Pilbeams Mechanical Ventilation

Physiological and Clinical Applications

5th Edition Cairo Test Bank
Visit to download the full and correct content document: https://testbankdeal.com/dow
nload/pilbeams-mechanical-ventilation-physiological-and-clinical-applications-5th-editi
on-cairo-test-bank/
Chapter 10; Assessment of Respiratory Function
Test Bank

MULTIPLE CHOICE

1. A pulse oximeter differentiates oxyhemoglobin from deoxygenated hemoglobin by which of

the following methods?
a. Relating cyclical changes in light transmission through the sampling site
b. Shining and comparing two wavelengths of light through the sampling site
c. Direct measurement by a heated polarographic electrode applied to the skin
d. Using a color sensing device that absorbs one wavelength of light through the skin
ANS: B
A pulse oximeter uses spectrophotometry to differentiate between oxyhemoglobin and
deoxygenated hemoglobin. Two wavelengths of light (660 nm and 940 nm) are shined
through a sample site. Oxyhemoglobin absorbs more light at 940 nm (infrared light [IR])
than does deoxygenated hemoglobin. Deoxyhemoglobin absorbs more light at 660 nm. The
use of cyclical changes in light transmission measured at the sampling site is the method to
determine the pulse rate with a pulse oximeter. A heated polarographic electrode is used for
transcutaneous partial pressure of oxygen (PtcO2) measurements. A color sensing device is
used to detect the amount of carbon dioxide in exhaled gas.

DIF: 1 REF: pg. 177

2. An arterial blood gas should be done to confirm pulse oximetry findings less than a
minimum of _____________.
a. 60%
b. 70%
c. 80%
d. 90%
ANS: C
When a patient’s oxygen saturation measured by pulse oximeter (SpO2) is less than 80% an
arterial blood gas should be drawn to confirm the patient’s oxygenation status because a
pulse oximeter is generally accurate for oxygen saturations greater than 80%.

DIF: 1 REF: pg. 177

3. A pulse oximeter reading will be most accurate when used with a patient in which of the
following situations?
a. An intensive care unit patient with hyperbilirubinemia
b. A hypotensive patient receiving peripheral vasoconstrictors
c. An emergency department patient with evidence of smoke inhalation
d. An open heart patient receiving extracorporeal membrane oxygenation
ANS: A
 Hyperbilirubinemia does not appear to affect pulse oximetry measurements as do low
perfusion states, which are caused by the use of peripheral vasoconstrictors or
extracorporeal membrane oxygenation (ECMO). Carbon monoxide poisoning will lead to an
overestimation of oxygen saturation measured by pulse oximeter (SpO2).

DIF: 1 REF: pg. 177

4. A patient arrives in the emergency department via ambulance following rescue from a house
fire. The instrument that would be most appropriate to assist the respiratory therapist in
assessing this patient’s oxygenation status is which of the following?
a. Capnograph
b. Pulse oximeter
c. Calorimeter
d. CO-Oximeter
ANS: D
Laboratory CO-oximeters measure four types of hemoglobin: oxyhemoglobin (O2Hb),
deoxygenated hemoglobin (HHb), carboxyhemoglobin (COHb), and methemoglobin
(MetHb). This is beneficial for patients who are suffering from smoke inhalation. The
CO-oximeter provides the actual O2Hb and the COHb. Carbon monoxide produces an
erroneously high oxygen saturation measured by pulse oximeter (SpO2). Therefore, if smoke
inhalation is suspected, a CO-oximeter should be used to evaluate the oxygen saturation.
Capnography is the measurement of carbon dioxide concentrations in exhaled gases and is
used to assess proper airway placement. Calorimetry allows the clinician to estimate energy
expenditure from measurements of oxygen consumption ( O2) and carbon dioxide
production ( CO2). This measurement may be useful when weaning a patient from
mechanical ventilation.

DIF: 2 REF: pg. 178

5. While trying to use a finger probe to assess a patient’s oxygenation status, the respiratory
therapist finds that the pulse rate and the ECG monitor heart rate are not consistent and the
oxygen saturation measured by pulse oximeter (SpO2) reading is blank. The patient is
awake, alert, and in no obvious respiratory distress. The respiratory therapist should first
take which of the following actions?
1. Change the probe site.
2. Draw an arterial blood gas.
3. Adjust the probe position on the finger.
4. Remove probe, perform a capillary refill test.
a. 1 and 2 only
b. 2 and 3 only
c. 3 and 4 only
d. 1 and 4 only
ANS: C
 The fact that the patient is awake, alert, and in no respiratory distress decreases the
likelihood that the problem is with the patient. Therefore, the first action in this case should
not be to draw an arterial blood gas (ABG). In cases where the pulse oximeter cannot
identify a pulsatile signal, the oxygen saturation measured by pulse oximeter (SpO2) reading
may not be present. This could be alleviated by adjusting the probe position on the finger.
Absent SpO2 readings could also be due to low perfusion states. Performing a capillary refill
test on the finger being used for the probe would show whether or not the finger has
adequate blood flow. If this is true, the next step would be to change the site.

DIF: 3 REF: pg. 177

6. Pulse oximetry is most useful in which of the following situations?

a. Determining when to extubate an adult
b. Prescribing oxygen therapy for neonates
c. Monitoring patients undergoing chest physical therapy
d. Establishing initial oxygen necessity for home care patients
ANS: C
The oxygen status of a patient being considered for extubation needs to be assessed by an
arterial blood gas, not by pulse oximetry, because not only does the patient’s oxygen status
need assessment, but the acid-base balance does as well. Pulse oximetry is not used as a
basis for prescribing oxygen therapy in neonates. Neonatologists prefer to base oxygen
therapy decisions on arterial partial pressure of oxygen (PaO2) rather than oxygen saturation.
Pulse oximetry is useful for monitoring the oxygen status of patients undergoing chest
physical therapy because it gives immediate results and is used for continuous monitoring.
Pulse oximetry may not be as useful in prescribing oxygen therapy for home care patients.

DIF: 2 REF: pg. 179

7. During which phase of a capnograph does alveolar gas containing carbon dioxide (CO2) mix
with gas from the anatomical airways and the CO2 concentration rises?
a. Phase 1
b. Phase 2
c. Phase 3
d. Phase 4
ANS: B
In phase 1, the initial gas exhaled is from the conducting airways, which contain low levels
of carbon dioxide (CO2) from inspired air. During phase 2, alveolar gas containing CO2
mixes with gas from the anatomical airways and the CO2 concentration rises. In phase 3, the
curve plateaus as alveolar gas is exhaled. In phase 4, the concentration falls to zero.

DIF: 1 REF: pg. 181| pg. 182

8. During which phase of a capnogram does inhalation occur?

a. Phase 1
b. Phase 2
c. Phase 3
d. Phase 4
 ANS: D
During inhalation the capnogram will have a zero reading because there is no exhalation of
carbon dioxide (CO2). As soon as the exhalation phase begins there is rise of the wave form.
In phase 1, the initial gas exhaled is from the conducting airways, which contain low levels
of CO2 from inspired air. During phase 2, alveolar gas containing CO2 mixes with gas from
the anatomical airways and the CO2 concentration rises. In phase 3, the curve plateaus as
alveolar gas is exhaled. In phase 4, the concentration falls to zero because inspiration is
occurring.

DIF: 1 REF: pg. 181| pg. 182

9. The respiratory therapist has just stopped postural drainage for a 24-year-old patient with
cystic fibrosis because of shortness of breath and slight cyanosis in the “head-down”
position. The respiratory therapist should recommend which of the following adjustments to
therapy?
a. Continue postural drainage and monitor patient with capnography.
b. Use only upright or flat postural drainage positions and draw an arterial blood gas
(ABG).
c. Administer oxygen via nasal cannula and monitor with pulse oximetry.
d. Use a transcutaneous partial pressure of oxygen (PO2) monitor to assess the extent
of hypoxemia.
ANS: C
The presence of slight cyanosis and shortness of breath in the “head-down” position is
indicative of hypoxemia. The respiratory therapist should administer supplemental oxygen
via nasal cannula (possibly 1 to 2 L/min) and monitor the patient with a continuous pulse
oximetry. Capnography is not useful in detecting hypoxemia. Using flat postural drainage
positions where the head is not lower than the shoulders has not been proven to be effective.

DIF: 3 REF: pg. 179

10. A patient receiving mechanical ventilation is being continuously monitored for oxygen
saturation measured by pulse oximeter (SpO2) for the last 48 hours. When initially applied,
the SpO2 and the arterial oxygen saturation (SaO2), as well as the pulse on the pulse
oximeter, ECG, and manual pulse, were consistent. During clinical rounds, the respiratory
therapist notices that although the probe is appropriately placed and capillary refill is
normal, the SpO2 reading is down to 90% from 95%. The most appropriate immediate action
is to do which of the following?
a. Replace the probe.
b. Reposition the patient.
c. Draw an arterial blood gas.
d. Move the probe to a different site.
ANS: C
 The oxygen saturation measured by pulse oximeter (SpO2) has dropped from 95% to 90%.
Since the SpO2 and arterial oxygen saturation (SaO2) previously correlated, this situation
could mean that the patient is becoming hypoxemic. The probe is appropriately placed, so
changing sites is not appropriate. The patient has already been checked for and has adequate
circulation to the site of the probe, so moving the probe to a site with more perfusion is not
appropriate. Therefore, the patient needs to have an arterial blood gas to ascertain the SaO2
and partial pressure of oxygen (PaO2).

DIF: 3 REF: pg. 176

11. The partial pressure of end-tidal carbon dioxide (PetCO2) reading is taken at what point in
the figure?

a. Point A
b. Point B
c. Point C
d. Point D
ANS: C
Point C shows the concentration of carbon dioxide (CO2) at the end of the alveolar phase,
just before inspiration begins. This occurs in phase 3 of the four phases of a capnogram.
Point A depicts phase 1, which is the initial gas exhaled from the conducting airways. As a
person exhales, the amount of CO2 in the exhaled gas increases. The amount of CO2 exhaled
levels off at point B. This coincides with phase 4 or the alveolar plateau. Point D is showing
the fall in CO2 that occurs during inspiration.

DIF: 1 REF: pg. 181| pg. 182

12. A patient in the intensive care unit is receiving mechanical ventilation, has a pulmonary
artery catheter in place, and is being monitored continuously with a capnometer. The
patient’s arterial partial pressure of carbon dioxide (PaCO2) is 41 mm Hg and the partial
pressure of end-tidal carbon dioxide (PetCO2) is 36 mm Hg. There is a sudden decrease in
the PetCO2 to 18 mm Hg causing an alarm to sound. The most likely cause of this
development is which of the following?
a. Hypovolemia
b. Apneic episode
c. Pulmonary embolism
d. Increased cardiac output
ANS: C
 Pulmonary embolism will cause a decrease in blood flow to the lungs. This increases
alveolar deadspace and leads to a decrease in the partial pressure of end-tidal carbon dioxide
(PetCO2). Hypovolemia would also cause a decrease in the PetCO2, but it would not occur
as suddenly as it did in this situation. The fact that the patient has an indwelling pulmonary
artery catheter increases the risk of developing a pulmonary embolism, which often will
have a quick onset. An apneic episode would have increased the PetCO2. An increased
cardiac output would increase the PetCO2 because increases in cardiac output result in better
perfusion of the alveoli and a rise in PetCO2.

DIF: 2 REF: pg. 182

13. The capnogram in the figure is indicative of which of the following conditions?

a. Chronic obstructive pulmonary disease (COPD)

b. Cardiac arrest
c. Hyperventilation
d. Pulmonary embolism
ANS: A
Phase 3 becomes indistinguishable when physiological dead space increases, as in chronic
obstructive pulmonary disease (COPD), and causes the capnogram to appear as it does in
the figure. A cardiac arrest would lower the graph line to zero. Hyperventilation will
decrease the alveolar plateau, but its shape would remain the same as a normal capnogram.
A pulmonary embolism would also cause a drop in the alveolar plateau.

DIF: 1 REF: pg. 183| pg. 184

14. For a given minute ventilation, partial pressure of end-tidal carbon dioxide (PetCO2) is a
function of which of the following?
1. Metabolic rate
2. Cardiac output
3. Alveolar deadspace
4. Physiologic shunt
a. 1 and 3 only
b. 1, 2, and 3 only
c. 2, 3 and 4 only
d. 1, 2, 3, and 4
ANS: B
 Changes in metabolic rate cause changes in partial pressure of end-tidal carbon dioxide
(PetCO2). For instance, fever and shivering increase the metabolism and increase the
PetCO2. A change in cardiac output will change PetCO2 because the heart transports the
blood that carries the carbon dioxide (CO2) to the lungs for elimination. Increases in cardiac
output will increase PetCO2. A change in deadspace ventilation will also cause changes in
the PetCO2. Increasing deadspace will decrease the PetCO2.

DIF: 2 REF: pg. 182

15. The normal range for arterial-to-end-tidal partial pressure of carbon dioxide [P(a-et)CO2] is
which of the following?
a. 2 to 4 mm Hg
b. 4 to 6 mm Hg
c. 6 to 8 mm Hg
d. 8 to 10 mm Hg
ANS: B
The arterial-to-end-tidal partial pressure of carbon dioxide [P(a-et)CO2] for tidal breathing
should be approximately 4 to 6 mm Hg.

DIF: 1 REF: pg. 184

16. During shift report, the day shift respiratory therapist informs the night shift respiratory
therapist about a freshly postoperative patient who is receiving full support via mechanical
ventilation. At the time of the last patient-ventilator system check the patient had not
awaken from anesthesia. During first rounds on the day shift the respiratory therapist notes
the capnography shown in the figure. The most appropriate action to take would be to do
which of the following?

a. Administer a bronchodilator.
b. Begin the weaning process.
c. Fix the leak in the sampling line.
d. Reinflate the ET tube cuff.
ANS: B
The figure shows a patient whose capnography is demonstrating spontaneous respiratory
efforts during mechanical ventilation. This corresponds to the patient waking up from
anesthesia. With all else stable, the next step would be to begin the weaning process.

DIF: 3 REF: pg. 183| pg. 184

17. The area under the curve of a single breath carbon dioxide curve (SBCO2) represents which
of the following?
a. Tidal volume
b. Alveolar dead space
c. Physiologic dead space
d. Effective alveolar ventilation
ANS: D
The area under the single breath carbon dioxide curve (SBCO2) curve represents alveolar
volume. This is known as phase 3 on the SBCO2 curve. Phase 1 is the anatomic deadspace
volume. Phase 2 is a transitional phase between anatomic deadspace and alveolar volume.

DIF: 1 REF: pg. 184

18. The change in the single breath carbon dioxide (CO2) curve from “A” to “B” shown in the
figure may be as a result of which of the following?

a. Hypervolemia
b. Decreased positive-end-expiratory pressure (PEEP)
c. Increased mean airway pressure
d. Excessive bronchodilator administration
ANS: C
The change in the figure shows an increase in phase 1 and a decrease in phase 2 of the single
breath carbon dioxide curve (SBCO2) curve. An increase in phase 1 may be caused by an
increase in anatomical deadspace. This is possible as a result of increased airway obstruction
or excessive positive-end-expiratory pressure (PEEP). Therefore, answers “B” and “D”
cannot be correct. A decrease in phase 2 means there is a decrease in venous return or an
increase in intrathoracic pressure. This could be caused by hypovolemia or an increased
intrathoracic pressure as seen with increased mean airway pressures. Therefore, answer “A”
cannot be correct. Answer “C” is a measure of increased intrathoracic pressure and is the
correct answer.

DIF: 2 REF: pg. 184| pg. 185| pg. 186

19. Which of the following situations will cause an increase in the single breath carbon dioxide
(CO2) curve?
a. Decreased metabolic rate and decreased ventilation
 b. Decreased metabolic rate and increased ventilation
c. Increased metabolic rate and increased ventilation
d. Increased metabolic rate and decreased ventilation
ANS: D
The same cause for an increase in arterial partial pressure of carbon dioxide (PaCO2) will
increase the single breath carbon dioxide curve (SBCO2) curve. An increase in metabolic
rate will increase the carbon dioxide (CO2) production in the body. This accompanied by
either no change in ventilation or a decrease in ventilation will cause the amount of CO2 in
the body to increase and thus cause the amount of CO2 exhaled to increase. The only
combination that will do this is “D,” increased metabolic rate and decreased ventilation.

DIF: 2 REF: pg. 185

20. The area represented by the letter “Y” in the figure is which of the following?

a. End-tidal carbon dioxide (EtCO2)

b. Alveolar ventilation
c. Alveolar dead space
d. Airway dead space
ANS: C
The end-tidal carbon dioxide (EtCO2) is represented by the very end of the wave form. The
alveolar ventilation is represented by the area under the curve, which is “X.” The alveolar
dead space is represented by the difference between the arterial partial pressure of carbon
dioxide (PaCO2) and the EtCO2 line, which is “Y.” The airway dead space is represented by
“Z.”

DIF: 1 REF: pg. 186

21. A patient is receiving mechanical ventilation with a fractional inspired oxygen (FIO2) of
0.85 and a positive-end-expiratory pressure (PEEP) of 5 cm H2O. His arterial partial
pressure of oxygen (PaO2) is 68 mm Hg, arterial oxygen saturation (SaO2) is 88%, and
partial pressure of end-tidal carbon dioxide (PetCO2) is 32 mm Hg. Over the next few
minutes his PEEP is titrated resulting in the following data:
Time FIO2 PEEP cm H2O SpO2 PetCO2 (mm Hg)
0600 0.85 5 88% 30
0630 0.85 8 88% 30
0650 0.85 10 90% 32
0720 0.80 12 93% 34
0740 0.80 15 90% 25
 At 0740 the single breath carbon dioxide curve (SBCO2) curve shifted to the right. What
action should the respiratory therapist take at this time?
a. Increase the FIO2 to 0.90.
b. Reduce the set tidal volume.
c. Continue to increase the PEEP.
d. Reduce the PEEP to 12 cm H2O.
ANS: D
The increase in positive-end-expiratory pressure (PEEP) to 15 cm water (H2O) seems to
have decreased pulmonary perfusion because of overinflation of the alveoli. This is evident
by the decrease in the partial pressure of end-tidal carbon dioxide (PetCO2) to 25 mm Hg
and the right shift in the single breath carbon dioxide curve (SBCO2). Increasing the
fractional inspired oxygen (FIO2) will not address this problem. Reducing the set tidal
volume will increase the PetCO2 but will not improve the pulmonary circulation. Continuing
to increase the PEEP will further reduce pulmonary perfusion and cause more dead space.
Reducing the PEEP back to 12 cm H2O will optimize the PEEP and reduce overinflation.

DIF: 3 REF: pg. 186

22. Exhaled nitric oxide is used to monitor the effectiveness of which drug used in the treatment
of asthma?
a. Anticholinergic bronchodilators
b. Beta adrenergic bronchodilators
c. Corticosteroids
d. Leukotriene inhibitors
ANS: C
Exhaled nitric oxide (NO) is currently used as a marker for airway inflammation associated
with asthma. Monitoring the level of exhaled NO can also be used to monitor the
effectiveness of inhaled corticosteroid in the treatment of asthmatic patients.

DIF: 1 REF: pg. 187

23. The condition that is associated with a reduction in exhaled nitric oxide is which of the
following?
a. Alveolitis
b. Cystic fibrosis
c. Chronic bronchitis
d. Airway viral infection
ANS: B
See Box 10-3 in the text for a list of conditions that reduce and elevate levels of exhaled
nitric oxide.

DIF: 1 REF: pg. 187

24. What type of electrode is used by a transcutaneous partial pressure of oxygen (PtcO2)
device?
a. Galvanic
 b. Polarographic
c. Paramagnetic
d. Stow-Severinghaus
ANS: B
A heated Clark or polarographic electrode is used to monitor the transcutaneous partial
pressure of oxygen. The Stow-Severinghaus is used in the measurement of transcutaneous
carbon dioxide (CO2) partial pressure. Polarographic and Galvanic are types of oxygen
analyzers that use chemical reactions to measure oxygen concentrations in gas mixtures.

DIF: 1 REF: pg. 187

25. To properly operate, the transcutaneous partial pressure of oxygen electrode needs to be at
what temperature range?
a. 32° C to 35° C
b. 36° C to 39° C
c. 42° C to 45° C
d. 46° C to 49° C
ANS: C
The transcutaneous partial pressure of carbon dioxide (PtcO2) electrode is heated to between
42° C to 45° C to produce capillary vasodilation below the surface of the electrode. This
will improve diffusion of gases across the skin. If the PtcO2 temperature is lower than this
range, the results will not be reliable. A temperature higher than this range will produce skin
burns.

DIF: 1 REF: pg. 187

26. A transcutaneous partial pressure of oxygen (PtcO2) reading is inaccurate in all of the
following situations EXCEPT:
a. Hypothermia
b. Septic Shock
c. Infant Respiratory Distress Syndrome
d. Elevated peripheral (cutaneous) resistance
ANS: C
A reduction in cutaneous circulation will drastically effect the measurement of
transcutaneous partial pressure of oxygen (PtcO2). This situation is caused by hypothermia,
septic shock, and elevated peripheral resistance. PtcO2 measurements have been shown to be
reliable for neonates.

DIF: 1 REF: pg. 187| pg. 188

27. What type of electrode is used by a transcutaneous partial pressure of carbon dioxide
(PtcCO2) device?
a. Galvanic
b. Polarographic
c. Paramagnetic
d. Stow-Severinghaus
ANS: D
 The Stow-Severinghaus is used in the measurement of transcutaneous carbon dioxide partial
pressure. A Clark or polarographic electrode is used to monitor the transcutaneous partial
pressure of oxygen. Polarographic and Galvanic are types of oxygen analyzers that use
chemical reactions to measure oxygen concentrations in gas mixtures.

DIF: 1 REF: pg. 188

28. During calibration of a transcutaneous monitor the respiratory therapist notices a signal
drift. The respiratory therapist should do which of the following?
a. Increase the probe temperature.
b. Replace the monitor and call for repair.
c. Add more electrolyte gel to the patient’s skin.
d. Change the electrolyte and sensor’s membrane.
ANS: D
A signal drift on a transcutaneous monitor should be addressed by changing the electrode
and sensor’s membrane. The electrode and the sensor’s membrane should be changed
weekly due to the evaporation of the electrolyte solution caused by the heating of the
electrode. Increasing the probe temperature may cause patient burns if it is over 45° C. The
signal drift does not necessarily mean that the monitor itself needs to be taken out of service.
Adding more gel to the patient’s skin will help with gas diffusion during measurement only.

DIF: 3 REF: pg. 187| pg. 188

29. How often should the respiratory therapist reposition the sensor of a transcutaneous
monitor?
a. 30 minutes to 1 hour
b. 1 to 3 hours
c. 4 to 6 hours
d. 7 to 9 hours
ANS: C
Burns can occur because the site of measurement needs to be heated to between 42° C to
45° C. Repositioning the sensor every 4 to 6 hours will help avoid this problem.

DIF: 1 REF: pg. 189

30. The clinical data that should be recorded when making transcutaneous measurements
include which of the following?
1. Electrode temperature
2. Skin temperature
3. Probe placement
4. Fractional Inspired Oxygen (FiO2)
a. 1 and 3 only
b. 1 and 2 only
c. 2, 3, and 4 only
d. 1, 2, 3 and 4
ANS: D
 The electrode temperature is necessary to document to ensure that the temperature stays
within the range of 42° C to 45° C. The skin temperature should be noted to assess the
patient’s peripheral perfusion. The probe placement should be noted to ensure that the probe
is being moved to different sites every 4 to 6 hours. The fractional inspired oxygen (FiO2)
should be documented to determine the need for an increase or decrease in the amount of
supplemental oxygen the patient is receiving.

DIF: 1 REF: pg. 189

31. Components of an indirect calorimeter may include which of the following?

1. Pressure manometer
2. Pneumotachometer
3. Pressure-sensitive transducer
4. Oxygen and carbon dioxide analyzers
a. 1 and 2 only
b. 2 and 4 only
c. 2, 3, and 4 only
d. 1, 2, 3, and 4
ANS: B
Indirect calorimeters contain analyzers for measuring the concentration of inspired and
expired gases, oxygen (O2) and carbon dioxide (CO2), pneumotachometers, turbine
flowmeters, or ultrasonic vortex flowmeters to measure volume and flow,
temperature-sensitive, solid-state transducers to measure barometric pressure and exhaled
gas temperatures.

DIF: 1 REF: pg. 189| pg. 190

32. An energy expenditure (EE) of 60 kcal/hr/m2 for an adult is indicative of which of the
following conditions?
a. Burns
b. Sedation
c. Starvation
d. Hypothermia
ANS: A
An energy expenditure (EE) of 30 – 40 kcal/hr/m2 is normal for an adult. The EE of 60
kcal/hr/m2 is greater than 120% of predicted and is considered a hypermetabolic state. Burns
create a hypermetabolic state. Starvation, sedation and hypothermia create hypometabolic
states.

DIF: 2 REF: pg. 190

33. An energy expenditure (EE) of 20 kcal/hr/m2 for an adult is indicative of which of the
following conditions?
a. Pregnancy
b. Starvation
c. Hyperthyroidism
d. Stimulant drugs
 ANS: B
An energy expenditure (EE) of 30 – 40 kcal/hr/m2 is normal for an adult. The EE of 20
kcal/hr/m2 is less than 80% of predicted and is considered a hypometabolic state. Starvation
creates a hypometabolic state. Pregnancy, hyperthyroidism, and stimulant drugs create
hypermetabolic states.

DIF: 2 REF: pg. 190| pg. 191

34. The respiratory quotient (RQ) value associated with substrate utilization patterns in normal,
healthy individuals is which of the following?
a. 0.7
b. 0.8
c. 0.9
d. 1.0
ANS: B
A healthy adult consuming a typical American diet will have a respiratory quotient (RQ)
range from 0.80 to 0.85. An RQ of 0.7 is indicative of lipid metabolism as seen in prolonged
starvation or severe sepsis. The RQ for the metabolism of pure carbohydrates is 1.0. An RQ
of 0.9 would mean that the individual is consuming a higher amount of carbohydrates than a
normal diet.

DIF: 1 REF: pg. 191

35. A patient whose carbon dioxide (CO2) production is 390 mL/min and oxygen (O2)
consumption is 375 mL/min is most likely experiencing which of the following?
a. Ketosis
b. Severe sepsis
c. Hyperventilation
d. Too much carbohydrate intake
ANS: C
The respiratory quotient (RQ) is the ratio of carbon dioxide (CO2) production to oxygen
(O2) consumption. This patient has an RQ of (390/375) 1.04. Ketosis causes the RQ to be
less than 0.7. Severe sepsis is associated with RQ levels of approximately 0.7.
Hyperventilation is associated with RQ levels greater than 1.0. Pure carbohydrate RQ is 1.0.

DIF: 2 REF: pg. 191

36. A mechanically ventilated patient with chronic obstructive pulmonary disease is in the
process of being weaned from mechanical ventilation. A diet containing which of the
following will be most beneficial to this process?
a. High protein, low fats and carbohydrates
b. Low fats and proteins, high carbohydrates
c. Low carbohydrate with increased fats and proteins
d. Equal amounts of carbohydrates, fats, and proteins
ANS: C
 Diets with a high percentage of carbohydrates will raise the amount of carbon dioxide (CO2)
a patient produces. This will overburden a patient with limited ventilatory reserves, as with
chronic obstructive pulmonary disease (COPD). The added CO2 is greater than the patient’s
ventilatory capacity and when attempting to maintain spontaneous breathing the patient will
fail to wean.

DIF: 2 REF: pg. 191

37. The newest types of mechanical ventilators use which of the following devices to measure
airway pressures?
a. Barometers
b. Aneroid manometers
c. Electromechanical transducers
d. Variable orifice pneumotachometers
ANS: C
Barometers are used to measure atmospheric (barometric) pressure. Older ventilators
incorporated an aneroid manometer into the ventilator circuit. Variable orifice
pneumotachometers are used to measure flow. The devices that are used in the current
ventilators today are the electromechanical transducers, which include piezoelectric
transducers, variable capacitance transducers, and strain gauge transducers.

DIF: 1 REF: pg. 191

38. A strain gauge transducer is being used to measure airway pressures during mechanical
ventilation. The transducer measures 18 mm Hg. However, you are required to document
pressures in cm H2O. What should you document?
a. 39.6 cm H2O
b. 24.5 cm H2O
c. 13.2 cm H2O
d. 2.4 cm H2O
ANS: B
To convert mm Hg to cm H2O multiply the pressure in mm Hg by 1.36. Therefore, 18
multiplied by 1.36 is 24.5 cm H2O.

DIF: 2 REF: pg. 192

39. To measure plateau pressure, inspiration should be held for how many seconds?
a. 1 - 2
b. 2 - 3
c. 3 - 4
d. 4 – 5
ANS: A
Plateau pressure requires the establishment of a period of no-flow for 1 to 2 seconds to
allow pressure equilibration by the redistribution of the tidal volume and stress relaxation.
This maneuver increases inspiratory time and if held longer than 2 seconds may cause
barotrauma.
 DIF: 1 REF: pg. 192| pg. 193

40. Select the ventilator flowmeter that will read accurately when used with heliox.
a. Turbine
b. Vortex ultrasonic
c. Variable capacitance
d. Variable orifice pneumotachometer
ANS: B
Vortex ultrasonic flowmeters are not affected by the viscosity, density, or temperature of the
gas being measured. The turbine and variable orifice pneumotachometer will not be accurate
when using heliox because of its decreased density. A variable capacitance device is a
transducer used to measure airway pressure.

DIF: 1 REF: pg. 193| pg. 194

41. Bidirectional flow can be measured by which of the following devices?

a. Turbine flowmeter
b. Piezoelectric transducer
c. Ultrasonic vortex flowmeter
d. Variable orifice pneumotachometer
ANS: D
The turbine and ultrasonic flowmeters are inaccurate with bidirectional flows. The
piezoelectric transducer measures airway pressures. The variable orifice pneumotachometer
is a bidirectional flow measuring device.

DIF: 1 REF: pg. 194

42. During the application of positive-end-expiratory pressure (PEEP), the monitoring of which
pressure will alert the respiratory therapist specifically to alveolar overdistention?
a. Peak inspiratory pressure (PIP)
b. Plateau pressure (Pplateau)
c. Mean airway pressure ( )
d. Transairway pressure (PTA)
ANS: B
 The plateau pressure (Pplateau) is the pressure required to overcome only elastance. When
positive-end-expiratory pressure (PEEP) is applied, the alveolar pressure will rise. This will
result in a higher Pplateau. If overdistention occurs the Pplateau will rise immediately. Peak
inspiratory pressure (PIP) reflects the total force that must be applied to overcome both
elastance and airway resistance offered by the patient-ventilator system. The mean airway
pressure represents the average pressure recorded during the entire respiratory cycle. It is
influenced by PIP, PEEP, inspiratory time and total cycle time. The mean airway pressure is
not a specific monitor for optimizing PEEP. The PIP will increase in the face of alveolar
overdistention, but it is not specific enough to rely on as the sole measurement to identify
overdistention. The transairway pressure is the difference between the PIP and the Pplateau,
and represents the amount of pressure needed to overcome airway resistance (all frictional
forces). The transairway pressure will not reflect alveolar overdistention because when
alveolar overdistention happens both the PIP and the Pplateau will rise, and the difference
between the two will remain constant unless there is an unrelated change in airway
resistance.

DIF: 2 REF: pg. 193

43. A patient-ventilator system check reveals the following information: peak inspiratory
pressure (PIP) 27 cm H2O, positive-end-expiratory pressure (PEEP) 5 cm H2O, plateau
pressure (Pplateau) 14 cm H2O, inspiratory time (TI) 0.75 second, set frequency 20/minute.
Calculate the mean airway pressure.
a. 6.75 cm H2O
b. 7.75 cm H2O
c. 11.75 cm H2O
d. 12.37 cm H2O
ANS: B
Total cycle time (TCT) = 60/frequency = 60/20 = 3 seconds. {P-macron}aw = [(PIP –
PEEP) X (TI/TCT)] + PEEP = [(27 – 5) X (0.75/3)] + 5 = [22 X 0.25] + 5 = 7.75
cm H2O.

DIF: 2 REF: pg. 193

44. A patient-ventilator system check reveals the following information: peak inspiratory
pressure (PIP) 32 cm H2O, positive-end-expiratory pressure (PEEP) 12 cm H2O, plateau
pressure (Pplateau) 20 cm H2O, inspiratory time (TI) 1 second, set frequency 12/minute.
Calculate the mean airway pressure.
a. 4 cm H2O
b. 8 cm H2O
c. 12 cm H2O
d. 14 cm H2O
ANS: D
Total cycle time (TCT) = 60/frequency = 60/12 = 5. {P-macron}aw = [(PIP – PEEP) X
(TI/ TCT)] + PEEP = [(32 – 12) X (1/5)] + 12 = [20 X 0.2] + 12 = 14 cm H2O.
 DIF: 2 REF: pg. 193

45. Calculate the dynamic compliance given the following clinical data: tidal volume 500 mL,
peak inspiratory time (PIP) 35 cm H2O, plateau pressure (Pplateau) 20 cm H2O,
positive-end-expiratory pressure (PEEP) 5 cm H2O, tubing compliance (CT) 2.5 mL/cm
H2O.
a. 11.8 mL/cm H2O
b. 14.2 mL/cm H2O
c. 25 mL/cm H2O
d. 46.2 mL/cm H2O
ANS: B
Dynamic compliance = tidal volume (VT) – [(PIP - PEEP) X CT]/(PIP - PEEP) = 500 – [(35
– 5) X 2.5]/(35 – 5) = 14.2 mL/cm H2O.

DIF: 2 REF: pg. 194

46. Calculate dynamic compliance given the following clinical data: tidal volume 600 mL, peak
inspiratory pressure (PIP) 28 cm H2O, plateau pressure (Pplateau) 15 cm H2O,
positive-end-expiratory pressure (PEEP) 10 cm H2O, CT 2 mL/cm H2O.
a. 30.2 mL/cm H2O
b. 31.3 mL/cm H2O
c. 38 mL/cm H2O
d. 44.1 mL/cm H2O
ANS: B
Dynamic compliance = tidal volume (VT) – [(PIP - PEEP) x CT]/(PIP - PEEP) = 600 – [(28
– 10) x 2]/(28 – 10) = (600 – 36)/18 = 31.3 mL/cm H2O

DIF: 2 REF: pg. 194

47. Calculate the static compliance given the following clinical data: tidal volume 500 mL, peak
inspiratory pressure (PIP) 35 cm H2O, plateau pressure (Pplateau) 25 cm H2O,
positive-end-expiratory pressure (PEEP) 12 cm H2O, measured unintended
positive-end-expiratory pressure (auto-PEEP) 3 cm H2O, tubing compliance (CT) 2.5 mL/cm
H2O.
a. 17.5 mL/cm H2O
b. 34 mL/cm H2O
c. 36 mL/cm H2O
d. 47.5 mL/cm H2O
ANS: D
Static compliance = tidal volume (VT) – [(Pplateau- PEEP) x CT]/(Pplateau- PEEP) = 500 – [(25
– 15) x 2.5]/25 – 15 = [500 – 25]/10 = 47.5 mL/cm H2O.

DIF: 2 REF: pg. 194| pg. 195

48. Calculate the static compliance given the following clinical data: tidal volume 600 mL, peak
inspiratory pressure (PIP) 40 cm H2O, plateau pressure (Pplateau) 30 cm H2O,
positive-end-expiratory pressure (PEEP) 15 cm H2O, tubing compliance (CT) 2 mL/cm H2O.
 a. 14.5 mL/cm H2O
b. 38 mL/cm H2O
c. 55 mL/cm H2O
d. 58 mL/cm H2O
ANS: B
Static compliance = tidal volume (VT) – [(Pplateau- PEEP) x CT]/(Pplateau- PEEP) = 600 – [(30
– 15) x 2]/30 – 15 = 570/15 = 38 mL/cm H2O.

DIF: 2 REF: pg. 194| pg. 195

49. Calculate the airway resistance given the following clinical data: flow rate 60 L/min, peak
inspiratory pressure (PIP) 42 cm H2O, plateau pressure (Pplateau) 15 cm H2O,
positive-end-expiratory pressure (PEEP) 5 cm H2O.
a. 10 cm H2O/L/sec
b. 30 cm H2O/L/sec
c. 37 cm H2O/L/sec
d. 42 cm H2O/L/sec
ANS: B
60 L/min = 1 L/sec. Raw = (PIP – Pplateau)/( (liters/sec) = (42 – 15)/1 = 30 cm H2O/L/sec.

DIF: 2 REF: pg. 195

50. Calculate the airway resistance given the following clinical data: flow rate 60 L/min, PIP 28
cm H2O, Pplateau 21 cm H2O, PEEP 8 cm H2O.
a. 7 cm H2O/L/sec
b. 13 cm H2O/L/sec
c. 20 cm H2O/L/sec
d. 28 cm H2O/L/sec
ANS: A
60 L/min = 1 L/sec. Raw = (PIP – Pplateau)/( (liters/sec) = (28 – 21)/1 = 7 cm H2O/L/sec.

DIF: 2 REF: pg. 193

51. The energy required to move gas through the airways and expand the thorax is known as
which of the following?
a. Airway resistance
b. Dynamic compliance
c. Intrinsic work of breathing
d. Extrinsic work of breathing
ANS: C
 Intrinsic work of breathing is a result of work done to overcome normal elastic and resistive
forces and work to overcome a disease process affecting normal workloads in the lungs and
thorax. Airway resistance is the opposition to airflow from nonelastic forces of the lung.
Dynamic compliance is a measurement of the ease of movement of gas through the airways.
The work of breathing is a result of the airway resistance, dynamic compliance, and static
compliance.

DIF: 1 REF: pg. 195

52. An increase in intrinsic work of breathing due to a decrease in static compliance is caused
by which of the following?
a. Emphysema
b. Bronchospasm
c. Pulmonary fibrosis
d. Airway inflammation
ANS: C
Static compliance is influenced by the elastic characteristics of the lungs and thorax. A
decrease in static compliance is due to either the lungs becoming stiffer or the thorax
inability to stretch to accommodate volume in the lungs. Pulmonary fibrosis is a
pathophysiologic condition that causes the alveoli to become stiffer due to scarring.
Therefore, pulmonary fibrosis will increase a patient’s work of breathing due to decreases in
the static compliance. Emphysema causes an increase in static compliance due to the loss of
elastic properties of the lungs and also an increase in airway resistance because of
bronchospasm, airway inflammation, and airway edema. Bronchospasm and airway
inflammation lead to increased airway resistance and decreased dynamic compliance.

DIF: 1 REF: pg. 195

53. The best assessment of the function of the diaphragm during inspiration is obtained by
measuring which of the following?
a. Airway resistance
b. Pressure-time product
c. Pressure-volume curve
d. Maximum inspiratory pressure
ANS: B
The pressure-time product is a way of estimating the contributions of the diaphragm during
inspiration. It is probably a better indication of a patient's effort to breathe than
measurement of work derived from pressure-volume curves. Airway resistance is a measure
of how much opposition there is to gas movement through the airways. An increase in
airway resistance will cause the diaphragm to have to work harder. However, airway
resistance is not a direct way of assessing the function of the diaphragm. Maximum
inspiratory pressure provides nonspecific information about the function of the respiratory
muscles in general, not specifically the diaphragm.

DIF: 1 REF: pg. 197

54. At which point in the pressure-time curve of a spontaneous breath should the
transdiaphragmatic pressure be greatest?
a. Mid-inspiration
b. Mid-expiration
c. End of exhalation
d. Beginning of inspiration
ANS: A
The transdiaphragmatic pressure is the difference between the gastric and esophageal
pressures, as measured during the respiratory cycle. The greatest distance between these two
pressures during the respiratory cycle is at the middle of inspiration, when the esophageal
pressure is at its lowest point. At mid-expiration the gastric and esophageal pressure
difference is at its smallest point. See Figure 10-25.

DIF: 2 REF: pg. 195