The tidal volume is 800 cc and the peak flow is set at 30 1/min. The respiratory rate is 12 breaths per minute and the sensitivity is negative 2 cm/h20.  What is the I-E ratio in this case?

a. 1-1

b. 1-2

c. 1-2.5

d. 1-3

If the peak flow is increased to 55 1 /min in the situation above with all other variables remaining constant, what is the I-E ratio now?

a. 1-1

b. 1-3 

c. 1-4

d. 1-5

You obtained blood gases on a child on nasal CPI of 5 cm/hg. The FI02 is set at 50%. The gas had the following results:

Ph 7.32     PC02 58    P02 61    Sao2 89%

Which of the following should you consider?

b.         increase the FI02

c.         decrease the CPAP and increase the Fi02

d.         place the child on mechanical ventilation with peep

The best means of determining the adequacy of continuous mechanical ventilation is through the use of:

a. chest x-ray studies

b. arterial blood gas monitoring

c. ventilator monitoring

d. physical assessment of the patient

e. spontaneous ventilatory monitoring of the patient

The practitioner can decrease the pressure-time relationship during continuous mechanical ventilation by:

I.         adding expiratory resistance

II.        reducing the cycling pressure

III.      adding a one second inspiratory hold

IV.        reducing the set rate

A. I only   B. I and II only   C. II and IV only   D. II, III and IV only

E. All of the above

A postoperative patient is receiving ventilation with a continuous mechanical ventilator. The blood gas evaluation after 20 minutes of ventilation shows a pH of 7:49, a PaC02 of 30 mm Hg, a HC03 of 23.8 and a Pa02 of 130 mm Hg. These blood gas values indicate:

a. compensated metabolic acidosis with normal oxygen     

b. acute metabolic acidosis with hyperoxemia

c. acute respiratory alkalosis with hyperoxemia

d. chronic respiratory alkalosis with hyperoxemia chronic metabolic alkalosis with hypoxemia

The physiological parameter defined as volume change per unit pressure change is called:

a. compliance

b. resistance

c. elastance

d. surface tension

e. conductance

A decrease in compliance will tend to:

a. increase total lung capacity

b. increase airway resistance

c. decrease vital capacity

d. increase residual volume

e. increase functional residual capacity

If a patient's tidal volume is 650 ml and the pressure measured while maintaining the volume is 15 cm H2O, which is the compliance?

a. .043 liter/cm H2O

b. .097 liter/cm H2O

c. 2.3 liters/cm H2O

d. 40 liters/cm H2O

e. 57 liters/cm H2O

Dead space is defined as:

a. ventilation greater than perfusion

b. ventilation greater than diffusion

c. perfusion greater than ventilation

d. perfusion greater than diffusion

e. no ventilation or perfusion

You are caring for a mechanically ventilated patient on SIMV 4 / min, Vt - 10 ml/Kg, PEEP 5, inspiratory time 2 sec, FI02 0.40. The patient's spontaneous rate is 35 / min and labored. You would now recommend:

a. increasing the rate to 8 / min

b. increasing the PEEP to 10

c. increasing the F102 to 0.50

d. maintaining the same parameters

Which of the following controls when adjusted independently will change the length of the expiratory phase of a volume ventilator incorporating a rate control?

I. volume      II. respiratory rate    III. flow rate

a. I only

b. II only

c. II and III

d. All of the above

When a ventilator is operating in the control mode, an inadequate inspiratory flow setting would be indicated by which of the following alarms?

a. temperature

b. pressure

c. I:E

d. low pressure

e. oxygen

During mechanical ventilation the inspiratory time can be extended by:

a. decreasing the sensitivity

b. increasing the sensitivity

c. decreasing the flow

d. increasing the flow

e. decreasing the inspiratory pressure limit

What is the mandatory pressure limit on all hand held resuscitators used in pediatric and neonatal resuscitators?

a. 20 cm H2O

b. 20 lpm

c. 40 cm H2O

d. no limit is required for hand held resuscitators

Calculate the inspiratory time given the following tidal volume 850 ml, peak pressure 50 cm H2O, plateau pressure 40 cm H2O, PEEP 10 cm H2O and a peak flow rate of 50 L/min?

a. 0.5 sec

b. 1.0

c. 1.4

d. 1.8

e. 2.2

Calculate the effective static compliance given tidal volume 800 ml, plateau pressure 42 cm/H20, peak inspiratory pressure 50 cm H2O and a PEEP of 10 cm H2O

a.18 ml/cm H2O

b. 22

c. 7 25

d. 28

e. 30

When applying an inflation hold pressure plateau maneuver the following would be true:

I.          the inspiratory time would become longer

II.        expiratory time would become longer

III.         during this maneuver the exhalation valve remains closed

IV.        this maneuver occurs following a ventilator breath,

a. I, II, III and IV

b. I, II and III

c. I, III and IV

d.  II, 111 and IV

A patient's minute volume is 7.5 liters and the respiratory rate is 15. What is the tidal volume?

a. 250 cc

b. 300

c. 500

d. 520

e. 600

A constant flow generator would exhibit which of the following characteristics?

I.          the inspired flow would remain constant throughout inspiration

II.        the ventilator is not influenced by the patients lung characteristics

III.         pressure would increase in a linear fashion throughout inspiration

a.         I and II

b.         I, II and III I and III

d.         II and III

When using the expiratory retard option during mechanical ventilation you would expect the possibility of:

a. the inspiratory flow rate to increase

b. the expiratory flow rate to increase

c. patient-ventilator asynchrony

d. auto-peep

The most popular method of adjusting the low inspired pressure alarm is to:

a. set the alarm 10 cm/H20 above the peak inspiratory pressure

b. set the alarm 10 cm/H20 below the peak inspiratory pressure

c. set the alarm 15 cm/H20 below the peak inspiratory pressure

d. set the alarm 1 cm/H20 below the peak inspiratory pressure

Patients with significant air-trapping disease may benefit during mechanical ventilation from the

use of:

a. inspiratory hold

b. accelerating flowrates

c. sighs

d. expiratory retard

Which of the following is true as it pertains to PSV?

a. inspiratory pressure can range from 1 to 100 cm/H20

b. PSV can be delivered each breath, every other breath or every fourth breath

c. PSV is present throughout the breath

d. A PSV breath is terminated when a certain minimum inspiratory flow rate is met

You set the flowrate on a volume ventilator to 40 L/min and an Inspiratory time of 1 second. The tidal volume being delivered in this case would be:

a          400 ml

b.         550 ml

c.         660 ml

d.         730 ml

With an exhaled tidal volume of 600 ml, a plateau pressure of 20 cm/H20 and a PEEP of 5 cm/H20, the static effective compliance value would be ___________m./cmH20.

a. 24

b. 36

c. 40

d. 56

e. 78

SIMV refers to a mode of ventilation where:

a. a deeper than normal ventilator breath is delivered

b. the breath volume and the initiation of the breath are under the patients control

c. there are no mechanical breaths - all breaths are spontaneous

d. the ventilator senses the patient assist efforts and synchronizes the ventilator breath accordingly

You would recommend use of an inspiratory plateau in a mechanically ventilated patient to accomplish:

a.         lower peak inspiratory pressure

b.         greater tidal volume

c.         a reduction in intrapleural pressure

d.         improved gas distribution

When recommending a sigh volume setting, the sigh volume should be times greater than the set tidal volume.

a. 1 -1.5

b. 1.5-2

c. 2-3

d. 3-4

The patient position that usually produces the best Pa02 is:

a. prone

b. upright

c. supine

d. left lateral

e. right lateral

Increasing the inspiratory time during continuous mechanical ventilation will:

 a. decrease the venous return­

b. decrease the peak airway pressure

c. increase the cardiac output

d. increase the blood pressure

e. not effect the cardiovascular system

Intermittent mandatory ventilation might be used in which of the following situations:

a. to wean a patient from mechanical ventilation

b. to improve ventilation

c. to improve oxygenation

d. to alter the I-E ratio

e. to decrease the work of breathing

In estimating the tidal volume and minute ventilation, a useful tool would be which nomogram?

a. Singer-Hastings

b. Astrup

c. Servinhaus

d. Siggaard - Anderson

e. Radford

The deadspace of a positive pressure ventilator is most closely related to:

a. length of mainline tubing

b. volume of the humidifying device

c. delivered tidal volume

d. size of the rebreathed volume

e. length of inspiration

If a patient's lung compliance decreases while on pressure control ventilation, which of the following actions should be taken to maintain adequate minute ventilation?

a. sigh the patient

b. increase the flow rate

c.  increase the cycling pressure

d. increase the expiratory time

A prolonged inspiratory time with high pressure during continuous mechanical ventilation will tend to cause a (n)

a. increase in cardiac output

b. decrease in venous pooling

c. increase in mean intrathoracic pressure

d. decrease in intrapleural pressure

e. increase in right atrial blood return

Which of the following would most likely violate the high pressure limit on a mechanical ventilator?

I.          increase in minute ventilation

II.          decrease in lung compliance

III.         endo tracheal tube occlusion

IV.        increase in inflation of the endo tracheal tube cuff

V.      cough

a. I, II and III    b. I only   c. II, III and V   d. V only

The use of PEEP during mechanical ventilation should:

a. increase lung compliance

b. increase resistance

c. improve arterial blood gases

d. decrease blood pressure

Which of the following would be a hazard of PEEP?

a. oxygen toxicity

b. absorption atelectasis

c. hypotension

d. hypercarbia

A mechanically ventilated patient has the following values:

peak pressure 56   plateau pressure 22   PEEP 5 cm/h2o 

Peak flow 80 lpm   Tidal volume 1000ml

What is the static compliance in this case?

a. 30 cc/cm/h2o

b. 40

c. 50

d. 60

A patient while being mechanically ventilated has a reduced chest excursion and reduced breath sounds. You would consider adding:

I.          PEEP

II.         Mechanical Vd

III.        Tidal volume

IV.        Peak flow

a. I and II     b. I and III      c. IV only     d. III and IV

When determining how a ventilator is cycled, one must consider:

a.         what begins inspiration

b.         what terminates inspiration

c.         what ends exhalation

d.         alarm systems

e.         power sources

Total cycle time is 6 seconds, E time is 5 seconds, tidal volume 1000cc. Using this data, which is the peak flow?

a.         18 L/min.

b.         24 L/min.

c.         30 L/min.

d.         60 L/min.

e.         there is not enough information supplied to identify

Major disadvantages of the common ventilators used to deliver IPPB therapy include:

I.          inadequate pressure for severely non-compliant patients

II.       inadequate flow rates

III.      inability to control volume delivered

IV.        inability to control F102 delivered

a. I and III only        b. II and III only       c. II and IV only

d. III and IV only      e. I, II, III and IV

Which of the following factors affect the volume delivered by ventilators used for IPPB treatments?

I.  patient lung compliance

II. patient airway resistance

III. ventilator pressure setting %

IV.  ventilator power source

a. I and II only         b. I and III only       c. I, II and III only

d. I, II and IV only    e. I, II, III and IV

During use of the Bird Mark 7 respiratory, an excessive leak will result in which of the following?

a. increase in mechanical dead space

b. fluctuations in the PI02

c. prolonged expiratory time

d. failure to end inspiration

e. failure to initiate inspiration

A check valve phenomenon in a distal airway during mechanical ventilation will results in which of the following?

a. atelectasis

b. air trapping

c. collateral ventilation

d. secretion evacuation

e. wheezing

Which of the following is a definite contraindication to IPPB administration?

a.         hypoxic drive

b.         bullous emphysema

c.         myocardial infarction

d.         staphylococcal infection

e.         tension pneumothorax

What would be the most common cause of a sudden absence of breath sounds on the left side during continuous mechanical ventilation?

a.         atelectasis has occurred on the left side

b.         a tension pneumothorax is present on the right side

c.         an obstruction is present in the left mainstem bronchus

d.         migration of the endotracheal tube into the right bronchus

Intermittent mandatory ventilation might be used in which of the following situations?

a. to allow a chronic lung patient to "find" his own PC02

b. to improve ventilation

c. to improve oxygenation

d. to alter the I-E ratio

e. to decrease the work of breathing

The minimum I -E ratio that should be maintained while ventilating adult patients is:

a. 3-1

b. 2-1.5

c. 1-1.5

d. 1-2

e. 1-3

Which of the following patient conditions will have the most significant adverse cardiovascular response to continuous mechanical ventilation with high pressure?

a. pneumonia

b. asthma

c. tuberculosis

d. emphysema

e. pneumoconiosis

If a tubing leak occurs during controlled ventilation with a 7200, which of the following will occur?

I.          the exhaled tidal volume will remain unchanged

II.          the peak airway pressure will decrease

III.         the inspiratory time will decrease

IV.        the ventilator rate will increase

a. II only    b. III only   c. I and II     d. I, II and III   e. II, III and IV

Which of the following makes up the Static Respiratory System Compliance measurement?

I.          lung compliance

II.          thorax compliance

III.         airway resistance

a. I, II and III      b. II only     c. I only I and II      d. II and III

Which of the following makes up the Dynamic System Compliance measurement?

I. lung compliance     II. thorax compliance    III. airway resistance

a. I, II and III

b. II only

c. I only

d. I and II

e. II and III

The adequacy of ventilation is best assessed by looking at the:

a. tidal volume

b. VA

c. pH

d  PaCO2

e. Pa02

The practitioner can decrease the pressure-time relationship during continuous mechanical ventilation by:

I.          adding expiratory resistance

II.        reducing the cycling pressure

III.         adding a one second inspiratory hold

IV.        reducing the set rate

a. I only         b. I and II only      c. II and IV only

d. II, III and IV only                    e. I, II, III and IV

CPAP is appropriate treatment to use on a patient with which of the following?

a. apnea

b. spontaneous respirations with intrapulmonary shunting

c. patients being mechanically ventilated

d. drug overdose patients

e. patients in the assist control mode of ventilation

The most effective way to increase a patient's alveolar ventilation while on a ventilator in the control mode would be to increase the:

a. inspiratory flow rate

b. ventilator rate

c. tidal volume

d. sensitivity

You obtained blood gases on a child on nasal CPAP of 5 cm/hg. The F102 is set at 50%. The gas had the following results:

Ph - 7.32 PC02 - 32 P02 - 40 Sao2 - 75%

Which of the following should you consider?

a. increase the CPAP to 10 cm/hg

b. increase the Fi02

c. decrease the CPAP and increase the Fi02

d. place the child on mechanical ventilation with peep

Your patient is on mechanical ventilation. The blood gas results show a Respiratory acidosis. You should consider

a.         increasing the peak flow rate

b.         adding mechanical deadspace

c.       increasing the minute ventilation

d.         changing to the SIMV mode

A patient is receiving mechanical ventilation with the following parameters:  Mode SIMV Mandatory rate 6   Mandatory Vt 800 mL

Total rate  3 0        Spontaneous Vt     180 mL

The physician asks the respiratory therapist to recommend and initiate a ventilator mode to augment the patient's spontaneous breathing efforts. The therapist should select:

a. pressure-support ventilation (PSV) and titrate the PSV level until the spontaneous V-r is about 8 mL/kg or greater

b. pressure-support ventilation (PSV) and titrate the PSV level until the spontaneous rate is less than 15/min.

c. pressure-controlled ventilation and titrate the pressure-controlled ventilation level until the spontaneous Vi, is about 10 mL/kg or greater

d. pressure-controlled ventilation and titrate the pressure-controlled ventilation level until the spontaneous rate is less than 15/min.

While adjusting the sensitivity on a mechanical ventilator you are adjusting the:

a. Inspiratory time

b. inspiratory threshold

c. expiratory time

d. peak flow rate

A volume ventilator that you are monitoring experiences a low exhaled volume alarm situation. Which of the following could cause this occurrence?

I. an increase in lung compliance

II. a decrease in lung compliance

Ill. a change in the sensitivity setting

IV. a leak somewhere in the inspiratory side of the system

a. I and III     b. III     c. I, II and IV     d.IV

Before placing the patient on a mechanical ventilator the practitioner should set the:                    I. tidal volume

II. respiratory rate

III. FI02

IV. High pressure limit

a. I, II, III       b. I, II and IV      c. I and II only      d. II and III

A pressure ventilator cycles on and will not cycle off. What could be the cause?

I.          a disconnected exhalation valve line

II.          a deflated endotracheal tube cuff

III.      a supply pressure of 50 psig

a. I only       b. III only       c. I and II        d. I, II and III

A patient is struggling to initiate a breath on a Bird Mark 7 ventilator. The settings are:

Flow control - 10    Pressure - 15    Sensitivity -5    Air mix - 0

You should adjust the:

a. sensitivity - 2

b. control pressure - 20

c. flow control to - 15

d. air mix to off

A Bird Mark 7 is set in the air - dilution position. It is connected to a source gas of oxygen. Which of the following is true about this situation?

a. The FI02 delivered to the patient will be between 50% and 100%

b. The delivered F102 will be 100%

c. The pneumatic clutch will not operate

d. The venture will not operate

For a spontaneously breathing patient, which of the following will provide the therapeutic effects of PEEP?

a. IPPB

b. SIMV 

c. CPAP

d. Inspiratory hold

CPAP would be most appropriate to treat hypoxia due to which of the following?

a. pulmonary shunting

b. dead space ventilation

c. low cardiac output

d. cyanide poisoning

A 65-year-old woman in congestive heart failure is receiving 10 cm H2O CPAP and 70% oxygen. Her arterial blood gas results are below.

PH 7.41      PaC02  40 torr       HC03 25 mEq/liter     Pa02     150 torr

Based on these findings, the respiratory care practitioner's most appropriate action would be to recommend which of the following?

a.         Maintain the present therapy

b.         Decrease the Fi02

c.         Decrease the CPAP level

d.         Attempt a trial with a T-piece for 1 hour and repeat the arterial blood gas analysis

If a patient is receiving an excessively high amount of CPAP, the result will be a decrease in the patient's:

a.blood pressure

b. respiratory rate

c. PaC02

d. Residual volume

Which of the following would NOT be appropriate for the initial management of a child during an acute asthmatic attack?

a.         metaproterenol (Alupent)

b.         cromolyn sodium (Intal)

c.         isoproterenol (Isuprel)

d.         epinephrine

A physiologic goal of CPAP is to increase:

a. tidal volume

b. functional residual capacity

c. inspiratory capacity

d. minute alveolar ventilation

Over a 3-hour period, you note that a patient's plateau pressure has remained stable, but her peak pressure has been steadily increasing. Which of the following is the best explanation for this observation?

a. the patient's airway resistance has increased

b. the patient is developing atelectasis

c. the patient's compliance has decreased

d. the patient is developing pulmonary edema