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Nursing:
doi: 10.1097/01.NURSE.0000352329.58362.01
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Building a solid understanding of Mechanical ventilation

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INSTRUCTIONS Building a solid understanding of mechanical ventilation

TEST INSTRUCTIONS

* To take the test online, go to our secure Web site at http://www.nursingcenter.com/ce/nursing.

* On the print form, record your answers in the test answer section of the CE enrollment form on page 29. Each question has only one correct answer. You may make copies of these forms.

* Complete the registration information and course evaluation. Mail the completed form and registration fee of $24.95 to: Lippincott Williams & Wilkins, CE Group, 2710 Yorktowne Blvd., Brick, NJ 08723. We will mail your certificate in 4 to 6 weeks. For faster service, include a fax number and we will fax your certificate within 2 business days of receiving your enrollment form.

* You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade.

* Registration deadline is June 30, 2011.

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* Send two or more tests in any nursing journal published by Lippincott Williams & Wilkins together and deduct $0.95 from the price of each test.

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PROVIDER ACCREDITATION

Lippincott Williams & Wilkins, publisher of Nursing2009 journal, will award 2.5 contact hours for this continuing nursing education activity.

Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia and Florida #FBN2454. Lippincott Williams & Wilkins home study activities are classified for Texas nursing continuing education requirements as Type 1. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.5 contact hours.

Your certificate is valid in all states.

Building a solid understanding of mechanical ventilation

GENERAL PURPOSE To provide nurses with an overview of mechanical ventilation. LEARNING OBJECTIVES After reading the preceding article and taking this test, you should be able to: 1. Discuss the relationship between mechanical ventilator settings and arterial blood gas results. 2. Describe various ventilator modes and strategies. 3. Identify when adjustments to ventilator settings are indicated.

1. Normal tidal volume in a spontaneously breathing patient should be

a. 2 to 4 mL/kg.

b. 5 to 8 mL/kg.

c. 9 to 11 mL/kg.

d. 15 to 20 mL/kg.

2. Which statement about tidal volume settings isn't correct?

a. A patient with ARDS would be ventilated at 4 to 8 mL/kg.

b. A patient with COPD would be ventilated at 8 to 10 mL/kg.

c. A patient with normal lungs would be ventilated at 10 to 12 mL/kg.

d. A patient with pneumothorax would be ventilated at 13 to 15 mL/kg.

3. An FIO2 of 1.0 means that the patient is receiving

a. 50% oxygen.

b. 60% oxygen.

c. 80% oxygen.

d. 100% oxygen.

4. In normal, nonventilated patients, the PEEP value is physiologically normal at

a. 1 to 2 cm H2O.

b. 3 to 5 cm H2O.

c. 6 to 7 cm H2O.

d. 8 to 9 cm H2O.

5. Which ABG value isn't considered within normal range?

a. pH of 7.41

b. PaCO2 of 48 mm Hg

c. HCO3 of 25 mEq/L

d. PaO2 of 100 mm Hg

6. Hypoventilation causes a drop in the patient's

a. pH.

b. PaCO2.

c. HCO3.

d. FIO2.

7. A pH of 7.56 and PaCO2 of 32 mm Hg indicate that your ventilated patient

a. has respiratory acidosis.

b. is hyperventilated.

c. is hypoventilated.

d. is ready to wean.

8. Minute ventilation in a mechanically ventilated patient is calculated by

a. dividing the tidal volume by the ventilator rate.

b. multiplying the ventilator rate by the FIO2.

c. multiplying the tidal volume by the ventilator rate.

d. multiplying the tidal volume by the FIO2.

9. If your patient is hypoventilated, the minute ventilation may need to be adjusted by

a. decreasing the tidal volume or PEEP.

b. decreasing the tidal volume and oxygen saturation.

c. increasing the tidal volume and FIO2.

d. increasing the tidal volume or ventilatory rate.

10. The tidal volume for a woman with normal lungs and a height of 5'11” should be

a. 620 to 710 mL.

b. 720 to 870 mL.

c. 880 to 920 mL.

d. 940 to 980 mL.

11. An increasing PIP but stable plateau pressure may be due to

a. overdistension of the lungs.

b. increased pressure in the ventilator tubing or the patient's tracheobronchial tree.

c. a ventilator-induced lung injury.

d. a tidal volume that's too low for the patient.

12. Typically, the transairway pressure is

a. less than 10 cm H2O.

b. 22 to 26 cm H2O.

c. 35 to 45 cm H2O.

d. 80 to 100 cm H2O.

13. The P/F ratio for a PaO2 of 180 mg Hg and FIO2 of 1.0 is

a. 180, which is normal.

b. 180, indicating refractory hypoxemia.

c. 280, indicating a problem with the ventilator tubing.

d. 360, indicating acute lung injury.

14. If your patient is breathing 50% oxygen, his PaO2 should normally be about

a. 150 mm Hg.

b. 250 mm Hg.

c. 350 mm Hg.

d. 450 mm Hg.

15. The three most common causes of refractory hypoxemia in a critically ill patient are atelectasis, pulmonary edema, and

a. asthma.

b. chronic bronchitis.

c. pneumothorax.

d. emphysema.

16. Which statement about PEEP is correct?

a. PEEP is used to completely empty the lungs of air at end-expiration.

b. A low level of PEEP (<5 cm H2O) is ineffective and rarely used.

c. PEEP levels over 5 cm H2O are used to treat refractory hypoxemia.

d. Using PEEP requires a higher FIO2 setting to reach target PaO2.

17. The ventilator mode that delivers a tidal volume in response to every patient inspiratory effort is called

a. assist/control.

b. SIMV.

c. CPAP.

d. volume control ventilation.

18. The ventilator strategy that sets the PIP for each mandatory breath is called

a. CPAP.

b. pressure control ventilation.

c. pressure support ventilation.

d. assist/control ventilation.

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