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Egans Fundamentals of Respiratory Care 10th Edition Kacmarek Stoller Heuer Sullivan Test Bank

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Egans Fundamentals of Respiratory Care 10th Edition Kacmarek Stoller Heuer Sullivan Test Bank

ISBN-13: 978-0323082037

ISBN-10: 0323082033

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Egans Fundamentals of Respiratory Care 10th Edition Kacmarek Stoller Heuer Sullivan Test Bank

ISBN-13: 978-0323082037

ISBN-10: 0323082033

 

 

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Free Nursing Test Questions:

 

Chapter 47: Discontinuing Ventilatory Support

Test Bank

 

MULTIPLE CHOICE

 

  1. All of the following factors will increase ventilatory demand (workload) except:
a. severe hypoxemia
b. pulmonary infection
c. increased compliance
d. Bronchospasm

 

 

ANS:  C

Factors that may increase ventilatory workload are summarized in Box 47-1.

 

DIF:    Recall             REF:   p. 1224          OBJ:   1

 

  1. Ventilatory capacity is determined by all of the following except:
a. central nervous system (CNS) drive
b. trigger level
c. muscle strength
d. muscle endurance

 

 

ANS:  B

Ventilatory capacity is determined by (1) CNS drive, (2) ventilatory muscle strength, and (3) ventilatory muscle endurance.

 

DIF:    Recall             REF:   p. 1221          OBJ:   1

 

  1. All of the following factors can reduce a patient’s ventilatory drive except:
a. respiratory alkalosis
b. metabolic acidosis
c. depressant drugs
d. decreased metabolism

 

 

ANS:  B

Box 47-2 summarizes factors that may reduce ventilatory drive.

 

DIF:    Recall             REF:   p. 1202          OBJ:   2

 

  1. When is ventilator dependence likely to occur?
  2. when ventilatory capacity exceeds demand
  3. when arterial hypoxemia is present
  4. when the patient is malnourished
  5. when the cardiovascular system is unstable
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 2, 3, and 4

 

 

ANS:  D

Other factors that may contribute to ventilator dependence include inadequate arterial oxygenation, poor tissue oxygen delivery, myocardial ischemia, arrhythmias, low cardiac output, and cardiovascular instability.

 

DIF:    Recall             REF:   p. 1202          OBJ:   2

 

  1. What is the most important prerequisite for weaning a patient from ventilatory support?
a. improvement in the original problem requiring mechanical ventilation
b. assurance that the patient’s ventilatory demand exceeds the patient’s capacity
c. objective evidence indicating good respiratory muscle endurance
d. ability to maintain adequate oxygenation with an FIO2 less than 0.4

 

 

ANS:  A

The single most important criterion to consider when evaluating a patient for ventilator discontinuation or weaning is whether there has been significant alleviation or reversal of the disease state or condition that necessitated use of the ventilator in the first place.

 

DIF:    Recall             REF:   p. 1203          OBJ:   3

 

  1. What is the least reliable weaning index?
a. vital capacity (VC)
b. maximum inspiratory capacity (MIP)
c. minute ventilation (VE)
d. rapid-shallow breathing index (f/VT)

 

 

ANS:  A

With respect to the more traditional weaning indices, vital capacity can be highly variable, whereas MIP, minute ventilation, respiratory rate (f), and f/VT tend to be more reliable.

 

DIF:    Recall             REF:   p. 1204          OBJ:   3

 

  1. All of the following oxygenation measures support a patient’s readiness to wean except:
a. PaO2/PAO2 (a/A) = 0.45
b. PaO2/FIO2 (P/F) = 110
c. PAO2 – PaO2 = 240 mm Hg
d. physiologic shunt () = 12%

 

 

ANS:  B

See Table 47-1.

 

DIF:    Analysis         REF:   p. 1204          OBJ:   3

 

  1. All of the following indicate that an adult patient is ready to be weaned from ventilatory support except:
a. VC = 1.9 L
b. spontaneous rate of 32/min
c.  = 8%
d. MIP = –45 cm H2O

 

 

ANS:  B

See Table 47-1.

 

DIF:    Analysis         REF:   p. 1204          OBJ:   3

 

  1. All of the following indicate that an adult patient is ready to be weaned from ventilatory support except:
a. PAO2 – PaO2 = 430 on 100% O2
b. VD/VT = 0.55
c. MIP = –33 cm H2O
d. PO2 = 76 mm Hg on 40% O2

 

 

ANS:  A

See Table 47-1.

 

DIF:    Analysis         REF:   p. 1204          OBJ:   3

 

  1. Which of the following five adult patients receiving ventilatory support is the best candidate for weaning?

Maximum voluntary

Patient   VC      VE   ventilation (MVV)          MIP      VD/VT

a.
b.
c.
d.

 

 

ANS:  A

See Table 47-1.

 

DIF:    Analysis         REF:   p. 1204          OBJ:   3

 

  1. Which of the following patients exhibits an acceptable ventilatory demand?

VE                         PaCO2

a.
b.
c.
d.

 

 

ANS:  C

See Table 47-1.

 

DIF:    Analysis         REF:   p. 1204          OBJ:   3

 

  1. A patient has an adequate ventilatory reserve if which of the following is TRUE?
a. ability to double the resting minute ventilation
b. normal PaCO2 and minute ventilation less than 10 L/min
c. MIP = –55 cm H2O
d. VD/VT less than 0.4

 

 

ANS:  A

See Table 47-1.

 

DIF:    Analysis         REF:   p. 1204          OBJ:   3

 

  1. You measure the spontaneous rate of breathing and VT on four patients receiving ventilator support. For which one is successful weaning most likely?

Breathing frequency      VT

a.
b.
c.
d.

 

 

ANS:  B

See Table 47-1.

 

DIF:    Analysis         REF:   p. 1204          OBJ:   3

 

  1. A patient receiving ventilator support has a spontaneous rate of breathing of 26/min and an average VT of 300 ml. What is this patient’s rapid-shallow breathing index?
a. 12
b. 87
c. 105
d. 66

 

 

ANS:  B

See Table 47-1.

 

DIF:    Application    REF:   p. 1204          OBJ:   3

 

  1. Which of the following signs observed on a mechanically ventilated patient indicate that successful weaning is unlikely?
  2. palpable scalene muscle use during inspiration
  3. palpable abdominal tensing during expiration
  4. presence of an irregular breathing pattern
  5. patient unable to alter breathing pattern on command
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

Evaluation of patients for the presence of palpable scalene muscle use during inspiration, an irregular ventilatory pattern, palpable abdominal muscle tensing during expiration, and inability to alter ventilatory pattern on command can be helpful in assessment of the potential for prolonged spontaneous ventilation.

 

DIF:    Recall             REF:   p. 1205          OBJ:   3

 

  1. Which of the following is false about the P0.1 measure?
a. P0.1 correlates well with central respiratory drive.
b. P0.1 is the airway pressure measured 100 ms after occlusion.
c. P0.1 is an effort-dependent measure of respiratory drive.
d. Chronic obstructive pulmonary disease (COPD) patients with a P0.1 greater than 6 cm H2O are difficult to wean.

 

 

ANS:  C

Airway occlusion pressure (P0.1) is the inspiratory pressure measured 100 milliseconds after airway occlusion. The P0.1 is effort independent and correlates well with central respiratory drive. Ventilator-dependent patients with COPD who have a P0.1 greater than 6 cm H2O tend to be difficult to wean.

 

DIF:    Recall             REF:   p. 1205          OBJ:   3

 

  1. Successful weaning is less likely when a patient’s work of breathing exceeds what level?
a. 4 J/min
b. 8 J/min
c. 12 J/min
d. 16 J/min

 

 

ANS:  D

Successful weaning has been found to be less likely among patients with spontaneous work levels greater than 1.6 kg/m/min (16 J/min) or 0.14 kg/m/L (1.4 J/L).

 

DIF:    Application    REF:   p. 1205          OBJ:   3

 

  1. Above what pressure-time index (PTI) will most patients be unable to sustain spontaneous breathing?
a. 0.03
b. 0.05
c. 0.10
d. 0.15

 

 

ANS:  D

A PTI greater than 0.15 to 0.18 has been associated with diaphragmatic fatigue, and a PTI greater than 0.15 cannot be sustained indefinitely.

 

DIF:    Application    REF:   p. 1206          OBJ:   4

 

  1. Which of the following metabolic factors can hinder weaning?
  2. excessive carbohydrate feeding
  3. amino acid-based parenteral nutrition
  4. calorie intake = 1.5 ´ resting energy expenditure (REE)
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  B

Excessive carbohydrate feeding can increase carbon dioxide production and may precipitate acute hypercapnic respiratory failure. Parenteral nutrition solutions containing amino acid formulations (arginine/lysine) can cause metabolic acidosis and thus increase ventilatory demand.

 

DIF:    Recall             REF:   p. 1206          OBJ:   5

 

  1. All of the following indicate that a patient’s renal function is adequate for weaning except:
a. output = 20 ml/hr
b. no major weight gain
c. no edema present
d. normal electrolytes

 

 

ANS:  A

The patient ideally should have an adequate urine output (greater than 1000 ml/day), and there should be no inappropriate weight gain or edema.

 

DIF:    Application    REF:   p. 1206          OBJ:   5

 

  1. Which of the following electrolyte imbalances can hinder weaning from ventilatory support?
  2. hypophosphatemia
  3. hypomagnesemia
  4. hypokalemia
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  A

Key electrolytes should be normal (magnesium, 1.8 to 3.0 mEq/L; phosphate, 2.5 to 4.8 mEq/L; potassium, 3.5 to 5.0 mEq/L).

 

DIF:    Recall             REF:   p. 1206          OBJ:   5

 

  1. Which of the following cardiovascular signs would indicate that a patient’s cardiovascular status is unstable and that weaning should NOT begin at this time?
a. cardiac index of 2.5 L/min/m2
b. hemoglobin content of 10 g/dl
c. heart rate of 108/min
d. systolic blood pressure of 80 mm Hg

 

 

ANS:  D

Table 47-2 provides criteria for confirming cardiovascular stability.

 

DIF:    Application    REF:   p. 1207          OBJ:   4

 

  1. Of the following adult patients receiving ventilatory support, which has a stable enough cardiovascular profile to consider weaning?

Systolic blood

Heart rate pressure (mm Hg) Hemoglobin (g/dl)            Clinical status

a.
b.
c.
d.

 

 

ANS:  A

Table 47-2 provides criteria for confirming cardiovascular stability.

 

DIF:    Application    REF:   p. 1207          OBJ:   4

 

  1. Prerequisites for successful weaning include:
  2. psychological readiness
  3. adequate gag and swallow reflexes
  4. ability to follow instructions
  5. adequate cough
a. 1, 2, and 3
b. 2 and 4
c. 1, 2, 3, and 4
d. 3 and 4

 

 

ANS:  C

Adequate central nervous system function is needed to ensure stable ventilatory drive, adequate secretion clearance (cough and deep breathing), and protection of the airway (gag reflex and swallow). In addition, level of consciousness, dyspnea, anxiety, depression, and motivation can affect weaning success. The patient ideally is awake and alert, free of seizures, and able to follow instructions.

 

DIF:    Recall             REF:   p. 1206-1207                                   OBJ:   5

 

  1. Which of the following must you verify when considering weaning an obtunded patient?
  2. adequate gag reflex
  3. no depressant drugs
  4. adequate cough
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  D

Obtunded patients should, at a minimum, have an adequate gag reflex and cough.

 

DIF:    Recall             REF:   p. 1207          OBJ:   5

 

  1. All of the following drug categories can depress ventilatory drive and hinder weaning except:
a. analgesics
b. narcotics
c. hypnotics
d. antibiotics

 

 

ANS:  D

Level of consciousness is affected by the use of narcotic, sedative, and analgesic drugs.

 

DIF:    Recall             REF:   p. 1207          OBJ:   5

 

  1. Which of the following techniques can help to decrease a patient’s imposed work of breathing during weaning from ventilatory support?
  2. use of pressure-supported ventilation (PSV)
  3. trigger breath by flow, not pressure
  4. application of small amounts of continuous positive airway pressure (CPAP) or positive end-expiratory pressure (PEEP)
  5. use of automatic tube compensation (ATC)
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

The patient’s ventilatory workload should be minimized with PSV. Flow trigger, flow-by, or ATC also may be helpful in minimizing imposed ventilatory work. Intrinsic PEEP during mechanical ventilation may increase trigger work, and small amounts of PEEP or CPAP can help overcome this problem.

 

DIF:    Application    REF:   p. 1208          OBJ:   6

 

  1. Common approaches used to wean patients from ventilatory support include which of the following?
  2. T-tube alternating with mechanical ventilation
  3. pressure-supported ventilation (PSV)
  4. intermittent mandatory ventilation
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  C

There are three basic methods of discontinuing ventilatory support: (1) spontaneous breathing trials (usually with a T tube) alternating with mechanical ventilatory support, (2) synchronized intermittent mandatory ventilation, and (3) PSV.

 

DIF:    Recall             REF:   p. 1209          OBJ:   6

 

  1. Which of the following ventilator strategies would you consider as a good alternative to T-tube trials when using a rapid weaning protocol?
  2. continuous positive airway pressure (CPAP) with flow-by (flow triggering)
  3. low-level pressure-supported ventilation (PSV)
  4. intermittent mandatory ventilation
a. 2 and 3
b. 1 and 2
c. 1, 2, and 3
d. 1 and 3

 

 

ANS:  B

Rather than using a T-tube trialRemember,me clinicians prefer to maintain the patient attached to the ventilator with zero PSV and zero CPAP.

 

DIF:    Recall             REF:   p. 1210          OBJ:   6

 

  1. Which method of weaning may be useful to minimize auto-PEEP?
a. intermittent mandatory ventilation
b. synchronized intermittent mandatory ventilation
c. continuous positive airway pressure (CPAP)
d. T-piece

 

 

ANS:  C

Low levels of CPAP may be useful in maintaining lung volumes and overcoming intrinsic PEEP, if present.

 

DIF:    Application    REF:   p. 1210          OBJ:   6

 

  1. A physician orders a T-tube trial for a patient receiving ventilatory support in the assist-control mode with an FIO2 of 0.4. What FIO2 would you recommend for this patient during the spontaneous breathing period?
a. 0.3
b. 0.4
c. 0.5
d. 0.6

 

 

ANS:  C

See Box 47-8.

 

DIF:    Application    REF:   p. 1211          OBJ:   6

 

  1. Advantages of adding continuous positive airway pressure (CPAP) to T-tube weaning include all of the following except:
a. improved blood oxygenation
b. decreased work of breathing
c. compensation for auto-PEEP
d. faster weaning or extubation

 

 

ANS:  D

CPAP has the advantage of maintaining lung volume during the weaning phase and thus of improving the patient’s oxygenation status. Minimal levels of CPAP may be useful in reducing work of breathing and compensating for auto-PEEP, particularly in patients with obstructive lung disease.

 

DIF:    Recall             REF:   p. 1214          OBJ:   6

 

  1. An alert patient receiving intermittent mandatory ventilation at a rate of 8/min and VT of 600 ml has stable vital signs and satisfactory blood gases on an FIO2 of 0.45. What would you do to initiate weaning for this patient?
a. Lengthen the automatic sigh interval.
b. Decrease the mandatory rate to 5 to 6/min.
c. Increase FIO2 to 60%.
d. Decrease the VT to 500 ml.

 

 

ANS:  B

At this point, the rate is reduced in a stepwise manner until complete spontaneous breathing can be achieved.

 

DIF:    Application    REF:   p. 1215          OBJ:   6

 

  1. A physician has selected a pressure support protocol to wean a patient off ventilatory support. Which of the following pressure levels would you recommend to begin the weaning process?
a. pressure sufficient to obtain a VT of 3 to 5 ml/kg of ideal body weight (IBW)
b. pressure sufficient to overcome the imposed workload
c. pressure sufficient to obtain a VT of 6 to 10 ml/kg IBW
d. pressure equal to 30% of the volume-cycled peak inspiratory pressure

 

 

ANS:  C

For initial ventilator setup in the pressure support mode, the beginning pressure level can be adjusted to deliver an appropriate tidal volume, usually approximately 6-10 ml/kg of IBW.

 

DIF:    Application    REF:   p. 1215          OBJ:   6

 

  1. A physician is using a pressure support protocol to wean a patient off ventilatory support. The patient is now at a 5 cm H2O pressure level and has a spontaneous respiratory rate of 21/min. Other cardiovascular and respiratory signs indicate that the patient remains stable. Which of the following actions would you recommend at this point?
a. Switch the patient to 5 cm H2O continuous positive airway pressure (CPAP) through the endotracheal tube.
b. Extubate the patient and provide supplemental O2.
c. Switch the patient to intermittent mandatory ventilation at a rate of 2/min.
d. Decrease the pressure support level to 3 cm H2O.

 

 

ANS:  B

In general, patients who can spontaneously breathe comfortably at this level of pressure support can be extubated without problems.

 

DIF:    Analysis         REF:   p. 1215          OBJ:   6

 

  1. An alert patient receiving ventilatory support through a demand flow intermittent mandatory ventilation system exhibits clinical signs of an increased work of breathing whenever you try to decrease the mandatory rate below 6/min. In order to aid in weaning this patient, which of the following would you recommend?
a. Apply a low level of pressure support.
b. Apply a high level of inspiratory pressure.
c. Increase the mandatory VT.
d. Decrease the mandatory VT.

 

 

ANS:  A

With synchronized intermittent mandatory ventilation, the addition of pressure support can overcome the work of breathing imposed during “spontaneous” breaths because of the presence of endotracheal and tracheostomy tubes, demand flow systems, and ventilator circuits.

 

DIF:    Application    REF:   p. 1216          OBJ:   6

 

  1. What are some advantages of mandatory minute ventilation (MMV) as a weaning tool?
  2. It provides greater control over PaCO2 than intermittent mandatory ventilation does.
  3. It prevents acidemia with acute hypoventilation.
  4. It eliminates concerns over depressant drugs.
  5. It ensures an efficient pattern of ventilation.
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

See Box 47-12.

 

DIF:    Recall             REF:   p. 1216          OBJ:   7

 

  1. Which of the following ventilator modes can ensure delivery of a preset VT during spontaneous breathing?
  2. volume support or VERSUS (Siemens Servo Ventilator 300)
  3. volume-assured pressure support or VAPS (Bird 8400ST)
  4. augmented minute ventilation or MMV (Bear 1000)
a. 2 and 3
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  B

Volume-assured pressure support is similar to volume support in that a minimum preset tidal volume is maintained by means of automatic adjustment of the ventilator.

 

DIF:    Recall             REF:   p. 1216          OBJ:   7

 

  1. Which of the following is false about noninvasive positive-pressure ventilation (NPPV)?
a. NPPV can support ventilation without a tracheal airway.
b. NPPV should not be used with patients at risk for aspiration.
c. Patients likely to fail weaning are good candidates for NPPV.
d. NPPV can be used to prevent reintubation when weaning fails.

 

 

ANS:  C

Patients who are likely to be unsuccessful at weaning are not good candidates for NPPV.

 

DIF:    Recall             REF:   p. 1210-1211                                   OBJ:   7

 

  1. In most weaning protocols, what minimum blood gas parameters are needed to start the process?
a. PaO2 greater than 70 mm Hg and PaCO2 less than 50 mm Hg on FIO2 less than 0.6 and PEEP less than 5 cm H2O
b. PaO2 greater than 70 mm Hg and PaCO2 less than 50 mm Hg on FIO2 less than 0.4 and PEEP 5 cm H2O or greater
c. PaO2 greater than 50 mm Hg and PaCO2 less than 50 mm Hg on FIO2 less than 0.6 and PEEP less than 10 cm H2O
d. PaO2 greater than 70 mm Hg and PaCO2 less than 70 mm Hg on FIO2 less than 0.6 and PEEP 5 cm H2O or greater

 

 

ANS:  B

See Box 47-14.

 

DIF:    Recall             REF:   p. 1227          OBJ:   6

 

  1. Which of the following weaning methods provides the best respiratory muscle strength conditioning?
a. pressure-supported ventilation
b. T-tube
c. intermittent mandatory ventilation
d. volume-assured pressure support (VAPS)

 

 

ANS:  B

See Table 47-4.

 

DIF:    Recall             REF:   p. 1219          OBJ:   7

 

  1. All of the following are disadvantages of using the T-tube method for weaning except:
a. more staff time required
b. abrupt transition sometimes difficult
c. high imposed work of breathing
d. lack of alarm systems

 

 

ANS:  C

See Table 47-4.

 

DIF:    Recall             REF:   p. 1219          OBJ:   7

 

  1. All of the following are disadvantages of using intermittent mandatory ventilation for weaning except:
a. potentially high work of breathing
b. weaning time possibly prolonged
c. patient-ventilator dyssynchrony
d. higher mean airway pressures

 

 

ANS:  D

See Table 47-4.

 

DIF:    Recall             REF:   p. 1219          OBJ:   7

 

  1. All of the following are advantages of using pressure-supported ventilation for weaning except:
a. guaranteed VT
b. reduced work of breathing
c. respiratory muscle fatigue prevented
d. better patient comfort and synchrony

 

 

ANS:  A

See Table 47-4.

 

DIF:    Recall             REF:   p. 1219          OBJ:   7

 

  1. Which of the following cardiovascular changes would you consider a bad sign during weaning a patient from ventilatory support?
a. development of chest pain
b. increase in both stroke volume and cardiac index
c. increase in heart rate from 95 to 110/min
d. fall in blood pressure from 143/95 to 126/88 mm Hg

 

 

ANS:  A

See Table 47-6.

 

DIF:    Application    REF:   p. 1220          OBJ:   6

 

  1. While monitoring a patient being weaned through a T-tube protocol, signs indicating that mechanical ventilation should be restored include all of the following except:
a. development of cardiac arrhythmias
b. asynchronous or paradoxical breathing
c. development of severe hypotension
d. moderate rise in respiratory rate

 

 

ANS:  D

See Table 47-6.

 

DIF:    Recall             REF:   p. 1220          OBJ:   6

 

  1. While monitoring a patient during a T-tube weaning trial, you notice the following: an increase in heart rate from 86 to 100/min; an increase in respiratory rate from 12 to 23/min; an increase in PaCO2 from 39 to 45 mm Hg; and a decrease in PaO2 from 82 to 73 mm Hg. Which of the following actions would be appropriate at this time?
a. Reconnect the patient to the ventilator with prior settings.
b. Request that the patient be administered a mild sedative.
c. Suction the patient after manual hyperinflation or oxygenation.
d. Encourage the patient to relax, and continue careful monitoring.

 

 

ANS:  D

See Table 47-6.

 

DIF:    Analysis         REF:   p. 1220          OBJ:   6

 

  1. Which of the following changes can be expected when weaning a patient through a T-tube trial?
  2. increase in respiratory rate of 10/min
  3. increase in heart rate of 15 to 20/min
  4. 5 to 10 mm Hg rise in the arterial PCO2
  5. doubling of the minute ventilation
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

See Table 47-6.

 

DIF:    Application    REF:   p. 1220          OBJ:   6

 

  1. While monitoring a patient during a T-tube weaning trial, you notice the following: increased patient agitation; increased heart rate (from 90 to 118/min); increased respiratory rate (from 17 to 33/min with some paradoxical motion); and premature ventricular contractions (PVCs) increasing to an average of 5/min. Which of the following actions would be appropriate at this time?
a. Reconnect the patient to the ventilator with prior settings.
b. Encourage the patient to relax, and continue careful monitoring.
c. Request that the patient be given a stat (immediate) bolus of lidocaine.
d. Request that the patient be given a strong sedative or hypnotic.

 

 

ANS:  A

See Table 47-6.

 

DIF:    Analysis         REF:   p. 1220          OBJ:   6

 

  1. Which of the following is FALSE about artificial tracheal airways and weaning?
a. There are decreases in tube inner diameter (ID) and increases in VE increase the work of breathing.
b. The added work due to artificial airways can increase ventilator dependence.
c. Artificial airways can increase the work of breathing nearly threefold.
d. Tracheostomy tubes increase the work of breathing more than can endotracheal tubes.

 

 

ANS:  D

The presence of an artificial airway may increase airway resistance nearly threefold, although some evidence calls into question the assumption that breathing through an endotracheal tube offers a greater work of breathing than does breathing through a natural airway postextubation. In a study with 14 successfully extubated patients, at the end of a 2-hour spontaneous breathing trial there was no difference in work of breathing before and after extubation.

 

DIF:    Recall             REF:   p. 1220          OBJ:   6

 

  1. What is the best way to decrease the work of breathing imposed by an artificial airway on a patient receiving ventilatory support?
a. Provide pressure support.
b. Decrease inspiratory flow.
c. Lower the minute ventilation.
d. Use low rates of breathing.

 

 

ANS:  A

Pressure support ventilation can be very effective in overcoming this imposed work.

 

DIF:    Application    REF:   p. 1216          OBJ:   6

 

  1. What are some factors that indicate a patient’s readiness for extubation?
  2. adequate oxygenation or ventilation with spontaneous breathing
  3. minimal risk for upper airway obstruction
  4. adequate airway protection or minimal aspiration risk
  5. adequate clearance of pulmonary secretions
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

See Box 47-15.

 

DIF:    Recall             REF:   p. 1224          OBJ:   8

 

  1. What patients are at high risk for postextubation upper airway obstruction?
  2. those with neuromuscular disorders
  3. those who have had major neck surgery
  4. those with infectious masses or abscesses
a. 2 and 3
b. 1 and 2
c. 1 and 3
d. 1, 2, and 3

 

 

ANS:  D

Compression of the airway due to traumatic or postoperative hematoma of the neck, infectious masses or abscesses, and malignant tumors or compression after major head or neck surgery can lead to upper airway obstruction after extubation.

 

DIF:    Recall             REF:   p. 1221          OBJ:   6

 

  1. In considering a patient for endotracheal tube extubation, which of the following procedures would you recommend to determine the risk of postextubation upper airway obstruction?
a. methylene blue test
b. pre- and post-bronchodilator
c. cuff leak test
d. forced vital capacity

 

 

ANS:  C

The cuff leak test is recommended to detect airway obstruction before extubation.

 

DIF:    Recall             REF:   p. 1221          OBJ:   5

 

  1. Which of the following patients are at high risk for severe laryngeal edema after an endotracheal tube extubation?
  2. pediatric burn victim
  3. patient with epiglottitis
  4. smoke inhalation patient
  5. pulmonary fibrosis patient
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  B

Children, patients with epiglottitis or angioedema (dermal, subcutaneous, or submucosal edema of the face or larynx), and patients who have sustained smoke inhalation are at greater risk.

 

DIF:    Recall             REF:   p. 1222          OBJ:   5

 

  1. In considering a patient for extubation, which of the following would you recommend to minimize the risk of postextubation aspiration?
a. Perform and confirm a positive cuff leak test.
b. Discontinue (DC) tube feeding 4 to 6 hours before extubation.
c. Perform deep endotracheal suctioning before extubation.
d. Keep the cuff inflated when removing the tube.

 

 

ANS:  B

Withholding feeding 4 to 6 hours before extubation and clamping feeding tubes may be prudent.

 

DIF:    Recall             REF:   p. 1221          OBJ:   8

 

  1. Common causes for weaning failure include all of the following except:
a. myocardial ischemia
b. critical illness polyneuropathy
c. psychological dependence
d. secondary polycythemia

 

 

ANS:  D

Myocardial ischemia may occur frequently among ventilator-dependent patients and has been associated with weaning failure. Critical illness polyneuropathy has been cited as a frequent cause of neuromuscular weaning failure among critically ill patients. Unsuspected neuromuscular disease may be an important factor in ventilator dependency. Inability to wean can sometimes be attributed to psychological dependence, poor oxygenation status, or cardiovascular instability (congestive heart failure or ischemia).

 

DIF:    Recall             REF:   p. 1222          OBJ:   9

 

  1. A patient whom you are trying to wean below 5 cm H2O pressure support develops respiratory muscle fatigue. Which of the following would you recommend to overcome this problem?
  2. Make sure there is adequate O2 transport or cardiac output.
  3. Make sure that the patient is adequately nourished.
  4. Check and replace any depleted electrolytes.
  5. Clear secretions and provide bronchodilation.
a. 2 and 4
b. 1, 2, and 3
c. 3 and 4
d. 1, 2, 3, and 4

 

 

ANS:  D

See Table 47-8.

 

DIF:    Application    REF:   p. 1223          OBJ:   9

 

  1. All of the following are useful strategies in managing the psychological problems encountered in weaning some patients from ventilator support except to:
a. secure a psychiatric consult
b. decrease environmental stress
c. avoid mental stimulation
d. teach relaxation methods

 

 

ANS:  C

See Table 47-8.

 

DIF:    Recall             REF:   p. 1223          OBJ:   10

 

  1. Who should make the decisions related to terminal weaning?
a. patient
b. patient’s family and patient’s physician
c. nurse
d. respiratory therapist

 

 

ANS:  B

The decision should be made by the family in consultation with the patient’s physician and in accordance with established ethical and legal guidelines.

 

DIF:    Recall             REF:   p. 1224          OBJ:   10

 

  1. In an effort to determine a patient’s need for ventilatory support, which of the following factors increase ventilatory workload?
  2. decreased lung compliance
  3. decreased thoracic compliance
  4. increased airway resistance
  5. artificial airways
a. 1 only
b. 1, and 2 only
c. 1, 2, and 3 only
d. 1, 2, 3, and 4

 

 

ANS:  D

See Box 47-3.

 

DIF:    Recall             REF:   p. 1203          OBJ:   2

 

  1. The physician has requested that the respiratory therapist determine a patient’s rapid shallow breathing index (RSBI) before placing the patient on PSV. The patient has a respiratory rate of 32/min and VT of 300 mL. What is the patient’s RSBI?
a. 107
b. 110
c. 112
d. 114

 

 

ANS:  A

The formula for calculating RSBI is f/VT. The therapist would calculates 32/.30 = 107

 

DIF:    Application    REF:   p. 1204          OBJ:   3

 

  1. Which of the following health care disciplines should be involved in the care of a patient who is considered difficult to wean?
  2. physical therapy
  3. speech therapy
  4. social services
  5. occupational therapy
a. 1 and 2 only
b. 2 and 3 only
c. 1, 2, and 4 only
d. 1, 2, 3, and 4

 

 

ANS:  D

This patient should be classified as a difficult to wean patient that would benefit from a program designed specifically for patients failing to wean. This program should systemically evaluate all systems to determine the cause of weaning failure and include the assistance of other health care providers specifically; physical therapy, occupational therapy, speech and language pathology as well as social service. Ideally this should take place in a unit specifically designed for patients who are difficult to wean.

 

DIF:    Recall             REF:   p. 1222          OBJ:   5

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