Egan's Chapter 48 Study

Egan's Chapter 48
5.0 (2 reviews)

Terms in this set (97)

Which of the following is the Aspiration

least frequent cause of acute
respiratory failure needing
mechanical ventilation?

Which of the following clinical Hypotension

findings is least likely to be
seen in a patient with acute
hypoxic respiratory failure?

Which of the following findings Bradycardia

would you expect to see in a
patient who has acute
ventilatory failure with severe
hypercapnia?

Support or manipulate gas exchange.

Physiological goals of artificial
ventilatory support include Reduce or manipulate the work of breathing.
which of the following?
Increase lung volume.
Egan's Chapter
After starting 48
volume-cycled Lower the delivered VT.
mechanical ventilation on a
patient in respiratory failure
with a VT of 10 ml/kg, you
measure and obtain a plateau
pressure of 45 cm H2O. Which
of the following actions would
you recommend to the
patient's physician?

Reduced cardiac output

Which the following are
hazards associated with Increased work of breathing
mechanical ventilation?
Acute lung injury

Optimize oxygenation.

What goal(s) does the

Optimize ventilation.
practitioner hope to achieve
when selecting initial
Maintain acid-base balance.
ventilatory support settings?

Avoid harmful side effects.

Airway temperature
To stabilize a patient during the
initial application of ventilatory
Ventilatory support mode
support, which of the following
parameters must be set?
O2 concentration (FiO2)

Minimal safe level of ventilation achieved.

Which of the following are
advantages of Assist Control Patient can set breathing rate.
Volume ventilation?
May reduce work of breathing.
Egan's Chapter
Which of the following is48
an Improved gas distribution allows for lower VT.
advantage of Pressure Control
Ventilation?

Management of acute exacerbation of chronic

In which of the following obstructive pulmonary disease (COPD)
clinical conditions would
noninvasive ventilation (NIV) Management of premature extubation
be recommended?
Management of cardiogenic pulmonary edema

To reverse hypoxemia
Which of the following are
specific clinical objectives of To prevent or reverse atelectasis
ventilatory support?
To reverse acute respiratory acidosis

What percentage of 5% to 10%

mechanical ventilated patients
has a tracheostomy tube place
at some point?

Which of the following modes Pressure-supported ventilation

of ventilatory support would
you recommend for a patient
who can breathe
spontaneously and only
requires assistance to
overcome the work of
breathing created by the ET
tube?
Egan's
ComparedChapter 48
to a pressure- Guarantees a minimum minute ventilation.
controlled strategy, what is the
primary advantage of volume-
controlled ventilatory support?

Compared with a volume- Limit and control of peak airway pressures

cycled strategy, what are some
potential advantages of Provision of a decelerating flow pattern
pressure-targeted ventilatory
support?

What is the recommended 6 to 8 ml/kg

range for the tidal volume for
the initial ventilator settings in
the volume control mode in a
patient with normal lungs?

If the patient is being Increase

ventilated via a mechanical
ventilator via intermittent
mandatory ventilation with
partial ventilatory support,
what would probably happen
to PaCO2 if the patient
suddenly had no spontaneous
breathing?

Which of the following During weaning from continuous mandatory

represents a clinical situation ventilation
where partial ventilatory
support is commonly used?
Egan's Chapter
Which of the following 48 Patient with ARDS
situations is most likely to call
for ventilator settings of low
volume and high rate while
allowing for permissive
hypercapnia?

When a patient is initially FiO2

started on mechanical
ventilation common orders Mode
from the physician in the
patient's chart include which of Tidal volume
the following?

Which of the following is one Proportional assist ventilation (PAV)

of the modes of ventilation that
may be considered when
partial ventilatory support is
indicated?

Which of the following It is usually applied with a backup rate of 5 to 8

statements is false regarding breaths/min.
ventilation in the assist-control
mode?

Adequate alveolar ventilation (VA)

Which of the following are
primary goals of mechanical Restoring acid-base balance
ventilation?
Maintaining adequate alveolar oxygenation
Egan's Chapter
Patient's RR 48
is 12 breaths/min, 18
PaCO2 is 60 mm Hg. If a
PaCO2 of 40 were desired, the
RR be set at what value?

Air trapping is a major concern Chronic obstructive pulmonary disease (COPD)

in patients with what diagnosis
when using the assist-control
mode?

What phrase is used to Permissive hypercapnia

describe the situation where
the patient with acute lung
injury is ventilated with a
smaller tidal volume and the
PaCO2 is allowed to increase
above normal range to avoid
additional lung injury?

Which of the following The usual range is 10 to 15 cm H2O.

statements is false regarding
pressure-supported
ventilation?

In what scenario is pressure- When limiting plateau pressure is needed

controlled ventilation (PCV)
most often used?

Prone positioning
Which of the following are
used as alternative lung
ECMO
protective strategies in patients
with ARDS?
High-frequency ventilation
Egan's Chapter
Which of the 48
following would Increase the level of pressure support.
decrease PaCO2 when
ventilating a patient using
intermittent mandatory
ventilation with pressure
support?

A physician orders intubation 14 breath/min 540 ml

and mechanical ventilation in
volume-controlled ventilation
mode for a 170-lb adult man
with neuromuscular disease.
Which of the following initial
settings would you
recommend?

A ventilator has separate rate 7800 ml/min (7.8 L/min)

and VT controls. If you set a VT
of 650 ml and a respiratory rate
of 12/min in the continuous
mandatory ventilation mode,
what will the minute ventilation
be?

A ventilator has separate rate 6600 ml/min (8.6 L/min)

and minute ventilation controls.
A physician orders continuous
mandatory ventilation with a VT
of 550 ml at a respiratory rate
of 12/min. What minute
ventilation would you set on
this ventilator?
Egan's Chapter
On a ventilator that has 48 850 ml
separate rate and minute
ventilation (VE) controls, the
rate is set at 13/min and the VE
at 11 L/min. Approximately what
VT is the patient receiving?

For adolescents in the 8- to 16- 25 to 35 breaths/min 6 to 8 ml/kg

year-old age range, which of
the following ranges of
ventilator setting would you
initially recommend?

A physician orders intubation 14 breaths/min 400 ml

and mechanical ventilation in
the continuous mandatory
ventilation assist-control mode
for a 125-lb adult woman with
normal lungs. Which of the
following initial settings would
you recommend?

A physician orders intubation 11 breaths/min 450 ml

and mechanical ventilation in
the continuous mandatory
ventilation mode for a 200-lb
predicted body weight (PBW)
adult man with acute asthma
exacerbation. Which of the
following initial ventilator
settings would you
recommend?
Egan's
A physicianChapter 48
orders intubation 12 breaths/min 500 ml
and mechanical ventilation in
the synchronized intermittent
mandatory ventilation mode
for a 160-lb adult man with a
history of chronic obstructive
pulmonary disease. Which of
the following settings would
you recommend?

On some ventilators, which of Autotriggering

the following can occur if a
trigger setting is set too
sensitive on a mechanical
ventilator?

Which of the following trigger 0.5 to 1.5 cm H2O below the baseline pressure
levels is appropriate when
setting a ventilator for pressure
triggering?

Which of the following is false Flow triggering will decrease the work of breathing
about flow-triggered in patients with small endotracheal tubes and auto-
ventilatory support? PEEP.

Which of the following is false Flow triggering reduces the work of breathing due
about flow triggering of to small endotracheal tubes.
spontaneous breaths during
mechanical ventilation?

Which of the following trigger 1 to 2 L/min below baseline flow

levels is appropriate when
setting a ventilator for flow
triggering?
Egan's
For adults Chapter 48
with otherwise 1:2
normal lungs who are
receiving ventilatory support in
the continuous mandatory
ventilation control or assist-
control mode, inspiratory flow
should be set to provide what
1:E?

When starting flow-limited 60 L/min

ventilatory support on an adult
patient, which of the following
inspiratory flow settings would
you initially select?

A chronic obstructive Increase the inspiratory flow rate.

pulmonary disease (COPD)
patient receiving ventilatory Decrease the assist-control rate.
support in the CMV assist-
control mode at a rate of 14
and a VT of 750 ml exhibits
clinical signs of air trapping.
Which of the following would
you recommend to correct this
problem?

Beneficial effects of using high Decreased work of breathing

inspiratory flows in patients
with chronic airflow Improved gas exchange
obstruction receiving flow-
limited mechanical ventilation Decreased auto-PEEP
include which of the following?
Egan's Chapter 48
Which of the following
Increase the peak flow.

ventilator adjustments would

Change the flow pattern from a decelerating wave
decrease inspiratory time?
to a square wave.

Which of the following would Increase the level of pressure support.

decrease PaCO2 when
ventilating a patient using
intermittent mandatory
ventilation with pressure
support?

What flow pattern is least Decelerating flow pattern

optimal for ventilating a patient
with cardiovascular instability?

Which of the following It has been shown to increase effectiveness of

statements is false regarding bronchodilator therapy.
the use of an inspiratory pause
during mechanical ventilation?

Immediately after cardiac 1.0

arrest and resuscitation, a
patient is placed on a ventilator
in the continuous mandatory
ventilation assist-control mode.
What initial FiO2 would you
recommend?

When adjusting the FiO2 Decrease the FiO2 to below 0.50 as soon as
setting for a patient receiving possible.
mechanical ventilatory support,
what should your goal be?
Egan's Chapter
An adult patient 48
in respiratory 0.50
failure has the following blood
gases on a nasal cannula at 5
L/min: pH = 7.20; PaCO2 = 67
mm Hg; HCO3-= 27 mEq/L;
PaO2 = 89 mm Hg. The
attending physician orders
intubation and ventilatory
support. What FiO2 would you
recommend to start with?

ARDS
In which of the following
conditions is PEEP likely to be Pulmonary edema
useful?
Acute lung injury

Which of the following criteria PaO2 less than 50 to 60 on FiO2 greater than 0.40 -
represents the recommended 0.50
starting point for considering
the use of PEEP?

To prevent atelectasis and 5 cm H2O PEEP

improve gas exchange, most
thoracic surgery patients
placed on ventilatory support
receive which of the following?

In which of the following Patients with high respiratory rates

clinical situations is the
incidence of auto-PEEP the Intubated patients with obstructive lung disease
greatest?
Egan's Chapter
A patient receiving 48
continuous Applying PEEP
mandatory ventilation in the
assist-control mode develops Switching ventilating mode to synchronized
auto-PEEP. Which of the intermittent mandatory ventilation
following general approaches
would you consider to
minimize the effects of auto-
PEEP in this patient?

A patient receiving continuous Decreasing the rate or increasing VT

mandatory ventilation in the
assist-control mode develops Using low-rate synchronized intermittent mandatory
auto-PEEP. Which of the ventilation
following changes in
ventilatory patterns would you Lowering the VT and letting the PaCO2 rise
consider to minimize the
effects of auto-PEEP in this
patient?

A COPD patient in respiratory Applying 4 to 6 cm H2O PEEP.

failure is receiving ventilatory
support in the volume-
targeted intermittent
mandatory ventilation mode at
a rate of 6/min. You measure an
auto-PEEP level of 9 cm H2O.
Which of the following would
you recommend to decrease
the effects of auto-PEEP in this
patient?
Egan's Chapter
When the therapist 48
is initially 10 to 20 cm H2O above the peak pressure
setting the high-pressure alarm
on the ventilator and the
patient's plateau pressure is
less than 30 cm H2O, what
should the high-pressure alarm
be set at?

After placing a patient on a 70 cm H2O

volume-cycled ventilator in the
continuous mandatory
ventilation assist-control mode,
you note that 55 cm H2O
pressure is required to deliver
the preset VT of 950 ml. What
high-pressure limit would you
now set for this patient?

If available, the FiO2 alarm ±5%

should be set to what
percentage?

What limits should be initially ±10% to 15%

set for high and low VT values
and/or minute volume alarms
on a ventilatory support
device?

A heat-moisture exchanger Patients with excessive secretions

(HME) should be avoided in
which of the following Patients with low body temperature
circumstances?
Egan's Chapter 48 There should be no problem with retained
Which of the following criteria secretions.
should be met before
considering use of a heat- The patient should not have fever (normothermic).
moisture exchanger (HME) for
a patient being placed on The patient should be adequately hydrated.
ventilatory support?
The support should be short term (24 to 48 hr).

For which of the following Patient with an expired VT less than 70% of the
patients requiring ventilatory delivered VT
support would you
recommend against using a Patient with a spontaneous minute ventilation of 14
heat-moisture exchanger L/min
(HME) for airway
humidification? Patient with body temperature less than 32° C

A dehydrated, feverish patient Heated wick humidifier with servo-control

suffering from acute bacterial
pneumonia is being intubated
in order to provide mechanical
ventilatory support. Which of
the following devices would
you select to control
humidification and airway
temperature for this patient?
Egan's Chapter
A patient suffering from48 Switch over to a heated wick humidifier.
postoperative complications
has been receiving mechanical
ventilation for 6 days with a
volume ventilator. A heat-
moisture exchanger (HME) is
providing control over
humidification and airway
temperature. Over the past 24
hr, the patient's secretions have
decreased in quantity but are
thicker and more purulent.
Which of the following actions
would you suggest at this time?

When using a heated humidifier 35° to 37° C

during mechanical ventilation,
the inspired gas temperature at
the airway should be set to
what level?

Before and after suctioning

Indications for delivering sigh
breaths during mechanical
During chest physical therapy
ventilation include which of the
following?
When small VT values are used

ABGs
Which of the following would
you assess immediately after a
Patient's airway
patient is placed on a
ventilatory support device?
Patient's vital signs
Egan's Chapter
When setting 48
the tidal volume It should never cause the plateau pressure to
on a patient being exceed 28 mm Hg.
mechanically ventilated, what
criteria should be kept in
mind?

What is the predicted change Decrease of 50 to 70 ml

in tidal volume by adding 6 in
of tubing to a ventilator circuit?

Cuff pressure
Which of the following would
you initially verify in assessing
Tube position
the airway of a patient placed
on ventilatory support?
Tube patency

After setting up a patient on a Suction source and catheters

ventilatory support device,
which of the following Backup artificial airway
supplementary equipment
would you require to be Manual resuscitator with O2
available at the bedside?

You have just placed a chronic 30 min

obstructive pulmonary disease
(COPD) patient on intermittent
mandatory ventilation at a rate
of 8/min, a VT of 550 ml, and an
FiO2 of 0.40. To ensure proper
equilibration between the
alveolar and arterial gas
tensions, how long should you
wait before drawing a sample
for measurement of the ABG?
Egan's Chapter
When adjusting 48
a patient's PaO2 of 60 to 100 mm Hg
oxygenation during
mechanical ventilatory support,
what should your goal be?

When titrating the FiO2 level 20%

downward from 100% to 40%,
what is the maximum increment
that should be applied
between estimates of
oxygenation?

When titrating the FiO2 down 5% to 10%.

from 50% to 21%, in what
increments should it be
reduced?

A patient with ARDS receiving Make no changes.

ventilatory support with PEEP
through a volume-cycled
ventilator has a plateau
pressure of 38 cm H2O. ABGs
on 55% O2 are as follows: pH =
7.44; PCO2 = 37 mm Hg;
HCO3- = 25 mEq; PO2 = 55 mm
Hg; SaO2 = 88%. Which of the
following would you
recommend?

When is the PEEP/CPAP level O2 delivery to the tissues is maximized.

optimum?
Egan's Chapter
When using 48
a pressure-volume Point of lung over distension
curve to identify optimal PEEP
levels, what does the upper
inflection point represent?

When performing a lung Patient has a run of premature ventricular

recruitment strategy, which of complexes.
the following would cause the
therapist to stop?

When the patient stabilizes on In increments of 2 cm H2O every 6 hr

mechanical ventilation with a
PEEP of 12 cm H2O and the
FiO2 has been reduced to 0.40,
how should the PEEP level
reduce?

What is the recommended Return the PEEP to the previous level.

response to a drop in PaO2
when the PEEP level is reduced
in a mechanically ventilated
patient?

Which of the following Proning the patient

techniques can be used to
improve oxygenation beyond Use of inverse I:E ratio ventilation
increasing the FiO2 or PEEP
level?

In what clinical condition has ARDS/acute lung injury

pressure-controlled ventilation
with a prolonged inspiratory
time been shown to be
helpful?
Egan's Chapter
How frequently should a48 6 to 8 hr
clinician make changes when
weaning from PEEP?

What is the primary concern Displacement of tubes and lines

when using proning to improve
oxygenation in the patient with
ARDS?

What is considered to be the PaCO2

single best indicator of
effective ventilation?

Your patient develops a fever Increase in PaCO2

while being mechanically
ventilated in the control mode.
As a result of the fever, the
patient's CO2 production
increases while alveolar
ventilation is unchanged. What
is the probable change in
ABGs?

A patient receiving control- 5.9 L/min

mode continuous mandatory
ventilation has the following
ABGs on an FiO2 of 0.4: pH =
7.51; PCO2 = 30 mm Hg;
HCO3- = 25 mm Hg. Her
current minute ventilation (VE)
is 7.9 L/min. What new VE
would you recommend?
Egan's Chapter
A patient receiving 48
control- 14.0 L/min
mode continuous mandatory
ventilation has the following
ABGs on an FiO2 of 0.5: pH =
7.23; PCO2 = 61 mm Hg;
HCO3- = 26 mm Hg. The
current minute ventilation (VE)
is 9.2 L/min. What new VE
would you recommend?

During initial mechanical 55 mm Hg

ventilation of the chronic
obstructive pulmonary disease
(COPD) patient with chronic
hypercapnia, what PaCO2 is
most likely used as a target
value?