Q1) A 47-year-old,6'1" male patient is admitted to the hospital due to trauma from a motor vehicle accident.Forty-eight hours post admission,the patient is suffering from respiratory distress with severe hypoxemia and is intubated.A chest X-ray,done prior to intubation,reveals a ground glass appearance bilaterally.The physician requests the volume-controlled continuous mandatory ventilation (VC-CMV)mode for this patient.The initial settings for the ventilator should be which of the following?
A) V = 450 mL, rate = 18 breaths/min, PEEP = 8 cm H O
B) V = 600 mL, rate = 10 breaths/min, PEEP = 5 cm H O
C) V = 750 mL, rate = 15 breaths/min, PEEP = 10 cm H O
D) V = 900 mL, rate = 12 breaths/min, PEEP = 5 cm H O
Q2) Calculate the average tidal volume for a patient who has a minute ventilation of 10 L/min with a respiratory rate (RR)of 12 breaths/min.
A) 120 mL
B) 833 mL
C) 1000 mL
D) 1200 mL
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8
Chapter 7: Final Considerations in Ventilator Setup
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Sample Questions
Q1) Following successful cardiac resuscitation,a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (F O )settings?
A) 0.5
B) 0.6
C) 0.8
D) 1.0
Q2) A patient is intubated due to an acute exacerbation of chronic obstructive pulmonary disease (COPD).The patient is now breathing with pressure support ventilation 5 cm H O and continuous positive airway pressure (CPAP)5 cm H O.The patient is unable to flow trigger every inspiration.Unintended positive end-expiratory pressure (auto-PEEP)is measured at 10 cm H O.The most appropriate action to take is which of the following?
A) Decrease the CPAP to 3 cm H O.
B) Increase the CPAP to 8 cm H O.
C) Increase pressure support to 10 cm H O.
D) Change the flow trigger setting to 1 L/min.
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Chapter 8: Initial Patient Assessment
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Sample Questions
Q1) A 6'2" male patient is being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV)mode with a set tidal volume (V )of 650 mL.There is 40 mL of mechanical dead space.Calculate the final alveolar ventilation.
A) 432 mL
B) 445 mL
C) 510 mL
D) 535 mL
Q2) 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?
A) Tidal volume (V ) = 500 mL, Flow rate = 60 L/min, High pressure limit = 50 cm H O
B) V = 1000 mL, Flow rate = 20 L/min, High pressure limit = maximum
C) V = 500 mL, Flow rate = 20 L/min, High pressure limit = maximum, Inspiratory pause = 2 seconds
D) V = 200 mL, Flow rate = Maximum, High pressure limit = 50 cm H O, Inspiratory pause = 1 second
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Chapter 9: Ventilator Graphics
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Sample Questions
Q1) 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.
Q2) The type of flow curve produced by volume ventilation with constant flow is which of the following?
A) Sinusoidal
B) Rectangular
C) Descending ramp
D) Exponential decay
Q3) Which of the following conditions causes a pressure-volume loop during volume-controlled continuous mandatory ventilation (VC-CMV)to extend farther to the right and flatten out?
A) Asthma
B) Bronchitis
C) Emphysema
D) Pneumonia
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Chapter 10: Assessment of Respiratory Function
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Sample Questions
Q1) A patient-ventilator system check reveals the following information: peak inspiratory pressure (PIP)32 cm H O,positive end-expiratory pressure (PEEP)12 cm H O,plateau pressure (P )20 cm H O,inspiratory time (T )1 second,and set frequency 12/min.Calculate the mean airway pressure.
A) 4 cm H O
B) 8 cm H O
C) 12 cm H O
D) 14 cm H O
Q2) The best assessment of the function of the diaphragm during inspiration is obtained by measuring which of the following?
A) Airway resistance
B) Pressure-time product
C) Pressure-volume curve
D) Maximum inspiratory pressure
Q3) Select the ventilator flowmeter that will read accurately when used with heliox.
A) Turbine
B) Vortex ultrasonic
C) Variable capacitance
D) Variable orifice pneumotachometer
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Page 12
Chapter 11: Hemodynamic Monitoring
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Sample Questions
Q1) The following hemodynamic measurements were obtained from a patient in the intensive care unit: pulmonary artery pressure (PAP)= 67/25 mm Hg,pulmonary artery occlusion pressure (PAOP)= 18 mm Hg,blood pressure (BP)= 100/50 mm Hg,central venous pressure (CVP)= 17 mm Hg,cardiac output (C.O.)= 5.7 L/min,and heart rate (HR)= 75 beats/min.Calculate this patient's systemic vascular resistance (SVR).
A) 295 dyne × sec × cm
B) 393 dyne × sec × cm
C) 800 dyne × sec × cm
D) 1165 dyne × sec × cm
Q2) During the insertion of a pulmonary artery catheter,the balloon needs to be inflated with air when it enters which of the following?
A) Right atrium
B) Right ventricle
C) Pulmonary artery
D) Intrathoracic vessel
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Chapter 12: Methods to Improve Ventilation in Patient-Ventilator
Management
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Sample Questions
Q1) When using an SVN or pMDI with NPPV,where in the NPPV circuit should the device be placed to obtain the greatest aerosol deposition?
A) Before the leak port
B) Anywhere in the circuit
C) Between the NPPV and the humidifier
D) Between the leak port and the face mask
Q2) A 28-year-old female (55-kg IBW)is being mechanically ventilated with VC-CMV,f = 14/min,V = 700 mL.The patient has no history of pulmonary disease.The resulting ABG values are: pH 7.55,P CO 27 mm Hg,HCO 23 mEq/L.The most appropriate action to take is which of the following?
A) Decrease V to 600 mL.
B) Decrease V to 450 mL.
C) Decrease f to 12/min.
D) Decrease f to 10/min.
Q3) At what point during deep suctioning should negative pressure be applied?
A) Five seconds after resistance is met
B) Ten seconds after insertion of the catheter
C) After 1-cm withdrawal from the point of resistance
D) After 2-cm withdrawal from the point of resistance
Page 14
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Chapter 13: Improving Oxygenation and Management of ARDS
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Sample Questions
Q1) How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?
A) 5 minutes
B) 15 minutes
C) 25 minutes
D) 40 minutes
Q2) Assessing the outcome of PEEP at levels set above 15-20 cm H O is best done using which of the following?
A) Static compliance measurements
B) Pressure-volume loop graphics
C) Pulmonary artery occlusion pressure
D) Central venous pressure measurements
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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Sample Questions
Q1) The mortality rate for VAP depends on which of the following?
1)Length of stay on the ventilator
2)Presence of underlying disease
3)Prior antimicrobial therapy
4)Presence of a heated humidifier
A) 1 and 2 only
B) 2 and 3 only
C) 1 and 4 only
D) 1, 2, 3, and 4
Q2) The incidence of ventilator-associated pneumonia for all intubated patients is
A) 8-28%
B) 15-35%
C) 25-50%
D) 38-76%
Q3) Sixty percent of all VAP infections are caused by which of the following?
A) Aerobic gram-negative bacilli
B) Anaerobic gram-negative bacilli
C) Aerobic gram-negative rods
D) Anaerobic gram-positive cocci
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Chapter 15: Sedatives, Analgesics, and Paralytics
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Sample Questions
Q1) Permissive hypercapnia is needed to protect patients with ARDS from atelectrauma.Which of the following medications is appropriate to facilitate this?
A) Propofol
B) Fentanyl
C) Midazolam
D) Cisatracurium
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
Q3) The drug of choice for sedating mechanically ventilated patients in the ICU for longer than 24 hours is which of the following?
A) Lorazepam (Ativan)
B) Midazolam (Versed)
C) Diazepam (Valium)
D) Propofol (Diprivan)
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Chapter 16: Extrapulmonary Effects of Mechanical
Ventilation
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Sample Questions
Q1) Positive pressure ventilation has which of the following effects on the kidneys?
A) Increases blood flow to the kidneys
B) Redistributes blood flow in the kidneys
C) Decreases sodium reabsorption in the kidneys
D) Increases urinary output
Q2) Urinary output is severely reduced when the renal arterial pressure decreases below what level?
A) 75 mm Hg
B) 85 mm Hg
C) 95 mm Hg
D) 105 mm Hg
Q3) 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..
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Page 18
Chapter 17: Effects of Positive Pressure Ventilation on the
Pulmonary System
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Sample Questions
Q1) 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.
Q2) Shear stress injury and loss of surfactant from the resulting unstable lung units result in a loss of surfactant.This type of pulmonary trauma is known as _____________.
A) atelectrauma
B) barotrauma
C) biotrauma
D) volutrauma
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Chapter 18: Troubleshooting and Problem Solving
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Sample Questions
Q1) The initial step in the management of patient-ventilator asynchrony is which of the following?
A) Lower the high pressure alarm setting.
B) Check the endotracheal tube cuff pressure.
C) Ventilate the patient with a manual resuscitator bag.
D) Check the low and high pressure alarm settings.
Q2) Reduction of preload and afterload is important in the management of which of the following?
A) Pulmonary embolism
B) Dynamic hyperinflation
C) Cardiogenic pulmonary edema
D) Noncardiogenic pulmonary edema
Q3) During ventilation with VC-CMV,pleural drainage leaks sometimes can be compensated for by increasing which of the following?
A) The number of chest tubes
B) The set tidal volume
C) The set pressure limit
D) The set peak inspiratory flow
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Chapter 19: Basic Concepts of Noninvasive
Positive-Pressure Ventilation
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Sample Questions
Q1) A patient with acute cardiogenic pulmonary edema is to be placed on CPAP.What should the initial setting be?
A) 3-5 cm H O
B) 5-7 cm H O
C) 10-12 cm H O
D) 15-20 cm H O
Q2) A 75-year-old man with a long history of COPD is brought to the emergency department with shortness of breath.He has a persistent,productive cough with green purulent sputum,cyanosis of the lips and extremities,and is uncooperative.His arterial blood gas values on 2 L/min by nasal cannula are: pH = 7.25; P CO = 90 mm Hg; P O = 38 mm Hg; S O = 59%; HCO = 38 mEq/L.The most appropriate action at this time is which of the following?
A) IPPB
B) Mask CPAP
C) NIV via full face mask
D) Invasive mechanical ventilation
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Chapter 20: Weaning and Discontinuation from Mechanical Ventilation
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Sample Questions
Q1) 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.
A) 6
B) 12
C) 24
D) 36
Q2) What ends inspiration in pressure support ventilation?
A) Time
B) Flow
C) Volume
D) Pressure
Q3) 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
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22
Chapter 21: Long-Term Ventilation
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Sample Questions
Q1) Follow-up assessment of a patient who is home ventilated on a regular service schedule generally includes which of the following?
1)Vital signs
2)Arterial blood gas (ABG)evaluation
3)Oxygen saturation measured by pulse oximeter (S O )
4)Portable chest radiograph
A) 1 only
B) 2 only
C) 1 and 3 only
D) 1, 2, 3, and 4
Q2) The preferred location for ventilator-dependent patients is ________________________.
A) a skilled nursing facility
B) a subacute care unit
C) their own homes
D) a long-term acute care hospital
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Chapter 22: Neonatal and Pediatric Ventilation
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Sample Questions
Q1) Newer ventilators allow neonates to use what type of trigger for better synchronization with the ventilator?
A) Time
B) Flow
C) Pressure
D) Volume
Q2) Bubble CPAP should_________________________________.
A) bubble only on expiration
B) bubble only on inspiration
C) bubble on inspiration and expiration
D) have a gas flow setting of 10 L/min
Q3) A full-term neonate shows signs of respiratory distress after delivery by cesarean section.The baby is placed on nasal CPAP at 4 cm H O with an F O of 0.6.The ABG results on these settings are: pH = 7.32,P CO = 45 mm Hg,P O = 48 mm Hg,S O = 70%,HCO = mEq/L.The respiratory therapist should recommend which of the following?
A) Intubate and mechanically ventilate.
B) Increase the F O to 0.7.
C) Increase the CPAP to 6 cm H O.
D) Intubate and use ventilator CPAP.
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Page 24
Chapter 23: Special Techniques in Ventilatory Support
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Sample Questions
Q1) The advantage of APRV over VC-CMV or PC-CMV is which of the following?
A) It enhances CO elimination.
B) Volume delivery is consistent.
C) Independent lung regions are better ventilated.
D) It reduces the risk of ventilator-induced lung injury.
Q2) The chest radiograph of a patient just placed on HFOV shows the diaphragm at the level of the seventh rib.Which of the following parameters should be adjusted?
A) mP<sub>aw</sub>
B) Power
C) Bias flow
D) Amplitude
Q3) The most common concentration of heliox is
A) 50% helium:50% oxygen
B) 60% helium:40% oxygen
C) 70% helium:30% oxygen
D) 80% helium:20% oxygen
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