A.

2 cm H2O
1. How should a ventilator breath that has the following B. 6 cm H2O
characteristics during a ventilator-assisted inspiration be C. 10 cm H2O
classified? D. 14 cm H2O
I. Pressure waveform changes when patient’s lung
compliance and airway resistance change.
II. Volume waveform remains constant despite changes in 5. A patient is being mechanically ventilated with a transport
patient’s pulmonary compliance and airway resistance. ventilator as he is being moved to another hospital. The
III. Volume is measured, and used to control the volume PEEP was set at 5 cm H2O with a trigger threshold of 2 cm
waveform. H2O. Immediately before the transport the baseline was
A. pressure controlled raised to 10 cm H2O. To what level will the circuit pressure
B. volume controlled need to fall for inspiration to be triggered if this ventilator is
C. time controlled not PEEP compensated?
D. flow controlled A. –2 cm H2O
B. –7 cm H2O
C. –10 cm H2O
2. Which of the following statements accurately describe D. –12 cm H2O
closed-loop control? Closed-loop control:
I. maintains consistent inspiratory pressure, volume, or flow
waveforms in the presence of changing lung compliance and 6. An ICU patient is receiving flow-triggered breaths from a
airway resistance. mechanical ventilator. The continuous flow in the breathing
II. measures the output, and compares it with a referencecircuit is 6 L/min. The flow trigger threshold is 2 L/min. To
value. what level does the continuous flow in the breathing circuit
III. lacks a stream of information from the output to need to reach for the breath to be flow triggered?
generate a new input. A. 2 L/min
IV. provides a steady output in the presence of B. 4 L/min
unanticipated disturbances. C. 6 L/min
A. I, IV only D. 8 L/min
B. I, II, III only
C. I, II, IV only 7. What is the significance of performing an inspiratory
D. II, III, IV only pause during mechanical ventilation?
A. It provides the opportunity to view the pressure, volume,
and flow waveforms.
3. Which of the following terms are phase variables? B. This maneuver affords the clinician the chance to
I. inspiration ascertain the presence of auto-PEEP.
II. flow C. An inspiratory pause enables the clinician to determine
III. cycle the trigger variable.
IV. trigger D. It allows for the measurement of pulmonary mechanics.
A. I, II only
B. III, IV only
C. I, III only 8. What defines a spontaneous breath, as compared with a
D. II, IV only mandatory breath?
A. Inspiration is initiated by time, and is terminated by the
patient’s pulmonary mechanics.
4. The baseline pressure on a mechanical ventilator B. Inspiration is initiated by the patient’s own ventilatory
operating in the ICU has been changed from 8 cm H2O to drive.
12
cm H2O. The trigger sensitivity had been set, and remainsC. atInspiration is initiated by the patient’s lung mechanics,
2 cm H2O. To what pressure will the circuit pressure have andto expiration is initiated by the patient’s ventilatory drive.
decrease for inspiration to be pressure triggered? D. Inspiration is initiated by the patient’s ventilatory drive,
and is terminated by the patient’s lung mechanics. rectangular

9. Which of the following classifications matched the

volume-controlled, continuous mandatory ventilation (VC- 13. The therapist enters the ICU, and hears the high-
CMV) mode? pressure alarm sounding on a mechanical ventilator.
A. pressure-controlled, time-triggered, volume-limited, Which of the following considerations need to be
volume-cycled taken into account as possible causes of this alarm
B. volume-controlled, pressure-triggered, pressure-limited,
situation?
flow-cycled I. Auto-PEEP may have developed.
C. volume-controlled, time-triggered, flow-limited, time- II. The cuff on the patient’s endotracheal tube has deflated.
cycled III. The patient may be experiencing increased lung
D. volume-controlled, pressure-triggered, flow-limited, secretions.
pressure-cycled IV. The flow waveform has converted from a square
configuration to that of a descending ramp.
A. I, III only
10. Which of the following air compressors are commonlyB. II, III only
used inside ventilators? C. I, II, IV only
I. fluidic D. II, III, IV only
II. piston and cylinder
III. turbine
IV. bellows 14. What type of drive mechanism would produce the
A. I, III only pressure, volume, and flow waveforms illustrated below?
B. II, IV only A. spring-loaded bellows
C. I, III, IV only B. proportional solenoid valve
D. II, III, IV only C. piston attached to a rotating crank
D. electric motor/rack and pinion

11. Which of the following terms describe the configuration

of a ventilator waveform? 15. A patient is receiving PC-CMV with a target tidal volume
I. hyperbolic of at 750 ml. The average peak inspiratory pressure is 30 cm
II. sinusoidal H2O, and the compliance factor for the breathing circuit is 3
III. rectangular ml/cm H2O. Calculate the volume compressed in the
IV. exponential ventilator tubing.
A. II, III only A. 250 ml
B. I, II, IV only B. 90 ml
C. I, III, IV only C. 25 ml
D. II, III, IV only D. 10 ml

16. (Refer to #15 data) What tidal volume would the

12. If a rectangular (square) pressure waveform is generated
during pressure-controlled ventilation, what type of therapist need to set on the ventilator to achieve the desired
waveforms will develop for volume and flow? tidal volume of 750 ml?
A. volume waveform: exponential rise; flow waveform: A. 760 ml
exponential decline B. 775 ml
B. volume waveform: exponential decline; flow waveform: C. 840 ml
exponential rise D. 1000 ml
C. volume waveform: sinusoidal; flow waveform: ascending
ramp
D. volume waveform: descending ramp; flow waveform:
17. Calculate the tubing compliance (CT) when c. 1000 mL
the measured volume is 150 mL and the static d. 1200 mL
pressure is 53 cm H2O.
a. 0.003 mL/cm H2O 22. Calculate the inspiratory time (TI) when a
b. 0.35 cm H2O/mL ventilator is set at a tidal volume (VT) of 500 mL
c. 2.8 mL/cm H2O and a constant flow rate of 30 L/min.
d. 7.95cm H2O/mL a. 0.6 second
b. 1 second
18. When initially setting up a ventilator the c. 1.5 seconds
plateau pressure (PPlateau) is measured at 47 cm d. 1.7 seconds
H2O with a set volume of 100 mL. After applying
the ventilator to the patient, the average peak 23. Calculate the inspiratory to expiratory (I:E)
pressure reached during volume delivery is 28 cm ratio when the inspiratory time is 0.5 seconds
H2O. How much volume is lost in the ventilator and the respiratory rate is 30 bpm.
tubing? a. 1:3
a. 13 mL b. 1:4
b. 60 mL c. 4:1
c. 147 mL d. 3:1
d. 168 mL
24. Calculate the expiratory time (TE) when the
19. A 90kg patient was placed on a mechanical ventilator frequency is set to 25 bpm and the
ventilator following a major thoracic surgery. A inspiratory time (TI) is 0.75 second.
square flow-generating volume ventilator was a. 0.75 second
used with the following settings: peak flow = b. 1.16 seconds
60L/min, f=15, sensitivity = -1 cmH2O, FI2 = 0.4, c. 1.65 seconds
and expiratory time = 3 seconds. What was the d. 2.4 seconds
delivered VT for this patient?
A. 600 mL 25. Setting flow rates high will cause which of the
B. 800 mL following to occur?
C. 900 mL a. Improve gas exchange
D. 1000 mL b. Lengthen inspiratory time
c. Increase air trapping
20. A 31 year old male patient has a body surface d. Increase peak pressures
area of 2.0 m2 and an IBW of 180lbs (82kgs).
Body temperature is 37° C. He is still under the 26. Slow flow rates will cause which of the
effects of anesthesia following surgery on his leg. following to occur?
He has no history of lung disease. What minute a. Poor gas exchange
ventilation would be appropriate as an initial b. Increase peak pressures
setting? c. Shorten expiratory time
a. 6 L/min d. Decrease mean airway pressure
b. 7 L/min 27. The flow waveform pattern that is created
c. 8 L/min during pressure targeted ventilation is which of
d. 9 L/min the following?
a. Sine
21. Calculate the average tidal volume for a b. Rectangular
patient who has a minute ventilation of 10 L/min c. Ascending Ramp
with a respiratory rate (RR) of 12 bpm. d. Descending Ramp
a. 120 mL
b. 833 mL
28. The most appropriate tidal volume setting for a. VT = 450 mL, rate = 18 bpm, PEEP = 8 cm H2O
a 6'3" male ventilator patient with normal lungs b. VT = 600 mL, rate = 10 bpm, PEEP = 5 cm H2O
is which of the following? c. VT = 750 mL, rate = 15 bpm, PEEP = 10 cm H2O
a. 300 mL d. VT = 900 mL, rate = 12 bpm, PEEP = 5 cm H2O
b. 500 mL
c. 700 mL 33. What fractional inspired oxygen (FIO2) setting
d. 900 mL should be set on the ventilator when the patient
currently has a partial pressure of oxygen (PaO2)
29. A 5'2" female patient with normal lungs has of 53 mm Hg while receiving 50% oxygen and the
been intubated and requires mechanical desired PaO2 is 90 mm Hg?
ventilation with volume-controlled continuous a. 64%
mandatory ventilation (VC-CMV). The tidal b. 74%
volume (VT) and ventilator rate settings that c. 85%
should be recommended for this patient if d. 95%
7ml/kg is being used are which of the following?
a. VT = 315 mL, rate = 30 bpm 34. The goal of selecting a specific oxygen
b. VT = 364 mL, rate = 14 bpm concentration is to try to achieve clinically
c. VT = 468 mL, rate = 12 bpm acceptable arterial oxygen tensions within which
d. VT = 563 mL, rate = 10 bpm of the following ranges?
a. 40 and 55 mm Hg
30. A patient has a body temperature of 40° C. b. 50 and 60 mm Hg
How should the initial minute ventilation setting c. 60 and 100 mm Hg
be adjusted? d. 100 and 120 mm Hg
a. Increase it by 15%
b. Decrease it by 18%
c. Decrease it by 25% 35. What is the range for setting flow triggering?
d. Increase it by 30% a. 1 to 10 L/min
b. 10 to 15 L/min
31. The pattern that has been shown to improve c. 12 to 16 L/min
the distribution of gas in the lungs for an d. 20 to 30 L/min
intubated patient on volume-controlled
continuous mandatory ventilation (VC-CMV) is 36. Following successful cardiac resuscitation, a
which of the following? patient being placed on mechanical ventilation
a. Sine waveform should have which of the following fractional
b. Ascending ramp inspired oxygen (FIO2) settings?
c. Descending ramp a. 0.5
d. Square waveform b. 0.6
c. 0.8
32. A 47-year-old, 6'1" male patient is admitted to d. 1
the hospital due to trauma from a motor vehicle
accident. Forty-eight hours post admission, the 37. A patient is intubated due to an acute
patient is suffering from respiratory distress with exacerbation of Chronic Obstructive Pulmonary
severe hypoxemia and is intubated. A chest x-ray, Disease (COPD). The patient is now breathing
done prior to intubation, reveals a ground glass with pressure support ventilation 5 cm H2O and
appearance bilaterally. The physician requests the continuous positive airway pressure (CPAP) 5 cm
volume-controlled continuous mandatory H2O. The patient is unable to flow trigger every
ventilation (VC-CMV) mode for this patient. The inspiration. Unintended positive-end-expiratory
initial settings for the ventilator should be which of pressure (auto-PEEP) is measured at 10 cm H2O.
the following if approx. 5ml/kg is being used? The most appropriate action is to take is which of
the following? 42. The ventilator volume is set at 575 mL. The
a. Decrease the CPAP to 3 cm H2O. low exhaled tidal volume (VT) alarm should be
b. Increase the CPAP to 8 cm H2O. set at which of the following?
c. Increase pressure support to 10 cm H2O. a. 150 mL
d. Change the flow trigger setting to 1 L/min. b. 350 mL
c. 400 mL
38. How much patient effort is needed to trigger d. 500 mL
a ventilator breath when there is 8 cm H2O of
unintended positive-end-expiratory pressure 43. The respiratory therapist in the intensive care
(auto-PEEP) and a pressure trigger setting of 2 cm unit (ICU) responds to a patient's room because
H2O? the ventilator is alarming. The most appropriate
a. 2 cm H2O immediate action is which of the following?
b. 6 cm H2O a. Replace the ventilator immediately.
c. 8 cm H2O b. Silence the alarms and call for help.
d. 10 cm H2O c. Ensure the patient is being ventilated.
d. Troubleshoot the alarm settings.
39. A humidifier used with a mechanical
ventilator should deliver a minimum of how 44. Essential capabilities of an adult intensive
much humidity? care unit (ICU) ventilator include all of the
a. 10 mg H2O/L at 35° C to 37° C following except:
b. 20 mg H2O/L at 31° C to 35° C a. Expiratory pause
c. 30 mg H2O/L at 31° C to 35° C b. Pressure control modes
d. 47 mg H2O/L at 35° C to 37° C c. Flow rates up to 250 L/min.
d. Respiratory rates up to 60 breaths/min.
40. In which situation should the heat moisture
exchanger (HME) be replaced with a heated 45. A 70-year-old, 61-inch-tall, female patient
humidification system? was admitted with an acute exacerbation of
a. With all tracheostomy tubes chronic obstructive pulmonary disease (COPD).
b. After 3 days of ventilation After 12 hours of oxygen therapy, bronchodilator
c. After 24 hours of ventilation therapy, and intravenous corticosteroids, the
d. Thick secretions not cleared by suctioning patient began to show signs of clinical
deterioration. Her chest x-ray revealed an
enlarged heart and bilateral infiltrates. Her
41. Following intubation and placement on arterial blood gas shows acute on chronic
volume-controlled continuous mandatory respiratory failure. It is decided that this patient
ventilation (VC-CMV), a patient's average peak requires intubation and mechanical ventilation.
inspiratory pressure (PIP) is 26 cm H2O following The most appropriate ventilator settings for this
suctioning. The appropriate settings for the low patient include which of the following?
and high pressure alarms are which of the a. VC-CMV, rate = 15, VT = 200 mL, FIO2 = 100%,
following? PEEP = 5 cm H2O
a. Low pressure = 6 cm H2O, high pressure = 46 b. VC-CMV, rate = 12, VT = 400 mL, FIO2 = 40%,
cm H2O PEEP = 3 cm H2O
b. Low pressure = 15 cm H2O, high pressure = 41 c. PC-SIMV, rate = 10, PIP = 30 cm H2O, FIO2 =
cm H2O 60%, PEEP = 3cm H2O
c. Low pressure = 20 cm H2O, high pressure = 35 d. PC-SIMV, rate = 12, PIP = 35 cm H2O, FIO2 =
cm H2O 30%, PEEP = 8 cm H2O
d. Low pressure = 24 cm H2O, high pressure = 31
cm H2O 46. Methods to minimize air trapping in
mechanically ventilated patients include which of
the following? pressure (PEEP)
a. Using a longer inspiratory time (TI) b. Open lung approach
b. Switching to pressure support ventilation (PSV) c. Offset intrinsic PEEP
c. Increasing inspiratory flow d. Minimize mean airway pressure
d. Administering a mucolytic agent
51. The first step in the assessment and
47. A 45-year-old, 73-inch-tall, 200lb male documentation of patient-ventilator interaction
patient is admitted to the emergency following the placement of a patient on a
department with an exacerbation of myasthenia mechanical ventilator is which of the following?
gravis. The respiratory therapist assesses the a. Verifying physician's orders
patient and finds the patient's maximum b. Verifying a passing operational verification
inspiratory pressure is 15 cm H2O and his vital procedure
capacity is 1200 mL. It is decided that the patient c. Checking the integrity of the ventilator circuit
requires ventilatory support. The most and the humidifier system
appropriate ventilator settings for this patient d. Assessment of the patient's vital signs, breath
are which of the following? sounds, and level of consciousness
a. PSV 5 cm H2O, CPAP 10 cm H2O, FIO2 50%
b. PC-CMV, f = 16 bpm, PIP = 35 cm H2O, PEEP 3 52. How long after beginning mechanical
cm H2O, FIO2 45% ventilation on a patient should an arterial blood
c. NPPV/BiPAP, f = 14 bpm, IPAP = 28 cm H2O, gas sample be drawn?
EPAP = 5 cm H2O, FIO2 30% a. 5 minutes
d. VC-SIMV, f = 12 bpm, VT = 725 mL, PS 5 cm b. 10 minutes
H2O, PEEP 5 cm H2O, FIO2 24% c. 15 minutes
d. 20 minutes
48. Patients with acute severe asthma requiring
mechanical ventilation are difficult to manage 53. A female patient who is 5'7" tall and weighs
because of which of the following? 68 kg is being mechanically ventilated with
a. Diaphragmatic paralysis volume-controlled continuous mandatory
b. Increased lung compliance ventilation (VC-CMV), set rate 12, patient trigger
c. Decreased airway resistance rate 25 bpm, tidal volume (VT) 500 mL, set flow
d. Uneven alveolar hyperexpansion rate 60 L/min, fractional inspired oxygen (FIO2)
40%, positive-end-expiratory pressure (PEEP) 5
49. During mechanical ventilation, a patient with cm H2O. The patient is currently in distress using
a closed head injury develops the Cushing accessory muscles of inspiration. A patient-
response. This may be immediately managed by ventilator system check is performed by the
using which of the following? respiratory therapist. The flow-time waveform
a. Pressure-controlled continuous mandatory shows a failure of the expiratory flow to return to
ventilation (PC-CMV) with positive-end- zero before the next breath is triggered. The
expiratory pressure (PEEP) most appropriate action for the respiratory
b. Sedation and paralysis therapist to take includes which of the following?
c. Permissive hypercapnia a. Sedate the patient.
d. Iatrogenic hyperventilation b. Switch to (PC-CMV).
c. Decrease set rate to 8 bpm.
50. While initially ventilating a patient with acute d. Switch to (VC-SIMV).
respiratory distress syndrome (ARDS), the
extrinsic positive-end-expiratory pressure 54. An increasing PIP may indicate which of the
(PEEPE) should be maintained using which of the following?
following methods? a. Decreasing lung compliance
a. 50% of intrinsic positive-end-expiratory b. Decreasing airway resistance
c. Leak in the ventilator circuit an igloo shape)
d. Increasing dynamic compliance A. Auto PEEP
B. system leak
55. During the course of several patient- C. Plateau pressure
ventilator system checks, a respiratory therapist D. Volume triggering
notices that the patient's peak inspiratory
pressure (PIP) is rising, while the plateau 60. Calculate the effective static compliance (Cs) given
pressure (Pplateau) has remained the same. This the following information about a patient receiving
is most likely indicates which of the following? mechanical ventilation: plateau pressure (Pplateau) is 40 cm
a. Decrease in dynamic compliance H2O, exhaled tidal volume (VT) is 650 mL, and positive-end
B. Increase in airway resistance expiratory pressure (PEEP) is 10 cm H2O.
C. Decrease in static compliance a. 14.1 mL/cm H2O
D. Increase in elastic recoil of alveolar walls. b. 16.3 mL/ cm H2O
c. 21.7 mL/cm H2O
56. A patient's transairway pressure (Pta) is rising d. 40.6 mL/cm H2O
while the plateau pressure (Pplateau) remains
unchanged. The treatment plan that could
correct this problem includes which of the 61. A patient receiving mechanical ventilation has an
following? exhaled tidal volume (VT) of 500 mL and a positive-end
A. Administer a bronchodilator expiratory pressure setting (PEEP) of 5 cm H2O. Patient-
B. Insert a chest tube ventilator system checks reveal the following data:
C. Increase extrinsic PEEP Time PIP (cm H2O) Pplateau (cm
D. Suction airway secretions
0600 27 15
57. Following initiation of VC-CMV ventilation, 0800 29 15
the patient's average peak inspiratory pressure
1000 36 13
(PIP) is 23 cmH2O. The high pressure limit alarm
should be set at which of the following? The respiratory therapist should recommend which of the
A. 28 cmH2O following for this patient?
B. 33 cmH2O 1. Tracheobronchial suctioning
C. 38 cmH2O 2. Increase in the set tidal volume
D. 42 cmH20 3. Beta adrenergic bronchodilator therapy
4. Increase positive end expiratory pressure
58. A 46-year-old male patient is 2 days post-op a. 1 and 3 only
for surgery to repair an aortic aneurysm. He is b. 2 and 4 only
currently receiving mechanical ventilation. c. 1, 2 and 3 only
Auscultation of the anterior and posterior chest d. 2, 3 and 4 only
reveals bilateral late inspiratory crackles.
Percussion is dull in both lower lobes. A stat 62. The values below pertain to a patient who is
rediograph reveals bibasilar infilitrates. The most being mechanically ventilated with a measured
likely cause of this patient's clinical presentation exhaled tidal volume (VT ) of 700 mL.
is which of the following? Time Peak Inspiratory Plateau Pressure
A. Asthma Pressure (cm H2O) (cm H2O)
B. Pneumonia 0800 35 30
C. Pneumothorax 1000 39 34
D. Pleaural effusion 1100 45 39
1130 50 44
59. The volume-time curve is demonstrating Analysis of this data points to which of the following
which of the following? (there is a graphic with conclusions?
a. Airway resistance in increasing. 67. Calculate airway resistance (Raw) for a
b. Airway resistance is decreasing. ventilator patient, in cm H2O/L/sec, with the
c. Lung compliance is increasing. following information: Peak inspiratory pressure (PIP)
d. Lung compliance is decreasing. is 20 cm H2O, plateau pressure (Pplateau) is 15 cm H2O,
PEEP is 5 cm H2O, and set flow rate is 50 L/min.
a. 5 Raw
63. Plateau pressure (Pplateau) is measured during b. 6 Raw
which phase of the ventilatory cycle? c. 10 Raw
a. Inspiration d. 15 Raw
b. End-inspiration
c. Expiration
d. End-expiration
68. What type of ventilator increases
transpulmonary pressure (PL) by mimicking the
normal mechanism for inspiration?
64. An increase in peak inspiratory pressure (PIP) a. Positive pressure ventilation (PPV)
without an increase in plateau pressure (Pplateau) is b. Negative pressure ventilation (NPV)
associated with which of the following? c. High frequency oscillatory ventilation (HFOV)
a. Increase in static compliance (CS) d. High frequency positive pressure ventilation
b. Decrease in static compliance (CS) (HFPPV)
c. Increase in airway resistance
d. Decrease in airway resistance

69. Air accidently trapped in the lungs due to

65. The patient-ventilator data over the past few mechanical ventilation is known as which of the
hours demonstrates an increased peak inspiratory following?
pressure (PIP) with a constant transairway pressure a. Plateau pressure (Pplateau)
(PTA). The respiratory therapist should conclude b. Functional residual capacity (FRC)
which of the following? c. Extrinsic positive end expiratory pressure
a. Static compliance (CS) has increased. (extrinsic PEEP)
b. Static compliance (CS) has decreased. d. Intrinsic positive end expiratory pressure (intrinsic
c. Airway resistance (Raw) has increased. PEEP)
d. Airway resistance (Raw )has decreased.

70. The ventilator that functions most

66. Calculate airway resistance (Raw ) for a physiologically uses which of the following?
ventilator patient, in cm H2O/L/sec, when the peak a. Open loop
inspiratory pressure (PIP) is 50 cm H2O, the plateau b. Double circuit
pressure (Pplateau) is 15 cm H2O, and the set flow rate is c. Positive pressure
60 L/min. d. Negative pressure
a. 0.58 Raw
b. 1.2 Raw
c. 35 Raw
d. 50 Raw

71. During pressure-controlled continuous

mandatory ventilation, when the patient’s lung
compliance increases, which of the following will
occur? reasons for this lack of effect?
a. The tidal volume will increase. 1. compensatory dilation of the large arteries
b. The FRC will increase. 2. compensatory increase in venomotor tone
c. The peak airway pressure will increase. 3. compensatory increase in the cardiac rate
d. The inspiratory time will decrease. a. 2 and 3
b. 1 and 2
72. During ventilatory support, peak inspiratory c. 1, 2, and 3
pressure (PIP) is the pressure needed to overcome d. 1 and 3
which of the following?
I. chest wall compliance 77. All of the following are TRUE about continuous
II. lung compliance positive airway pressure (CPAP), except:
III. airway resistance a. It maintains alveoli at greater inflation volumes.
IV. systemic arterial pressure b. It holds airway pressure essentially constant.
a. 1 and 2 only c. It provides the pressure gradient needed for
b. 2 and 3 only ventilation.
c. 1, 2, and 3 only d. It has side effects similar to those of positive
d. 2, 3, and 4 only pressure ventilation.

73. Ventilatory support strategies likely to result in 78. Bilevel positive airway pressure (BiPAP) is used
auto−positive end-expiratory pressure (PEEP) include for all of the following purposes except:
all of the following except: a. nocturnal ventilatory support of chronic disease
a. continuous mandatory ventilation (CMV) assist- patients
control b. preventing intubation of patients with acute
b. inverse ratio ventilation (IRV) exacerbations of chronic obstructive pulmonary
c. low-rate intermittent mandatory ventilation disease (COPD)
d. low inspiratory flows c. treatment of obstructive sleep apnea (OSA) in the
homed. providing ventilatory support for patients
with status asthmaticus
74. A patient receiving long-term positive-pressure
ventilation support exhibits a progressive weight gain 79. For patients with respiratory insufficiency,
and a reduction in the hematocrit. Which of the pressure-supported ventilation (PSV) has all of the
following is the most likely cause of this problem? following advantages over spontaneous breathing
a. pulmonary hemorrhage except:
b. water retention a. decreased respiratory rate
c. hypovolemia b. increased VT
d. hyponatremia c. decreased O2 consumption
d. increased muscle activity
75. Assuming a constant rate of breathing, which of
the following inspiratory/expiratory ratios (1:E)
would tend to most greatly impair a patient’s 80. What does pressure-supported ventilation consist
systemic diastolic pressure? of?
a. 1:4 a. patient-triggered, pressure-limited, flow-cycled
b. 1:3 breaths
c. 1:2 b. machine-triggered, pressure-limited, flow-cycled
d. 1:1 breaths
c. patient-triggered, pressure-limited, time-cycled
76. Moderate rises in pleural pressure during breaths
positive-pressure ventilation have a minimal effect d. machine-triggered, flow-limited, pressure-cycled
on cardiac output in normal subjects. What are some breaths
 85. During volume-controlled continuous mandatory
81. A patient switched from pressure-controlled ventilation, should either compliance decrease or
continuous mandatory ventilation (CMV) with airway resistance (Raw) increase, what will happen?
positive end-expiratory pressure (PEEP) to pressure- a. The peak airway pressure will decrease.
controlled inverse ratio ventilation (PC- IRV) shows a b. The inspiratory flow will increase.
good improvement in PaO2 but a decrease in tissue c. The peak airway pressure will increase.
oxygenation. Which of the following best explains d. The inspiratory time will decrease.
this observation?
a. High mean pressures caused by PC-IRV decreased
pulmonary blood flow. 86. Which of the following modes of ventilatory
b. Intrinsic PEEP caused by PC-IRV resulted in support would result in the highest mean airway
increased alveolar recruitment. pressure?
c. High mean pressures caused by PC-IRV decreased a. volume-controlled intermittent mandatory
cardiac output. ventilation
d. Intrinsic PEEP caused by PC-IRV compressed the b. (volume-controlled intermittent mandatory
pulmonary capillaries. ventilation) + pressure-supported ventilation
c. pressure-controlled intermittent mandatory
82. What mode of pressure-controlled ventilation is ventilation
designed to prevent alveoli with short time constants d. volume-controlled continuous mandatory
from collapsing, thereby improving oxygenation? ventilation
a. pressure-controlled inverse ration ventilation
b. pressure-controlled intermittent mandatory 87. Compared with a square wave flow pattern, a
ventilation decelerating flow waveform has all of the following
c. volume-assured pressure-supported ventilation potential benefits except:
d. bilevel positive airway pressure a. reduced peak pressure
b. improved cardiac output
83. Which of the following modes of ventilatory c. less inspiratory work
support is used to help decrease airway and alveolar d. decreased volume of dead space−to−tidal volume
pressures? ratio (VD/VT)
a. pressure-controlled continuous mandatory 88. Contraindications for using positive end-
ventilation expiratory pressure (PEEP) in conjunction with
b. pressure-controlled intermittent mandatory mechanical ventilation include which of the
ventilation following?
c. volume-controlled continuous mandatory 1. untreated bronchopleural fistula
ventilation 2. chronic airway obstruction
d. volume-assured pressure-supported ventilation 3. untreated pneumothorax
a. 1 and 2
84. The volume of gas actually delivered to a patient b. 1 and 3
by most positive-pressure ventilation is always less c. 2 and 3
than that expelled from the machine. Which of the d. 1, 2, and 3
following factors help to explain this finding?
1. gas compression under pressure 89. Beneficial physiological effects of positive end-
2. presence of built-in leaks expiratory pressure (PEEP) include which of the
3. expansion of the ventilator circuitry following?
a. 2 and 3 1. increased PaO2 for given FIO2
b. 1 and 2 2. increased lung compliance (CL)
c. 1, 2, and 3 3. decreased shunt fraction
d. 1 and 3 4. increased functional residual capacity
a. 1, 2, 3, and 4
b. 3 and 4 ventilator will decrease under all of the following
c. 2, 3, and 4 conditions, except:
d. 2 and 4 a. the patient’s lung or thoracic (chest wall)
compliance falls.
90. All of the following factors would tend to increase b. airway resistances rises (inspiratory time less than
mean airway pressure except: 3 times the time constant).
a. short inspiratory times c. the patient tenses the respiratory muscles during
b. increased mandatory breaths inspiration.
c. increased levels of positive inspiratory pressure d. airway resistances rises (inspiratory time greater
(PIP) than 3 times the time constant).
d. increased levels of positive end-expiratory
pressure (PEEP) 96. During pressure-targeted modes of ventilatory
support, the volume delivered depends on which of
91. Which level of plateau pressure increases the the following?
likelihood of causing lung injury? 1. set pressure limit
a. >15cmH2O 2. patient lung mechanics
b. >25cmH2O 3. patient effort
c. >30cmH2O a. 1 and 2
d. It doesn’t matter as long as positive inspiratory b. 1 and 3
pressure is less than 50 cm H2O. c. 2 and 3
d. 1, 2, and 3
92. In which of the following modes of ventilatory
support would the patient’s work of breathing be 97. Mean airway pressure may be increased by all of
least? the following adjustments, except increasing the:
a. continuous positive airway pressure (CPAP) a. inspiratory time
b. pressure-supported ventilation (PSV) b. frequency
c. intermittent mandatory ventilation (IMV) c. positive end-expiratory pressure level
d. continuous mandatory ventilation (CMV) e. FIO2

93. In which of the following modes of ventilatory

support would the patient’s work of breathing be 98. Which of the following conditions does not
greatest? require high mechanical respiratory rates?
a. continuous positive airway pressure (CPAP) a. metabolic alkalosis
b. pressure-supported ventilation (PSV) b. ARDS
c. intermittent mandatory ventilation (IMV) c. increased intracranial pressure
d. continuous mandatory ventilation (CMV) d. metabolic acidosis

94. Which of the following are considered safe 99. Which of the following is the recommended tidal
settings for a recruitment maneuver? volume for mechanical ventilation of a patient with
1. pressures up to 50 cm H2O ARDS who is in acute respiratory failure?
2. pressures up to 35 cm H2O a. 4 to 8 mL/kg
3. pressures applied for 5 to 10 minutes b. 3 to 5 mL/kg
4. pressures applied for 1 to 3 minutes c. 6 to 10 mL/kg
a. 1 and 3 d. 10 to 12 mL/kg
b. 1 and 4
c. 2 and 3 100. Which of the following is considered a normal
d. 2 and 4 spontaneous tidal volume?
a. 3 to 5 mL/kg
95. The volume delivered by a pressure-limited b. 5 to 7 mL/kg
c. 7 to 9 mL/kg c. assist and control
d. 10 to 12 mL/kg d. proportional assist

107. A volume-cycled ventilator has a rate knob for

101. During mechanical ventilation, what variable setting the controlled frequency of breathing. If this
causes a breath to end? control is set to 12/min, which of the following other
a. limit settings will determine the inspiratory and expiratory
b. cycle times?
c. trigger 1. FIO2
d. baseline 2. flow
3. volume
102. To describe what happens during the a. 1 and 2
expiratory phase of mechanical ventilation, you must b. 1 and 3
know the value of which variable? c. 2 and 3
a. limit d. 1, 2, and 3
b. cycle
c. trigger 108. When you adjust the pressure drop necessary
d. baseline to trigger a breath on a ventilator, what are you
adjusting on the machine?
103. If a ventilator, not the patient, initiates a a. sensitivity
breath, what is the trigger variable? b. pressure limit
a. time c. mode setting
b. pressure d. positive end-expiratory pressure (PEEP) level
c. flow
d. volume
109. When using pressure as the trigger variable,
104. If a patient initiates a ventilator breath, the where do you typically set the trigger level?
trigger variable could be all of the following except: a. 0.5 to 1.5 cm H2O below the baseline expiratory
a. pressure pressure
b. flow b. 0.5 to 1.5 cm H2O above the baseline expiratory
c. time pressure
d. volume c. 2.0 to 3.5 cm H2O below the baseline expiratory
pressure
105. A patient receiving time-triggered continuous d. 2.0 to 3.5 cm H2O above the baseline expiratory
mechanical ventilation at a preset rate of 10/min pressure
stops breathing. Which of the following will occur?
a. The high-pressure limit alarm will sound (if 110. Which of the following is false about the
properly set). application of flow triggering on a mechanical
b. The patient will continue to receive 10 ventilator?
breaths/min. a. The ventilator measures both input and output
c. The low tidal volume (VT) alarm will sound (if flow.
properly set). b. Between patient breaths, input flow exceeds
d. Ventilation will drop to zero and the apnea alarm output flow.
will sound. c. A relative drop in output flow triggers the machine
to turn on.
106. Pure time-triggered ventilation is the same as d. Gas flows continuously through the ventilator
what type of ventilation? circuit.
a. assist
b. intermittent mandatory ventilation 111. A physician requests that you switch from
pressure-triggering a patient to flow-triggering. b. flow
Which of the following new settings would be c. time
appropriate? d. volume
a. Base flow = 0 L/min; trigger at 2 L/min
b. Base flow = 10 L/min; trigger at –2 cm H2O 117. You observe that a ventilator reaches a preset
c. Base flow = 10 L/min; trigger at 2 L/min pressure early in inspiration but holds it for a specific
d. Base flow = 0 L/min; trigger at 10 cm H2O time, after which inspiration ends. What mode of
ventilatory support is in force?
a. time cycled
112. Compared to using pressure as the trigger b. pressure limited
variable, what is the major advantage of flow- c. pressure cycled
triggering? d. volume limited
a. decreased work of breathing
b. improved minute ventilation (VE) 118. A time-cycled constant flow generator is set
c. decreased physiologic dead space up with a flow of 35 L/min and an inspiratory time of
d. improved arterial oxygenation 1.7 seconds. What is the approximate VT?
a. 750 ml (0.75 L)
113. What ventilatory variable reaches and b. 1000 ml (1.00 L)
maintains a preset level before inspiration ends? c. 1900 ml (1.90 L)
a. limit d. 1200 ml (1.20 L)
b. cycle
c. trigger 119. What is the name of a breath where a patient
d. baseline is able to change the inspiratory time?
a. patient cycled
114. Which of the following parameters can serve b. patient triggered
as the cycle variable during ventilatory support? c. machine triggered
1. volume d. machine cycled
2. pressure
3. flow
4. time 120. In which of the following modes inspiration
a. 1 and 4 ends when flow decays to some preset value?
b. 2 and 3 a. intermittent mandatory ventilation
c. 1, 2, and 4 b. pressure support ventilation
d. 1, 2, 3, and 4 c. continuous mandatory ventilation
d. airway pressure release ventilation
115. A volume-cycled ventilator provides gas under
positive pressure during inspiration until what point? 121. What parameter serves as the baseline
a. A preselected volume of gas is received by the variable on all modern ventilators?
patient. a. pressure
b. An adjustable, preselected airway pressure is b. flow
reached. c. time
c. The inspiratory time equals or exceeds the d. volume
expiratory time.
d. A preselected volume of gas is expelled from the 122. What is the default baseline value during
device. mechanical ventilation?
a. positive end-expiratory pressure (PEEP)
116. Flow serves as a limit variable whenever a b. zero end-expiratory pressure (ZEEP)
ventilator controls what? c. negative end-expiratory pressure (NEEP)
a. pressure d. continuous positive airway pressure (CPAP)
 a. intermittent mandatory ventilation (IMV)
123. What is the application of pressure above b. pressure support ventilation
atmospheric at the airway throughout expiration c. continuous mandatory ventilation (CMV)
during mechanical ventilation? d. airway pressure release ventilation
a. positive end-expiratory pressure (PEEP) 129. Which of the following modes is a good
b. pressure support ventilation example of adaptive control?
c. continuous mandatory ventilation (CMV) a. intermittent mandatory ventilation
d. continuous positive airway pressure (CPAP) b. airway pressure release ventilation
c. continuous mandatory ventilation (CMV)
d. pressure-regulated volume control (PRVC)
124. What is the primary physiological effect of
positive end-expiratory pressure (PEEP)? 130. A mode that allows spontaneously breathing
a. increase the functional residual capacity (FRC) patients to breathe at a positive-pressure level, but
b. increase the inspiratory reserve volume (IRV) drops briefly to a reduced pressure level for CO2
c. decrease the compliance of the lung (CL) elimination during each breathing cycle is also known
d. increase the length of expiration as:
a. intermittent mandatory ventilation
125. During mechanical ventilation, a spontaneous b. airway pressure release ventilation
breath is defined as one that: c. continuous mandatory ventilation (CMV)
a. initiated and terminated by the machine d. continuous spontaneous ventilation
b. begun by the patient and ended by the machine
c. initiated and terminated by the patient
d. begun by the machine and ended by the patient 131. Which of the following ventilator control
systems is NOT considered closed loop?
a. orientation based
126. During mechanical ventilation, a mandatory b. servo
breath is defined as one that is: c. adaptive
a. initiated or terminated by the machine d. optimal
b. initiated and terminated by the machine
c. initiated and terminated by the patient 132. Which of the closed-loop controllers is used
d. begun according to a preset time interval by all ventilators?
a. setpoint
b. auto setpoint
127. While observing a patient receiving c. adaptive
ventilatory support, you notice that all delivered d. servo
breaths are initiated or terminated by the machine.
Which of the following modes of ventilatory support 133. A ventilator that controls pressure and
is in force? delivers a rectangular pressure waveform will also
a. intermittent mandatory ventilation exhibit what waveform?
b. partial ventilatory support a. exponential (rise) volume
c. continuous mandatory ventilation b. rectangular flow
d. continuous spontaneous ventilation c. ascending ramp pressure
d. sinusoidal flow
128. While observing a patient receiving
ventilatory support, you notice that some delivered
breaths are begun or ended by the machine, whereas 134. A ventilator that controls flow and delivers a
others are begun and ended by the patient. Which of rectangular flow waveform will also exhibit what
the following modes of ventilatory support is in waveform?
force? a. exponential (rise) volume
b. rectangular pressure 1. volume
c. ascending ramp pressure 2. flow
d. descending ramp volume 3. rate
a. 1 and 2
135. Peak airway pressure is highest with what b. 1 and 3
waveform? c. 2 and 3
a. sinusoidal flow d. 1, 2, and 3
b. rectangular flow
c. ascending ramp flow 141. During volume-targeted ventilation, which of
d. descending ramp flow the following settings determine the total cycle time?
1. volume
136. Mean airway pressure is lowest with what 2. flow
waveform? 3. rate
a. sinusoidal flow a. 1 and 2
b. rectangular flow b. 2 and 3
c. ascending ramp flow c. 3 only
d. descending ramp flow d. 1, 2, and 3

137. Mean airway pressure is highest with what 142. During volume-targeted ventilation, which of
waveform? the following settings determine I:E ratio?
a. rectangular flow 1. volume
b. rectangular pressure 2. flow
c. ascending ramp flow 3. rate
d. sinusoidal flow a. 1 and 2
b. 1 and 3
138. During volume-targeted ventilation, which of c. 2 and 3
the following settings determine the machine- d. 1, 2, and 3
delivered minute volume?
1. volume 143. A patient receiving continuous mandatory
2. flow ventilation in the control mode has an inspiratory
3. rate time of 1.5 seconds and an expiratory time of 2.5
a. 1 and 2 seconds. What is the frequency of breathing?
b. 1 and 3 a. 10/min
c. 2 and 3 b. 12/min
d. 1, 2, and 3 c. 15/min
d. 18/min
139. During volume-targeted ventilation, which of
the following settings determine the inspiratory 144. A patient is receiving continuous mandatory
time? ventilation in the control mode at a rate of 15/min.
1. volume The expiratory time is 2.9 seconds. What is the
2. flow inspiratory time?
3. rate a. 1.1 seconds
a. 1 and 2 b. 1.3 seconds
b. 1 and 3 c. 1.5 seconds
c. 2 and 3 d. 1.7 seconds
d. 1, 2, and 3
145. A patient is receiving continuous mandatory
140. During volume-targeted ventilation, which of ventilation in the control mode at a rate of 10/min.
the following settings determine the expiratory time? The inspiratory time control is set at 40%. What is the
inspiratory time? b. 30 L/min
a. 1.60 seconds c. 45 L/min
b. 1.85 seconds d. 60 L/min
c. 2.40 seconds
d. 3.50 seconds 151. A need for some form of ventilatory support
is usually indicated when an adult’s rate of breathing
146. 65. A patient is receiving continuous rises above what level?
mandatory ventilation in the control mode at a rate a. 35/min
of 12/min. The inspiratory time control is set at 33%. b. 30/min
What is the expiratory time? c. 25/min
a. 1.65 seconds d. 20/min
b. 2.45 seconds
c. 3.35 seconds 152. Which of the following measures is/are useful
d. 3.85 seconds indicators in assessing the adequacy of a patient’s
oxygenation?
147. A patient is receiving continuous mandatory 1. PaO2–PaO2
ventilation in the control mode at a rate of 15/min. 2. PaO2-to-FIO2 ratio
The inspiratory time is 0.8 second. What is the 3. VD/VT
expiratory time? 4. pulmonary shunt ( s/ t)
a. 3.2 seconds a. 1 and 2
b. 2.8 seconds b. 1 and 3
c. 2.4 seconds c. 2 and 3
d. 4.2 seconds d. 1, 2, and 3

148. A patient is receiving continuous mandatory 153. Which of the following measures taken on
ventilation in the control mode at a rate of 20/min. adult patients indicate unacceptably high ventilatory
The inspiratory time is 0.75 second. What is the demands or work of breathing?
percentage inspiratory time? a. VE of 17 L/min
a. 20% b. breathing rate of 22/min
b. 25% c. VD/VT of 0.45
c. 30% d. MIP of –40 cm H2O
d. 33%
154. Ventilatory support may be indicated when
149. 68. A patient is receiving continuous the VC falls below what level?
mandatory ventilation in the control mode at a rate a. 45 ml/kg
of 10/min. The inspiratory time control is set at 25%. b. 65 ml/kg
What is the I:E ratio? c. 10 ml/kg
a. 1:3 d. 30 ml/kg
b. 1:2
c. 1:4 155. What is the normal range of maximum
d. 1:1 inspiratory pressure, or MIP (also called negative
inspiratory force, or NIF), generated by adults?
a. –80 to –100 cm H2O
150. A patient is receiving continuous mandatory b. –50 to –80 cm H2O
ventilation through a constant flow generator in the c. –30 to –50 cm H2O
control mode at a rate of 20/min with a VT of 750 d. –20 to –30 cm H2O
mL. The inspiratory time is 1 second. What is the
flow?
a. 15 L/min
156. Which of the following MIP measures taken d. 75 to 150
on an adult patient indicates inadequate respiratory
muscle strength? 162. Which of the following measures should be
a. –90 cm H2O used in assessing the adequacy of a patient’s alveolar
b. –70 cm H2O ventilation?
c. –40 cm H2O 1. PaO2
d. –15 cm H2O 2. arterial pH
3. PaCO2
157. Common bedside measures used to assess a. 1 and 2
the adequacy of lung expansion include all of the b. 1 and 3
following except: c. 2 and 3
a. VC d. 1, 2, and 3
b. respiratory rate
c. VT 163. A patient with a 10-year history of chronic
d. VD/VT bronchitis and an acute viral pneumonia exhibits the
following blood gas results breathing room air: pH =
158. You determine that an acutely ill patient can 7.22; PCO2 = 67; HCO3 − = 26; PO2 = 60. Which of
generate an MIP of –18 cm H2O. Based on this the following best describes this patient’s condition?
information, what might you conclude? a. chronic hypoxemic respiratory failure
a. The patient has inadequate respiratory muscle b. acute hypercapnic respiratory failure
strength. c. chronic hypercapnic respiratory failure
b. The patient has inadequate alveolar ventilation. d. acute hypoxemic respiratory failure
c. The patient has an excessive work of breathing.
d. The patient has an unstable or irregular ventilatory 164. Because an elevated PaCO2 increases
drive. ventilatory drive in normal subjects, the clinical
presence of hypercapnia indicates which of the
159. Which of the following indicate severely following?
impaired oxygenation requiring high FIO2s and 1. inability of the stimulus to get to the muscles
positive end-expiratory pressure? 2. weak or missing central nervous system response
1. PaO2–PaO2 greater than 350 mm Hg on 100% O2 to the elevated PCO2
2. VC less than 10 ml/kg 3. pulmonary muscle fatigue
3. PaO2/FIO2 less than 200 a. 1 and 2
a. 1 and 2 b. 1 and 3
b. 1 and 3 c. 2 and 3
c. 2 and 3 d. 1, 2, and 3
d. 1, 3, and 3
165. Which of the following indicators are useful in
160. Breathing 100% O2, a patient has a PaO2– assessing respiratory muscle strength?
PaO2 of 60 mm Hg. Based on this information, what 1. maximum voluntary ventilation (MVV)
might you conclude? 2. forced vital capacity (FVC)
a. The patient has severe hypoxemia. 3. dead space−to−tidal volume ratio (VD/VT)
b. The patient has an excessive work of breathing. 4. maximum inspiratory pressure (MIP)
c. The patient has acceptable oxygenation. a. 1 and3
d. The patient has inadequate ventilation. b. 2 and 4
c. 3 and 4
161. What is the normal range for PaO2/FIO2? d. 1, 2, and4
a. 350 to 450
b. 250 to 350
c. 150 to 250
166. A reversible impairment in the response of an 171. Which of the following modes of ventilatory
overloaded muscle to neural stimulation best support would you recommend for a severely
describes which of the following? hypoxemic patient with acute lung injury or acute
a. central respiratory muscle fatigue respiratory distress syndrome (ARDS)?
b. transmission respiratory muscle fatigue a. continuous positive airway pressure
c. contractile respiratory muscle fatigue b. high VT volume-cycled ventilation
d. chronic respiratory muscle fatigue c. pressure-controlled ventilation
d. bilevel pressure support by mask
167. When is respiratory muscle fatigue likely to
occur? 172. A patient who just suffered severe closed-
a. when VE exceeds 20% of the maximum voluntary head injury and has a high intracranial pressure (ICP)
ventilation (MVV) is about to be placed on ventilatory support. Which
b. when VE exceeds 40% of the MVV of the following strategies could help to lower the
c. when VE exceeds 60% of the MVV ICP?
d. when VE exceeds 80% of the MVV a. Maintain a PaCO2 from 25 to 30 mm Hg
(deliberate hyperventilation).
168. In intubated patients, what do sources of b. Allow as much spontaneous breathing as possible
increased imposed work of breathing include? (SIMV).
1. endotracheal tube c. Maintain a high mean pressure using PEEP levels of
2. ventilator circuit 10 to 15 cm H2O.
3. auto-PEEP d. Maintain a PaCO2 of 50 to 60 mm Hg (deliberate
a. 1 and 2 hypoventilation).
b. 1 and 3
c. 2 and 3 173. Which of the following patients are at
d. 1, 2, and 3 greatest risk for developing auto-PEEP during
mechanical ventilation?
169. A patient develops acute hypercapnic a. those with acute lung injury
respiratory failure due to muscle fatigue. Which of b. those with COPD
the following modes of ventilatory support would c. those with congestive heart failure
you consider for this patient? d. those with bilateral pneumonia
1. assist-control ventilation with adequate backup
2. continuous positive airway pressure 174. What are some causes of dynamic
3. synchronized intermittent mandatory ventilation hyperinflation?
with adequate backup rate 1. increased expiratory time
4. bilevel pressure support by mask 2. increased airway resistance
a. 2 and 4 3. decreased expiratory flow rate
b. 3 and 4 a. 1 and 2
c. 1, 2, and 3 b. 1 and 3
d. 1, 3, and 4 c. 2 and 3
d. 1, 2, and 3
170. Which of the following modes of ventilatory
support would you recommend for a hypoxemic 175. Strategies to reduce auto-PEEP in
patient with congestive heart failure? mechanically ventilated patients with obstructive
a. continuous positive airway pressure (CPAP) lung disease include all of the following except which
b. intermittent mandatory ventilation (IMV) one?
c. inverse-ratio pressure control ventilation (PCV) a. Use high inspiratory flows (60 to 100 L/min).
d. high-level pressure support ventilation (PSV) b. Apply extrinsic PEEP.
c. Use low VT values (8 to 10 ml/kg).
d. Use high respiratory rates (greater than 25/min).
 180. Indications for delivering sigh breaths during
176. For which of the following patients requiring mechanical ventilation include all of the following
ventilatory support would you recommend against except which of the following?
using a heat-moisture exchanger (HME) for airway A. before and after suctioning
humidification? I. patient whose expired VT is less B. during chest physical therapy
than 70% of the delivered VT C. in patients with stiff lungs
II. patient with a spontaneous minute ventilation of D. when small VT values are used
14 L/min
III. patient with body temperature less than 32° C 181. Which of the following would you assess
A. I and II immediately after a patient is placed on a ventilatory
B. I and III support device?
C. II and III I. ABGs
D. I, II, and III II. patient’s airway
III. patient’s vital signs
177. A dehydrated, feverish patient suffering from A. I and II
acute bacterial pneumonia is being intubated in B. I and III
order to provide mechanical ventilatory support. C. II and III
Which of the following devices would you select to D. I, II, and III
control humidification and airway temperature for
this patient? 182. All of the following machine factors can have
A. unheated large-volume wick humidifier a major impact on adult patient– ventilator
B. heated wick humidifier with servo-control interaction except:
C. large-reservoir, high-output heated jet nebulizer A. humidification system
D. heat-moisture exchanger B. PEEP valve function
C. trigger sensitivity
178. A patient suffering from postoperative D. tubing compliance
complications has been receiving mechanical
ventilation for 6 days with a volume ventilator. A 183. Which of the following factors influence
heat-moisture exchanger (HME) is providing control patient–ventilator interaction?
over humidification and airway temperature. Over I. artificial airway
the past 24 hours, the patient’s secretions have II. trigger sensitivity
decreased in quantity but are thicker and more III. presence of auto-PEEP
purulent. Which of the following actions would you A. I and II
suggest at this time? B. I and III
A. Replace the HME. C. II and III
B. Switch over to a heated wick humidifier. D. I, II, and III
C. Administer acetylcysteine every 2 hours via the
nebulizer. 184. Which of the following would you initially
D. Increase the frequency of suctioning. verify in assessing the airway of a patient placed on
ventilatory support?
179. When using a heated humidifier during I. cuff pressure
mechanical ventilation, the inspired gas temperature II. tube position
at the airway should be set to what level? III. tube patency
A. 29° to 31° C A. I and II
B. 31° to 35° C B. I, II, and III
C. 35° to 37° C C. I and III
D. 38° to 40° C D. II and III
185. After setting up a patient on a ventilatory 190. A patient with ARDS receiving ventilatory
support device, which of the following support with PEEP through a volumecycled ventilator
supplementary equipment would you require to be has a plateau pressure of 38 cm H2O. ABGs on 55%
available at the bedside? O2 are as follows: pH = 7.44; PCO2 = 37 mm Hg;
I. suction source and catheters HCO3 − = 25 mEq; PO2 = 55 mm Hg; SaO2 = 88%.
II. backup artificial airway Which of the following would you recommend?
III. manual resuscitator with oxygen A. Increase the PEEP level.
A. II and III B. Make no changes.
B. I and II C. Reduce the VT.
C. I, II, and III D. Increase the FIO2
D. I and III
191. Which of the following techniques can help to
186. You have just placed a chronic obstructive decrease a patient’s imposed work of breathing
pulmonary disease (COPD) patient on intermittent during weaning from ventilatory support?
mandatory ventilation at a rate of 8/min, a VT of 750 I. use of pressure-supported ventilation (PSV)
ml, and an FIO2 of 0.40. To ensure proper II. trigger breath by flow, not pressure
equilibration between the alveolar and arterial gas III. application of small amounts of continuous
tensions, how long should you wait before drawing a positive airway pressure (CPAP) or positive end-
sample for measurement of the ABG? expiratory pressure (PEEP)
A. 5 minutes IV. use of automatic tube compensation (ATC)
B. 10 minutes A. II and IV
C. 15 minutes B. I, II, and III
D. 30 minutes C. III and IV
D. I, II, III, and IV
187. When adjusting a patient’s oxygenation
during mechanical ventilatory support, what should 192. Common approaches used to wean patients
your goal be? from ventilatory support include which of the
A. SaO2 of 80% to 90% following?
B. PaO2 of 100 to 150 mm Hg I. T-tube alternating with mechanical ventilation
C. SaO2 of 95% to 100% II. pressure-supported ventilation (PSV)
D. PaO2 of 60 to 100 mm Hg III. intermittent mandatory ventilation
A. II and III
188. When titrating the FIO2 level downward from B. I and II
100% to 40%, what is the maximum increment that C. I, II, and III
should be applied between estimates of D. I and III
oxygenation?
A. 5% 193. Which of the following ventilator strategies
B. 10% would you consider as a good alternative to T-tube
C. 20% trials when using a rapid weaning protocol?
D. 25% I. continuous positive airway pressure (CPAP) with
flow-by (flow triggering)
189. When titrating the FIO2 down from 50% to II. low-level pressure-supported ventilation (PSV)
21%, in what increments should it be reduced? III. intermittent mandatory ventilation
A. all at once is acceptable A. II and III
B. no more than 5% B. I and II
C. 5% to 10% C. I, II, and III
D. 10% to 20% D. I and III 30.
194. Which method of weaning may be useful to protocol to wean a patient off ventilatory support.
minimize auto-PEEP? The patient is now at a 5 cm H2O pressure level and
A. intermittent mandatory ventilation has a spontaneous respiratory rate of 21/min. Other
B. synchronized intermittent mandatory ventilation cardiovascular and respiratory signs indicate that the
C. continuous positive airway pressure (CPAP) patient remains stable. Which of the following
D. T-piece actions would you recommend at this point?
A. Switch the patient to 5 cm H2O continuous
195. A physician orders a T-tube trial for a patient positive airway pressure (CPAP) through the
receiving ventilatory support in the assist-control endotracheal tube.
mode with an FIO2 of 0.4. What FIO2 would you B. Extubate the patient and provide supplemental
recommend for this O2.
patient during the spontaneous breathing period? C. Switch the patient to intermittent mandatory
A. 0.3 ventilation at a rate of 2/min.
B. 0.4 D. Decrease the pressure support level to 3 cm H2O.
C. 0.5
D. 0.6 200. An alert patient receiving ventilatory support
through a demand flow intermittent mandatory
196. 32. Advantages of adding continuous positive ventilation system exhibits clinical signs of an
airway pressure (CPAP) to T-tube weaning include all increased work of breathing whenever you try to
of the following except: decrease the mandatory rate below 6/min. In order
A. improved blood oxygenation to aid in weaning this patient, which of the following
B. decreased work of breathing would you recommend?
C. compensation for auto-PEEP A. Apply a low level of pressure support.
D. faster weaning or extubation B. Apply a high level of inspiratory pressure.
C. Increase the mandatory VT.
197. An alert patient receiving intermittent D. Decrease the mandatory VT.
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.

198. 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 8 to 10 ml/kg
IBW
D. pressure equal to 30% of the volume-cycled peak
inspiratory pressure

199. A physician is using a pressure support