1.

Which of the following techniques can help to decrease a patient’s imposed work of breathing during
weaning from ventilatory support?
I. use of pressure-supported ventilation (PSV)
II. trigger breath by flow, not pressure
III. application of small amounts of continuous positive airway pressure (CPAP) or positive end-
expiratory pressure (PEEP)
IV. use of automatic tube compensation (ATC)
A. II and IV
B. I, II, and III
C. III and IV
D. I, II, III, and IV

2. Common approaches used to wean patients from ventilatory support include which of the following?
I. T-tube alternating with mechanical ventilation
II. pressure-supported ventilation (PSV)
III. intermittent mandatory ventilation
A. II and III
B. I and II
C. I, II, and III
D. I and III

3. Which of the following ventilator strategies would you consider as a good alternative to T-tube trials
when using a rapid weaning protocol?
I. continuous positive airway pressure (CPAP) with flow-by (flow triggering)
II. low-level pressure-supported ventilation (PSV)
III. intermittent mandatory ventilation
A. II and III
B. I and II
C. I, II, and III
D. I and III

4. All of the following are disadvantages of using the T-tube method for weaning except:
A. more staff time required
B. abrupt transition sometimes difficult
C. high imposed work of breathing
D. lack of alarm systems

5. All of the following are disadvantages of using intermittent mandatory ventilation for weaning except:
A. potentially high work of breathing
B. weaning time possibly prolonged
C. patient−ventilator dyssynchrony
D. higher mean airway pressures

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

7. What is the best way to decrease the work of breathing imposed by an artificial airway on a patient
receiving ventilatory support?
A. Provide pressure support.
B. Decrease inspiratory flow.
C. Lower the minute ventilation.
D. Use low rates of breathing.
8. What are some factors that indicate a patient’s readiness for extubation?
I. adequate oxygenation or ventilation with spontaneous breathing
II. minimal risk for upper airway obstruction
III. adequate airway protection or minimal aspiration risk
IV. adequate clearance of pulmonary secretions
A. II and IV
B. I, II, and III
C. III and IV
D. I, II, III, and IV

9. What patients are at high risk for postextubation upper airway obstruction?
I. those with neuromuscular disorders
II. those who have had major neck surgery
III. those with infectious masses or abscesses
A. II and III
B. I and II
C. I and III
D. I, II, and III

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

11. Compared to a pressure-controlled strategy, what is the primary advantage of volumecontrolled

ventilatory support?
A. provides a decelerating flow pattern
B. limits and controls peak airway pressures
C. improves patient–ventilator synchrony
D. guarantees a minimum minute volume

12. Compared with a volume-cycled strategy, what are some potential advantages of pressure-targeted
ventilatory support?
I. limit and control of peak airway pressures
II. direct control over inspiratory time
III. provision of a decelerating flow pattern
A. I and II
B. II and III
C. I and III
D. I, II, and III

13. If the patient is being ventilated via a mechanical ventilator via synchronized intermittent mandatory
ventilation with partial ventilatory support, what would probably happen to PaCO2 if the patient
suddenly had no spontaneous breathing?
A. increase
B. decrease
C. stay the same
D. change according to FIO2

14. Which of the following represents a clinical situation where partial ventilatory support is commonly
used?
A. patient with head trauma
B. during weaning from continuous mandatory ventilation
C. while ventilating an asthmatic
 D. in a drug overdose case

15. Which of the following remedies is NOT commonly used in patients ventilated in the assist-control
mode with a high ventilatory drive to avoid hyperventilation?
A. synchronized intermittent mandatory ventilation
B. tranquilizers
C. analgesics
D. reduced inspiratory flow

16. Which of the following is FALSE about flow-triggered ventilatory support?

A. The work of breathing with flow-triggering is less than with pressure triggering.
B. Flow-triggered systems respond to changes in flow rather than pressure.
C. Pressure-triggering on new ventilators may be as sensitive as flow-triggering.
D. Flow-triggering will decrease the work of breathing in patients with small endotracheal tubes and
auto-PEEP.

17. Beneficial effects of using high inspiratory flows in patients with chronic airflow obstruction receiving
flow-limited mechanical ventilation include which of the following?
I. decreased work of breathing
II. improved gas exchange
III. decreased auto-PEEP
A. I and II
B. I and III
C. II and III
D. I, II, and III

18. A chronic obstructive pulmonary disease (COPD) patient in respiratory failure is receiving ventilatory
support in the volume-targeted intermittent mandatory ventilation mode at a rate of 6/min. You
measure an auto-PEEP level of 9 cm H2O. Which of the following would you recommend to decrease
the effects of auto-PEEP in this patient?
A. Decreasing the rate and increasing VT.
B. Lowering the VT and letting the PaCO2 rise.
C. Applying 4 to 6 cm H2O PEEP.
D. Decreasing the peak inspiratory flow.

19. Which of the following criteria should be met before considering use of a heatmoisture exchanger
(HME) for a patient being placed on ventilatory support?
I. There should be no problem with retained secretions.
II. The patient should not have a fever (normothermic).
III. The patient should be adequately hydrated.
IV. The support should be short term (24 to 48 hours).
A. I, II, and III
B. II and IV
C. I, II, III, and IV
D. III and IV

20. A dehydrated, feverish patient suffering from acute bacterial pneumonia is being intubated in order to
provide mechanical ventilatory support. Which of the following devices would you select to control
humidification and airway temperature for this patient?
A. unheated large-volume wick humidifier
B. heated wick humidifier with servo-control
C. large-reservoir, high-output heated jet nebulizer
D. heat-moisture exchanger

21. Because an elevated PaCO2 increases ventilatory drive in normal subjects, the clinical presence of
hypercapnia indicates which of the following?
 1. inability of the stimulus to get to the muscles
2. weak or missing central nervous system response to the elevated PCO2
3. pulmonary muscle fatigue
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

22. According to the equation of motion of the respiratory system, a ventilator can control all of the
following variables except:
a. volume
b. resistance
c. pressure
d. flow

23. If the pressure waveform of a ventilator remains the same when a patient's lung mechanics change,
then what is the ventilator?
a. volume controller
b. pressure controller
c. time controller
d. flow controller

24. During volume control ventilation, the clinician has control over which of the following?
1. pressure waveform
2. volume waveform
3. flow waveform
a. 1 or 2
b. 2 or 3
c. 2
d. 1, 2, and 3

25. During mechanical ventilation, what variable causes a breath to begin?

a. limit
b. cycle
c. trigger
d. baseline

26. To describe what happens during the expiratory phase of mechanical ventilation, you must know the
value of which variable?
a. limit
b. cycle
c. trigger
d. baseline

27. A patient receiving time-triggered continuous mechanical ventilation at a preset rate of 10/min stops
breathing. Which of the following will occur?
a. The high-pressure limit alarm will sound (if properly set).
b. The patient will continue to receive 10 breaths/min.
c. The low tidal volume (VT) alarm will sound (if properly set).
d. Ventilation will drop to zero and the apnea alarm will sound.

28. A volume-cycled ventilator has a rate knob for setting the controlled frequency of breathing. If this
control is set to 12/min, which of the following other settings will determine the inspiratory and
expiratory times?
1. FIO2
2. flow
 3. volume
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

29. A volume-cycled ventilator provides gas under positive pressure during inspiration until what point?
a. A preselected volume of gas is received by the patient.
b. An adjustable, preselected airway pressure is reached.
c. The inspiratory time equals or exceeds the expiratory time.
d. A preselected volume of gas is expelled from the device.

30. While observing a patient receiving ventilatory support, you notice that all delivered breaths are
initiated or terminated by the machine. Which of the following modes of ventilatory support is in
force?
a. intermittent mandatory ventilation
b. partial ventilatory support
c. continuous mandatory ventilation
d. continuous spontaneous ventilation
ANSWER KEY

1. ANS: D The patient’s ventilatory workload should be minimized with PSV. Flow trigger, flowby,
or ATC also may be helpful in minimizing imposed ventilatory work. Intrinsic PEEP during
mechanical ventilation may increase trigger work, and small amounts of PEEP or CPAP can help
overcome this problem.
2. ANS: C There are three basic methods of discontinuing ventilatory support: (1) spontaneous
breathing trials (usually with a T tube) alternating with mechanical ventilatory support, (2)
synchronized intermittent mandatory ventilation, and (3) PSV
3. ANS: B Rather than using a T-tube trial, some clinicians prefer to maintain the patient attached to
the ventilator with zero PSV and zero CPAP.
4. ANS: C
5. ANS: D
6. ANS: D
7. ANS: A Pressure support ventilation can be very effective in overcoming this imposed work.
8. ANS: D
9. ANS: D Compression of the airway due to traumatic or postoperative hematoma of the neck,
infectious masses or abscesses, and malignant tumors or compression after major head or neck
surgery can lead to upper airway obstruction after extubation.
10. ANS: C The cuff leak test is recommended to detect airway obstruction before extubation.
11. ANS: D The primary advantage of volume-controlled ventilation is maintenance of a stable
constant tidal volume in the face of changing lung mechanics.
12. ANS: C Pressure-control ventilation is useful in limiting airway pressure and providing a
decreasing (decelerating) flow, which may improve gas distribution, patient comfort, and
synchrony.
13. ANS: A With partial ventilatory support, if spontaneous breathing ceases or becomes inadequate,
as may be the case with the development of rapid shallow breathing or apnea, alveolar ventilation
may decrease, and PaCO2 may increase above an acceptable level.
14. ANS: B Partial ventilatory support techniques may be especially useful for weaning patients from
mechanical ventilatory support, and pressure-supported ventilation (PSV) and synchronized
intermittent mandatory ventilation have been used as partial support strategies for weaning.
15. ANS: D If methods of correcting the problem fail, one may try the synchronized intermittent
mandatory ventilation mode, which should be helpful in preventing respiratory alkalosis. Other
options include administration of analgesics, sedatives, and tranquilizers.
16. ANS: D Flow triggering may not be effective in reducing work of breathing because of the
presence of a small endotracheal tube or auto-PEEP.
17. ANS: D Higher flow (up to 100 L/min) may improve gas exchange in chronic obstructive
pulmonary disease patients, probably because of the resulting increase in expiratory time.
18. ANS: C
19. ANS: C Use of HMEs should be avoided in the care of patients with secretion problems and those
with low body temperature (less than 32° C), high spontaneous minute ventilation (greater than 10
L/min), or air leaks in which exhaled tidal volume is less than 70% of delivered tidal volume.
20. ANS: B We prefer an optimal humidity approach and use of a heated humidifier to deliver gas in
the range of 35° to 37° C at the airway.
21. ANS: D Because an elevated PaCO2 increases ventilatory drive in healthy subjects, the very
existence of hypoventilation suggests other problems with the respiratory apparatus. Specifically,
the presence of acute respiratory acidosis indicates one of three major problems: (1) the
respiratory center is not responding normally to the elevated PaCO2, (2) the respiratory center is
responding normally, but the signal is not getting through to the respiratory muscles, or (3) despite
normal neurologic response mechanisms, the lungs and chest bellows are simply incapable of
providing adequate ventilation due to parenchymal lung disease or muscular weakness
22. ANS: B There are only three variables in the equation of motion that a ventilator can control:
pressure, volume, and flow.
23. ANS: B If the ventilator controls pressure, the pressure waveform will remain consistent but
volume and flow will vary with changes in respiratory system mechanics.
24. ANS: B Volume can be controlled directly by the displacement of a device such as a piston or
bellows. Volume can be controlled indirectly by controlling flow.
25. ANS: C The variable causing a breath to begin is the trigger variable.
26. ANS: D To describe what happens during expiration, we must know what baseline variable is in
effect.
27. ANS: B When triggering by time, a ventilator initiates a breath according to a predetermined time
interval, without regard to patient effort.
28. ANS: C When a rate control is used, inspiratory and expiratory times will vary according to other
control settings, such as flow and volume.
29. ANS: D When a ventilator is set to volume-cycle, it delivers flow until a preselected volume has
been expelled from the device.
30. ANS: C In continuous mandatory ventilation, all breaths are mandatory