CH 17 WALSH

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1. A term infant is being invasively ventilated in pressure B. initiate pressure

targeted SIMV mode of ventilation. Rate is 16, PIP is support ventilation
18, PEEP 4, Ins. time is 0.4, and FiO2 is .30. the physi-
cian would like to wean the infant from the ventilator.
The clinician has tried turning the patients set rate
on SIMV down to 10 breaths per min, but the infant
immediately becomes tachypneic and desats to 85%.
Which of the following should e done at this time?

A. Increase the PEEP

B. Initiate pressure support ventilation
C. increase the inspiratory time
D. Extubate to nasal CPAP

2. A 600g neonate is being mechanically ventilated in B. 0.3 sec

pressure control ventilation with the following venti-
lator settings; peak inspiratory pressure 24, PEEP 4,
FIO2. 0. 45, RR 40, which inspiratory time should the
clinician set?
A. 0.6 sec
B. 0.3 sec
C. 0.8 sec
D. 1.0 sec

3. Which of the following issues would most likely ex- B. auto cycling
plain why a newborn infants measured RR would rise
from 40 to 100 on a ventilator after the patient was
turned and an audible endotracheal tube leak was
heard?
A. pneumothorax
B. auto cycling
C. secretions
D. bradypnea

4. A 10 yr old child is intubated and receiving mechan- C. 230ml

ical ventilation. The Vt is set at 280 ml, the peak air-
way pressure is at 38, the plateau pressure is at 20,
the PEEP is at 5. The tubing compliance factor is
1.5ml/cm. What is the actual delivered Vt to this patient
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if the ventilator did not compensate for compressible
volume loss?
A. 255ml
B. 157ml
C. 230ml
D. 330ml

5. The physicician would like to begin dual control ven- A. 5ml/kg

tilation of a 500g infant. What would be the initial
corrected volume target?
A. 5ml/kg
B. 7ml/kg
C. 8ml/kg
D. 10ml/kg

6. While observing a ventilator flow graphic for a 12 year B. decrease the

old patient with ashthma on a rate of 10 breaths per insp. time
minute, the clinician notices that expiratory flow does
not return to baseline and the patients autoPEEp level
is 6cm H2O. Which ventilator manipulation might help
this patient the most?
A. increase the RR by 8 breaths/min
B. decrease the insp. time
C. decrease the peak inspiratory flow
D. increase the PEEP

7. A neonatal pt with respiratory syncytial virus is re- B. suctioning and

ceiving mechanical ventilation in the puressure con- then increasing
trol mode with the following current settings. PIP 14, the PIP
PEEP 5, FIO2 0.50, RR 28,. The pt has poor chest rise
bilaterally, and the breath sounds are underaerated
with faint wheezes. You notice that the measured tidal
volume is 3ml/kg and the RR is 80. THe pt has nasal
flaring, retractions, and head bobbing. What should be
suggested at this time?
A. placing the pt on a high frequency oscillator
B suctioning and then increasing PIP
C. decreasing RR
D. using a neuromuscular blocking agent

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8. Which ventilator approach would e good for a 10 yr old B APRV
boy with severe ARDS who is spontaneously breath-
ing while undergoing ventilation?
A. PCV
B. APRV
C. CPAP
D. IRV

9. Which of the following factors does not affect mean C. time constant
airway pressure?
A. PEEP
B. I-time
C. Time constant
D. PIP

10. High frequency ventilation is defined by the US. FDA A. 150 breaths per
as delivering more than: min
A. 150 breaths per min
B. 120 breaths per min
C. 100 breaths per min
C. 100 breaths per min
D. 60 breaths per min

11. High frequency jet ventilation delivers gas by : B. Pulsing gas

A. intermittently occluding a high flow of gas with a down the ET tube
rotating vane at a high velocity
B. Pulsing gas down the ET tube at a high velocity
C. Passing gas past the ET tube and agitating it with
a piston
D the same method as conventional ventilation, just a
higher frequency

12. High frequency oscillatory ventilation delivers gas by: D. passing gas
A. the same method as conventional ventilation, just past the ET tube
at a higher frequency and agitating it
B. pulsing gas down the ET tube at a high velocity with a piston
C. alternating gas in and out via a rotating vane
D. passing gas past the ET tube and agitating it with a
piston

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13. The exhalation phase of HFOV differs from other A. exhaled gas is
forms of high frequency ventilation because: actively pulled out
A. exhaled gas is actively pulled out via the patient as via the patient as
the piston moves back the piston moves
B. exhalation is passive, whereas the HFJV gas is back
pulled out via a Venturi effect
C. exhalation is active during HFOV due to a separate
rate vacuum assist device.
D. exhaled gases passively exit the patient due to
passive chest recoil

14. Which of the following most accurately describes the C. I, III, IV

relationship of lung volume in a restrictive disease
and Paw:
I. increasing Paw increases lung volume and improves
ventilation perfusion matching
II. increasing Paw increases the pressure gradient,
allowing more oxygen to cross the alveolar capillary
membrane.
III. increasing Paw improves the efficiency of the jet or
piston.
IV. at very high and very low lung volumes ventilation
perfusion matching is impared

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

15. The goal in treating atelectatic prone lung is: A. high lung vol-
A. high lung volume to recruit alveolar lung units ume to recruit
B. low lung volumes to reduce the chance of barotrau- alveolar lung units
ma
C. high tidal volumes during convention ventilation to
assist in carbon dioxide removal
D. high lung volume to recruit the lung and large tidal
volumes to aid ventilation

16.

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The goal in treating infants with pulmonary interstitial B. low lung vol-
emphysema or active air leak is: ume to reduce the
A. high lung volume to recruit alveolar lung units chance of creating
B. low lung volume to reduce the chance of creating or worsening an
or worsening an air leak air leak
C. high lung volume to recruit the lung and large tidal
volumes to aid ventilation
D. low tidal volumes combined with high lung volumes

17. A neonate is progressing satisfactorily on HFOV, with C. 1-2 cm H20

a mean airway pressure of 15 cm H2O. The physician
consults the respiratory clinician to determine in what
increments the Paw should be weaned. What should
the RT recommend?
A. 4-6 cm H20
B. 3-4 cm H20
C. 1-2 cm H20
D. no increment, simply extubate

18. A clinician prepares to suction a pt undergoing HFV. A. hypoxia, requir-

What is the most likely consequence of suctioning? ing a temporary in-
A. hypoxia, requiring a temporary increase in Paw to crease in Paw to
resolve resolve
B. Pulmonary hemorrhage, reacquiring ETT epineph-
rine
C. Negative pressure pulmonary edema, requiring a
temporary increase in Paw to resolve
D. none of the above

19. An infant has just been placed on HFJV. What trending D. B and C
monitors should be recommended?
A. In line blood gas analyzer
B. pulse oximetry
C. transcutaneous monitoring
D. B and C

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