Mechanical Vent Test 3 Practice

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• Name three common etiologies of acute respiratory failure requiring MV.
• Which strategy helps minimize oxygen toxicity and hypercapnia risk for a patient with COPD on mechanical ventilation?
• A sudden rise in peak inspiratory pressure with a normal plateau pressure most likely indicates which issue, and what should be done?
• What is CPAP and how is it used during weaning or post-extubation?
• Driving pressure is defined as which of the following, and what does it reflect clinically?
• Initial ventilator settings for a patient with an intracranial bleed and ICP monitor should include which of the following?
• Based on the ventilator flow sheet in VC-CMV mode, which adjustment is most appropriate?
• Which radiographic finding is most associated with pneumonia in a postoperative patient?
• What plateau pressure limit is generally used to minimize volutrauma in adult ventilation?
• Which practice supports oxygenation and recruitment in the context of COPD management on MV?
• In VC-CMV, which parameter is set by the clinician?
• VC-CMV stands for which of the following?
• To reduce the risk of tracheal damage from overinflated cuffs, cuff pressures should be kept within which range?
• A humidifier used with a mechanical ventilator should deliver a minimum of how much humidity?
• What is a flow trigger and how does it differ from a pressure trigger?
• To identify auto-PEEP in a mechanically ventilated patient, which measurement is most appropriate?
• Which finding indicates an increase in airway resistance in a patient on mechanical ventilation with a constant tidal volume?
• Two common etiologies for a sudden rise in plateau pressure are decreased lung compliance and circuit/airway obstruction. How can these be differentiated clinically?
• In ARDS, what tidal volume is recommended as part of lung-protective ventilation?
• In ARDS management, what tidal volume is typically used to minimize volutrauma?
• How does sedation level influence MV weaning, and what is a common strategy to optimize weaning potential?
• Why is endotracheal tube cuff management important, and what is the typical cuff pressure range?
• What high-pressure alarm setting would be appropriate when peak inspiratory pressure is around 26 cm H2O on VC-CMV?
• In pediatric patients, typical tidal volume per kilogram during mechanical ventilation is approximately:
• A flow-time waveform shows expiratory flow failing to return to zero before the next breath is triggered during volume-controlled continuous mandatory ventilation (VC-CMV). What is the most appropriate action?
• Which ventilator mode is volume-controlled intermittent mandatory ventilation?
• How much pressure and time are typically used during a lung recruitment maneuver?
• What is the minimum humidity value delivered by a humidifier in this context?
• In pressure support ventilation, when is assistive pressure delivered?
• What is auto-PEEP (intrinsic PEEP) and one of its potential consequences?
• In ARDS, driving pressure is an important target. Which statement best captures its significance and the acceptable range?
• The ICU therapist responds to an alarm on the ventilator. What is the most appropriate immediate action?
• A 36-year-old female with asthma receives continuous aerosolized albuterol; after 1 hour ABG shows PaO2 53 mm Hg; what is the most appropriate action?
• Minute ventilation is calculated as tidal volume times respiratory rate; which adjustments can reduce PaCO2 if it is high?
• What is the Humidity Deficit Formula?
• Which auscultation finding is most characteristic of a pneumothorax?
• To help prevent inflated alveoli from collapsing and reexpanding with each breath, the PEEP level should be set at which point on the deflation part of the loop?
• While initially ventilating a patient with ARDS, the extrinsic PEEP should be maintained using which method?
• In the initial head injury ventilator settings, what was the tidal volume used?
• The normal airway resistance range is which of the following?
• What is the purpose of cuff pressure monitoring in endotracheal tubes?
• If peak inspiratory pressure rises while the plateau pressure remains the same during ventilation with a constant tidal volume, which parameter is most likely increasing?
• In the desired FiO2 formula, which term represents the FiO2 that is currently known?
• Which combination of suctioning practices is recommended to minimize suction-related adverse effects?
• On the static pressure-volume curve for ARDS, the pressure at which large numbers of alveoli are recruited is located at which point?
• Which physical examination finding supports a pleural effusion?
• What is physiologic dead space and how does it affect minute ventilation requirements?
• How often should the fractional inspired oxygen (FIO2) of an adult be measured?
• Following initiation of VC-CMV ventilation, the patient’s average peak inspiratory pressure (PIP) is 23 cm H2O. The high pressure limit alarm should be set at which value?
• An arterial blood gas in a patient on mechanical ventilation shows respiratory acidosis with hypoxemia. What is the correct interpretation?
• In volume-controlled continuous mandatory ventilation (VC-CMV), breaths are delivered with a set tidal volume. Which parameter is fixed?
• In a patient with myasthenia gravis requiring ventilatory support, which ventilator settings are most appropriate?
• Which is a best practice for managing ventilator alarms in a critical care setting?
• Which pathophysiologic condition increases peak inspiratory pressure (PIP) while transairway pressure (PTA) remains the same?
• What is a typical consequence of setting PEEP too high?
• How can the shape of the pressure-volume (PV) curve inform ventilator management?
• What ventilator alarm is most commonly associated with a circuit disconnection, and how should it be managed?
• Which clinical sign indicates respiratory distress in a patient who is mechanically ventilated?
• The static pressure-volume curve for 2 consecutive breaths indicates the presence of which of the following?
• Which FiO2 corresponds to a target PaO2 of 95 mm Hg when starting from PaO2 78 mm Hg on 35% oxygen?
• 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?
• In a patient with ARDS showing increased oxygen requirements and decreased lung compliance with bilateral fluffy infiltrates, which ventilator adjustments are most appropriate?
• Which of the following options falls within the typical ventilator flow triggering range?
• Transairway pressure (PTA) is rising while plateau pressure (Pplat) remains unchanged. Which action is most appropriate?
• A 49-kg female patient intubated on VC-CMV has persistent low-pressure and low-volume alarms with audible inspiratory murmuring. The most likely cause is?
• In pressure-controlled ventilation, if lung compliance decreases, what happens to tidal volume?
• Why should PEEP be set above the lower inflection point on the deflation limb of the PV loop?
• Which option best describes a lung recruitment maneuver?
• A humidifier malfunction on a ventilator is classified as which level of event?
• Describe typical APRV settings and rationale.
• In pressure-controlled continuous mandatory ventilation (PC-CMV), breaths are delivered at a set pressure with variable tidal volume depending on lung compliance. Which parameter is fixed?
• During permissive hypercapnia, which buffer is mentioned as helping maintain pH above 7.2?
• A patient is being ventilated with pressure-controlled intermittent mandatory ventilation (PC-IMV) at 15 breaths/min. The apnea alarm time setting should be which of the following?
• An increasing peak inspiratory pressure may indicate which of the following?
• Which physical exam finding is most consistent with pneumonia in a single lobe?
• Following initiation of VC-CMV ventilation, under which circumstance would switching to VC-IMV be most appropriate?
• During cuff measurement using a three-way stopcock, a manometer, and a syringe, which step minimizes cuff volume and pressure loss?
• If the absolute humidity is 12 mg/L, what is the humidity deficit?
• The first step in the assessment and documentation of patient-ventilator interaction following placement of a patient on a mechanical ventilator is which of the following?
• On the static pressure-volume curve for ARDS, the pressure at which large numbers of alveoli become overinflated is located at which point?
• Which statement supports the diagnosis of right middle lobe pneumonia in a mechanically ventilated patient?
• A PTA rising while plateau pressure remains unchanged. Which intervention could correct this problem?
• How does SIMV with pressure support differ from pure pressure support mode?
• Which statement best describes the core goals of lung-protective ventilation in ARDS?
• APRV (Airway Pressure Release Ventilation) has a key feature described as?
• In the initial head injury ventilator settings, which FiO2 value was used?
• A patient receiving 60% oxygen from an air entrainment mask has PaO2 45 mm Hg. The patient is being intubated and the ventilator is being set up. What FIO2 should be used to achieve PaO2 60 mm Hg?
• The goal of selecting a specific oxygen concentration is to try to achieve clinically acceptable arterial oxygen tensions within which range?
• During serial ventilator checks, a rise in peak inspiratory pressure with the plateau pressure remaining unchanged most likely indicates which change in the respiratory system?
• In volume-controlled ventilation with VC-CMV, a trend showing decreasing delivered tidal volume while inspiratory pressure is held constant indicates which change in the patient’s lungs?
• The ventilator volume is set at 575 mL. The low exhaled tidal volume alarm should be set at which value?
• Why can edema or pneumonia lead to desaturation despite MV, and what is a typical management implication?
• A patient’s baseline ABG shows PaO2 of 67 mm Hg while receiving 40% FiO2. To achieve a target PaO2 of 80 mm Hg, what FiO2 should be set?
• A patient is intubated due to an acute exacerbation of COPD. The patient is now breathing with pressure support ventilation 5 cm H2O and CPAP 5 cm H2O. The patient is unable to flow trigger every inspiration. Unintended positive end-expiratory pressure (auto-PEEP) is measured at 10 cm H2O. The most appropriate action to take is which of the following?
• A physical examination of a patient on mechanical ventilation shows normal breath sounds and percussion except over the right middle lobe, where late inspiratory crackles are heard and the area is dull to percussion. A chest radiograph reveals infiltrates in the right middle lobe. Based on these findings, what is the most likely diagnosis?
• Noninvasive ventilation (NIV) is best described as ventilatory support delivered via a noninvasive interface. In which scenario is NIV preferred to endotracheal intubation?
• What is a T-piece trial and when is it used?
• What is the purpose of a sigh or intermittent larger breath in mechanical ventilation?
• Which suction approach reduces desaturation during suctioning?
• For a COPD patient with hypercapnic respiratory failure on nasal cannula, which strategy is recommended?
• Before a ventilator is used, an operational verification check is performed. A simple variation of this procedure is also performed under which circumstance?
• To minimize tracheal injury from endotracheal cuff inflation, cuff pressures should be kept within which range?
• Identify a common indication for initiating invasive mechanical ventilation.
• What is the formula for calculating the desired FiO2?
• A patient on pressure support ventilation (PSV) has an average minute volume of 6.4 L. What should the low exhaled minute volume alarm be set at?
• Which statement accurately describes the right middle lobe pneumonia scenario?
• What is the primary purpose of increasing extrinsic PEEP?
• What is a spontaneous breathing trial (SBT) and what is its typical duration and modality?
• During airway suctioning, patients may experience transient desaturation and tachycardia. Which measures reduce these effects?
• Which feature describes APRV in terms of spontaneous breathing?
• Which of the following patients would most likely benefit from sigh breaths?
• An 87-kg male patient intubated on PC-CMV has low alarms; ETT at 21 cm at the gum line, cuff pressure added resulting in seal requires 44 cm H2O. The respiratory therapist should do which?
• Positive pressure ventilation benefits left ventricular failure by which effect?
• What is the difference between I:E ratio and inspiratory time on a ventilator?
• The application of positive pressure for a patient with left ventricular failure is beneficial because of which effect?
• During mechanical ventilation, a patient with a closed head injury develops the Cushing response. This may be immediately managed by using which of the following?
• In PCV mode, which statement is true about what is held constant and what can vary?
• If cuff pressure is measured at 41 cm H2O, what is the immediate intervention?
• In volume-controlled ventilation (VCV), which quantity remains preset, respectively?
• Following successful cardiac resuscitation, a patient being placed on mechanical ventilation should have which of the following fractional inspired oxygen (FIO2) settings?
• A calculation: tubing compliance CT 2.5 mL/cm H2O; tidal volume at the exhalation port is 550 mL; peak inspiratory pressure is 28 cm H2O. The volume delivered to the patient is which of the following?
• Which statement describes the open lung approach used in ARDS management?
• Define the alveolar-arterial (A-a) gradient and explain how mechanical ventilation can influence it.
• Which statement about permissive hypercapnia in ARDS management is true?
• In COPD patients, what SpO2 target range is typically used, and how should FiO2 be adjusted to achieve it?
• In a 72-year-old man with congestive heart failure presenting with dyspnea, pink frothy sputum, and ABG showing acidosis and hypercapnia on nonrebreather, what is the most appropriate immediate action?
• Biotrauma refers to injury caused by inflammatory mediators released in response to ventilation.
• What precautions should be taken when performing recruitment maneuvers?
• Which intervention would most directly reduce peak inspiratory pressure caused by increased airway resistance?
• Which radiographic finding is most consistent with pneumonia in a postoperative patient?
• How do PEEP and FiO2 interact to achieve target oxygenation?
• Ventilator-induced lung injury (VILI) is injury caused by mechanical ventilation. Which four mechanisms comprise VILI?
• Which clinical scenario favors noninvasive ventilation over endotracheal intubation?
• During evaluation of a patient receiving pressure support ventilation, examination findings include dull percussion at the right base, decreased movement on the right, and a chest X-ray showing blunting of the right costophrenic angle. What is the most likely pulmonary problem?
• Following intubation on volume-controlled continuous mandatory ventilation, a patient's peak inspiratory pressure is 26 cm H2O after suctioning. Which settings for the low- and high-pressure alarms are appropriate?
• In a flow sheet for a patient on pressure-controlled continuous mandatory ventilation (PC-CMV), if exhaled tidal volume is decreasing, which parameter is most likely changing?
• What does plateau pressure reflect in mechanical ventilation?
• A patient's baseline arterial blood gas reveals PaO2 78 mm Hg while receiving 35% supplemental oxygen. To achieve a target PaO2 of 95 mm Hg, what should the ventilator FIO2 be set at?
• In COPD patients on mechanical ventilation, which statement best reflects adjunct therapy?
• Which ventilator event is explicitly categorized as potentially life-threatening?
• How much patient effort is needed to trigger a ventilator breath when there is 8 cm H2O of unintended positive end-expiratory pressure (auto-PEEP) and a pressure trigger setting of 2 cm H2O?
• Which ventilator strategy is most associated with reducing ventilator-induced lung injury?
• A patient two days after surgery presents with bibasilar infiltrates and dull percussion in both lower lobes. The most likely diagnosis is which of the following?
• How do volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) differ in terms of what is preset and what varies?
• Which maneuver is used to measure plateau pressure during mechanical ventilation?
• A volume-time curve on a ventilator shows decreasing delivered volume with each breath, suggesting a circuit problem. What is the most likely cause?
• In a CHF patient with pulmonary edema and ABG indicating respiratory compromise, what is the most appropriate initial ventilatory management described?
• In the described COPD patient with acute on chronic respiratory failure, which ventilator settings are most appropriate?
• What is the primary physiologic effect of PEEP on oxygenation?
• Why might edema or pneumonia cause desaturation despite seemingly adequate MV settings?
• What is the primary physiological effect of applying PEEP in mechanical ventilation?
• What unit is used for humidity deficit in this context?
• The mechanical ventilator event considered potentially life-threatening, or a level one event, is which of the following?
• A high plateau pressure during inspiratory hold indicates which of the following?
• Which statement best describes PCV mode and when it is favored over VCV?
• Which has greater influence on oxygenation and why?
• Sigh breaths could be beneficial during which ventilation setting?
• The flow sheet for a patient on pressure-controlled continuous mandatory ventilation (PC-CMV) demonstrates which of the following when Exhaled Vt is increasing?
• A cuff leak test assesses risk for extubation. If a cuff leak is present, what does it indicate about extubation risk?
• In the severe asthma patient, which action after intubation and ventilation was described?
• What is the primary purpose of PEEP in mechanical ventilation?
• In which situation should the heat moisture exchanger (HME) be used over a heated humidifier?
• When are recruitment maneuvers indicated, and what precautions should be taken?
• What fractional inspired oxygen (FIO2) setting on the ventilator should be used when the patient has a PaO2 of 53 mm Hg while receiving 50% oxygen and the target PaO2 is 90 mm Hg?
• Calculate the humidity deficit when a heat moisture exchanger (HME) provided 20 mg/L of water to the set tidal volume. The material indicates the deficit as which value?
• Patients with acute severe asthma requiring mechanical ventilation are difficult to manage because of which of the following?
• How long after beginning mechanical ventilation should an arterial blood gas sample be drawn?
• Which statement best defines final alveolar ventilation per breath?
• What is the usefulness of the airway pressure-time curve in ventilator troubleshooting?
• How do peak inspiratory pressure (PIP) and plateau pressure differ, and what does each indicate?
• A patient on mechanical ventilation has a cuff pressure measurement of 18 cm H2O while low-pressure and low-tidal-volume alarms are sounding. What immediate action should you take?
• Why is humidification important in mechanical ventilation circuits, and when is it most critical?
• Which of the following methods is used to minimize air trapping in mechanically ventilated patients?
• All of the following are appropriate situations for the use of sigh or deep breaths EXCEPT which?
• What is the significance of inspiratory flow pattern (constant vs decelerating) in patient comfort and synchrony?
• In the scenario of auto-PEEP with inability to trigger, the recommended adjustment is to...?
• Using the formula for desired FiO2, if PaO2 desired is 100 mmHg, FiO2 known is 0.40, and PaO2 known is 80 mmHg, what is the required FiO2?
• If a patient with PaO2 45 mm Hg on 60% inspired oxygen is titrated to reach PaO2 60 mm Hg, what FiO2 should be set?
• The noninvasive ventilation recommendation for the COPD patient specifies a rate of breaths per minute?
• To improve oxygenation while minimizing VILI, you would primarily adjust which ventilator parameters?
• Which statement best describes the relationship between plateau pressure and volutrauma risk in lung-protective ventilation?
• On a static PV curve for ARDS, recruitment is associated with which inflection point?
• What is the range for setting flow triggering?
• Which ventilator strategy is considered lung-protective in ARDS?
• Which of the following is NOT an essential capability of an adult ICU ventilator?
• A high pressure ventilator alarm is sounding and you are unsure if ventilation is occurring. What action should you take first?
• During mechanical ventilation, how should FiO2 be managed to minimize oxygen toxicity while maintaining adequate oxygenation?
• Which ventilator event is considered potentially life-threatening or a level two event?
• List three common signs of patient-ventilator asynchrony.
• What is cuff pressure and what monitoring is recommended to prevent mucosal injury?
• Identify the patient who could benefit from sigh breaths.
• How is the Rapid Shallow Breathing Index (RSBI) calculated, and what value suggests easier weaning?
• Which of the following scenarios would indicate sigh breaths are appropriate?
• A patient is intubated and, after placement, has absent breath sounds on the right, hyperresonance on the right, and the trachea deviates to the left. Which complication is most likely?
• Which of the following indicates readiness to wean from mechanical ventilation?