Test Bank for Pilbeam's Mechanical Ventilation, 8th Edition 8e by James M. Cairo. Full Chapters test bank are included - Chapter 1 to 23
Chapter 1 Basic Terms and Concepts of Mechanical Ventilation
Chapter 2 How Ventilators Work
Chapter 3 How a Breath Is Delivered
Chapter 4 Establishing the N...
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Chapter 01: Basic Terms and Concepts of Mechanical Ventilation
Cairo: Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications, 8th
Edition
MULTIPLE CHOICE
1. The body’s mechanism for conducting air in and out of the lungs is known as which of the
following?
a. External respiration
b. Internal respiration
c. Spontaneous ventilation
d. Mechanical ventilation
ANS: C
The conduction of air in and out of the body is known as ventilation. Since the question asks
for the body’s mechanism, this would be spontaneous ventilation. External respiration
involves the exchange of oxygen (O2) and carbon dioxide (CO2) between the alveoli and the
pulmonary capillaries. Internal respiration occurs at the cellular level and involves movement
of oxygen from the systemic blood into the cells.
2. Which of the following are involved in external respiration?
a. Red blood cells and body cells
b. Scalenes and trapezius muscles
c. Alveoli and pulmonary capillaries
d. External oblique and transverse abdominal muscles
ANS: C
External respiration involves the exchange of oxygen and carbon dioxide (CO2) between the
alveoli and the pulmonary capillaries. Internal respiration occurs at the cellular level and
involves movement of oxygen from the systemic blood into the cells. Scalene and trapezius
muscles are accessory muscles of inspiration. External oblique and transverse abdominal
muscles are accessory muscles of expiration.
3. The graph that shows intrapleural pressure changes during normal spontaneous breathing is
depicted by which of the following?
a.
b.
, c.
d.
ANS: B
During spontaneous breathing, the intrapleural pressure drops from about 5 cm H2O at end-
expiration to about 10 cm H2O at end-inspiration. The graph depicted for answer B shows
that change from 5 cm H2O to 10 cm H2O.
4. What is the approximant alveolar pressure (PA) during spontaneous inspiration?
a. 1 cm H2O
b. +1 cm H2O
c. 0 cm H2O
d. 5 cm H2O
ANS: A
1 cm H2O is the lowest alveolar pressure will become during normal spontaneous
ventilation. During the exhalation of a normal spontaneous breath the alveolar pressure will
become 1 cm H2O.
5. The pressure required to maintain alveolar inflation is known as which of the following?
a. Transairway pressure (PTA)
b. Transthoracic pressure (PTT)
c. Transrespiratory pressure (PTR)
d. Transpulmonary pressure (PL)
ANS: D
The definition of transpulmonary pressure (PL) is the pressure required to maintain alveolar
inflation. Transairway pressure (PTA) is the pressure gradient required to produce airflow in the
conducting tubes. Transrespiratory pressure (PTR) is the pressure to inflate the lungs and
airways during positive-pressure ventilation. Transthoracic pressure (PTT) represents the
pressure required to expand or contract the lungs and the chest wall at the same time.
6. Calculate the pressure needed to overcome airway resistance during positive-pressure
ventilation when the proximal airway pressure (Pawo) is 35 cm H2O and the alveolar pressure
(PA) is 5 cm H2O.
a. 7 cm H2O
b. 30 cm H2O
c. 40 cm H2O
d. 175 cm H2O
, ANS: B
The transairway pressure (PTA) is used to calculate the pressure required to overcome airway
resistance during mechanical ventilation. This formula is PTA = Pawo - PA.
7. The term used to describe the tendency of a structure to return to its original form after being
stretched or acted on by an outside force is which of the following?
a. Elastance
b. Compliance
c. Viscous resistance
d. Distending pressure
ANS: A
The elastance of a structure is the tendency of that structure to return to its original shape after
being stretched. The more elastance a structure has, the more difficult it is to stretch. The
compliance of a structure is the ease with which the structure distends or stretches.
Compliance is the opposite of elastance. Viscous resistance is the opposition to movement
offered by adjacent structures such as the lungs and their adjacent organs. Distending pressure
is pressure required to maintain inflation, for example, alveolar distending pressure.
8. Calculate the pressure required to achieve a tidal volume of 400 mL for an intubated patient
with a respiratory system compliance of 15 mL/cm H2O.
a. 6 cm H2O
b. 26.7 cm H2O
c. 37.5 cm H2O
d. 41.5 cm H2O
ANS: B
C = V/P then P = V/C
9. Which of the following conditions causes pulmonary compliance to increase?
a. Asthma
b. Kyphoscoliosis
c. Emphysema
d. Acute respiratory distress syndrome (ARDS)
ANS: C
Emphysema causes an increase in pulmonary compliance, whereas ARDS and kyphoscoliosis
cause decreases in pulmonary compliance. Asthma attacks cause increase in airway resistance.
10. Calculate the effective static compliance (Cs) given the following information about a patient
receiving mechanical ventilation: peak inspiratory pressure (PIP) is 56 cm H2O, plateau
pressure (Pplat) is 40 cm H2O, exhaled tidal volume (VT) is 650 mL, and positive end
expiratory pressure (PEEP) is 10 cm H2O.
a. 14.1 mL/cm H2O
b. 16.3 mL/cm H2O
c. 21.7 mL/cm H2O
d. 40.6 mL/cm H2O
ANS: C
The formula for calculating effective static compliance is Cs = VT/(Pplat EEP).
, 11. Based upon the following patient information, calculate the patient’s static lung compliance:
exhaled tidal volume (VT) is 675 mL, peak inspiratory pressure (PIP) is 28 cm H2O, plateau
pressure (Pplat) is 8 cm H2O, and PEEP is set at 5 cm H2O.
a. 0.02 L/cm H2O
b. 0.03 L/cm H2O
c. 0.22 L/cm H2O
d. 0.34 L/cm H2O
ANS: C
The formula for calculating effective static compliance is Cs = VT/(Pplat EEP).
12. A patient receiving mechanical ventilation has an exhaled tidal volume (VT) of 500 mL and a
positive end expiratory pressure setting (PEEP) of 5 cm H2O. Patient-ventilator system checks
reveal the following data:
The respiratory therapist should recommend which of the following for this patient?
1. Tracheobronchial suctioning
2. Increase in the set tidal volume
3. Beta adrenergic bronchodilator therapy
4. Increase positive end expiratory pressure
a. 1 and 3 only
b. 2 and 4 only
c. 1, 2, and 3 only
d. 2, 3, and 4 only
ANS: A
Calculate the transairway pressure (PTA) by subtracting the plateau pressure from the peak
inspiratory pressure. Analyzing the PTA will show any changes in the pressure needed to
overcome airway resistance. Analyzing the Pplateau will demonstrate any changes in
compliance. The Pplateau remained the same for the first two checks and then actually dropped
at the 1000-hour check. Analyzing the PTA, however, shows a slight increase between 0600
and 0800 (from 12 to 14 cm H2O) and then a sharp increase to 23 cm H2O at 1000. Increases
in PTA signify increases in airway resistance. Airway resistance may be caused by secretion
buildup, bronchospasm, mucosal edema, and mucosal inflammation. Tracheobronchial
suctioning will remove any secretion buildup, and a beta adrenergic bronchodilator will
reverse bronchospasm. Increasing the tidal volume will add to the airway resistance according
to Poiseuille’s law. Increasing the PEEP will not address the root of this patient’s problem; the
patient’s compliance is normal.
13. The values below pertain to a patient who is being mechanically ventilated with a measured
exhaled tidal volume (VT) of 700 mL.
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