Question 1

Which of the following health care disciplines should be involved in the care of a patient who is considered difficult to wean?
1) Physical therapy
2) Speech therapy
3) Social services
4) Occupational therapy
A)1 and 2 only
B)2 and 3 only
C)1, 2, and 4 only
D)1, 2, 3, and 4

Accepted Answer

All listed disciplines play a role in the comprehensive care of a patient who is difficult to wean from mechanical ventilation. Physical therapy helps improve physical strength and endurance, speech therapy assists with swallowing and communication issues, social services provide support and resources for the patient and family, and occupational therapy aids in regaining the ability to perform daily activities.

Question 2

Which of the following cardiovascular signs would indicate that a patient's cardiovascular status is unstable and that weaning should not begin at this time? A) Cardiac index of 2.5 L/min/m² B) Hemoglobin content of 10 g/dl C) Heart rate of 108/min D) Systolic blood pressure of 80 mm Hg

Accepted Answer

A systolic blood pressure of 80 mm Hg indicates hypotension and unstable cardiovascular status, which would not be suitable for weaning. The other choices, a cardiac index of 2.5 L/min/m^2, hemoglobin content of 10 g/dl, and heart rate of 108/min, could be within normal ranges and would not necessarily indicate unstable cardiovascular status.

Question 3

Which of the following must you verify when considering weaning an obtunded patient?
1) Adequate gag reflex
2) No depressant drugs
3) Adequate cough
A)2 and 3 only
B)1 and 2 only
C)1, 2, and 3
D)1 and 3 only

Accepted Answer

When considering weaning an obtunded patient, it is important to verify that they have an adequate gag reflex to protect their airway and prevent aspiration. This corresponds to option 1). Additionally, an adequate cough is necessary to clear secretions from the airway and prevent pneumonia, which corresponds to option 3). Depressant drugs should also be avoided during weaning, but this is not the only consideration and therefore option 2) is not always necessary to verify. Therefore, the correct answer is 1 and 3 only, or choice D.

Question 4

What are some advantages of mandatory minute ventilation (MMV) as a weaning tool? 1) It provides greater control over PaCO₂than intermittent mandatory ventilation does. 2) It prevents acidemia with acute hypoventilation. 3) It eliminates concerns over depressant drugs. 4) It ensures an efficient pattern of ventilation. A)2 and 4 only B)1, 2, and 3 only C)3 and 4 only D)1, 2, 3, and 4

Accepted Answer

Mandatory minute ventilation (MMV) provides better control over PaCO2 and prevents acidemia during acute hypoventilation, but it does not eliminate concerns over depressant drugs or ensure an efficient pattern of ventilation.

Question 5

An alert patient receiving ventilatory support through a demand flow intermittent mandatory ventilation system exhibits clinical signs of an increased work of breathing whenever you try to decrease the mandatory rate below 6/min. In order to aid in weaning this patient, which of the following would you recommend? A) Apply a low level of pressure support. B) Apply a high level of inspiratory pressure. C) Increase the mandatory V_T. D) Decrease the mandatory V_T.

Accepted Answer

With intermittent mandatory ventilation, the addition of pressure support can overcome the work of breathing imposed during "spontaneous" breaths because of the presence of endotracheal and tracheostomy tubes, demand-flow systems, and ventilator circuits.

Question 6

Prerequisites for successful weaning include:
1) psychological readiness.
2) adequate gag and swallow reflexes.
3) ability to follow instructions.
4) adequate cough.
A)1, 2, and 3 only
B)2 and 4 only
C)1, 2, 3, and 4
D)3 and 4 only

Accepted Answer

All four options are prerequisites for successful weaning. Psychological readiness is important for patient motivation and compliance with the weaning plan. Adequate gag and swallow reflexes and cough are essential to prevent aspiration and manage secretions. Ability to follow instructions is necessary to ensure proper technique and management of the weaning process. Therefore, all four options are necessary for successful weaning.

Question 7

Which of the following drug categories can depress ventilatory drive and hinder weaning?
1) Analgesics
2) Narcotics
3) Hypnotics
4) Antibiotics
A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Accepted Answer

Analgesics, narcotics, and hypnotics can all depress ventilatory drive and hinder weaning. Antibiotics do not have a direct effect on ventilatory drive. Therefore, the correct answer is B, which includes all three drug categories that can hinder weaning.

Question 8

Which of the following techniques can help to decrease a patient's imposed work of breathing during weaning from ventilatory support?
1) Use of pressure-supported ventilation (PSV)
2) Trigger breath by flow, not pressure
3) Application of small amounts of continuous positive airway pressure (CPAP) or positive end expiratory pressure (PEEP)
4) Use of automatic tube compensation (ATC)
A)2 and 4 only
B)1, 2, and 3 only
C)3 and 4 only
D)1, 2, 3, and 4

Accepted Answer

All listed techniques can help decrease a patient's imposed work of breathing during weaning from ventilatory support. Pressure-supported ventilation reduces the effort required to breathe, triggering breaths by flow can be more sensitive and less work for the patient than pressure triggering, CPAP or PEEP can help keep the airways open and reduce the work of breathing, and automatic tube compensation helps by adjusting the support to the patient's effort, making breathing through an endotracheal tube feel more natural.

Question 9

Which of the following ventilator strategies would you consider as a good alternative to T tube trials when using a rapid weaning protocol?
1) Continuous positive airway pressure (CPAP) with flow-by (flow triggering)
2) Low-level pressure-supported ventilation (PSV)
3) Intermittent mandatory ventilation
A)2 and 3 only
B)1 and 2 only
C)1, 2, and 3
D)1 and 3 only

Accepted Answer

Both CPAP with flow-by and low-level PSV are effective alternatives to T tube trials in a rapid weaning protocol. CPAP with flow-by provides a constant positive pressure that allows the patient to initiate spontaneous breaths and reduces the work of breathing. Low-level PSV provides a small amount of pressure support to the patient during inspiration, which helps to augment the patient's own respiratory effort. Intermittent mandatory ventilation is not typically used in a rapid weaning protocol as it involves regularly scheduled mandatory breaths, which can interfere with the patient's ability to wean quickly.

Question 10

Advantages of adding continuous positive airway pressure (CPAP) to T tube weaning include which of the following?
1) Improved blood oxygenation
2) Decreased work of breathing
3) Compensation for auto-PEEP
4) Faster weaning or extubation
A)1 and 3 only
B)1, 2, and 3 only
C)3 and 4 only
D)2, 3, and 4 only

Accepted Answer

Adding continuous positive airway pressure (CPAP) to T tube weaning can improve blood oxygenation, decrease work of breathing, and compensate for auto-PEEP. This can result in a faster weaning or extubation process. Therefore, options 1, 2, and 3 are all advantages of using CPAP during T tube weaning. Option 4 may or may not be true, as the speed of weaning or extubation also depends on individual patient factors.

Question 11

Common approaches used to wean patients from ventilatory support include which of the following?
1) T tube alternating with mechanical ventilation
2) Pressure-supported ventilation (PSV)
3) Intermittent mandatory ventilation
A)2 and 3 only
B)1 and 2 only
C)1, 2, and 3
D)1 and 3 only

Accepted Answer

1) T tube alternating with mechanical ventilation, 2) Pressure-supported ventilation (PSV), and 3) Intermittent mandatory ventilation are all common methods used to wean patients from ventilatory support, allowing gradual transition to independent breathing.

Question 12

A physician is using a pressure support protocol to wean a patient off ventilatory support. The patient is now at a 5 cm H₂O pressure level and has a spontaneous respiratory rate of 21/min. Other cardiovascular and respiratory signs indicate that the patient remains stable. Which of the following actions would you recommend at this point? A) Switch the patient to 5 cm H₂O continuous positive airway pressure (CPAP) through the endotracheal tube. B) Extubate the patient and provide supplemental O₂. C) Switch the patient to intermittent mandatory ventilation at a rate of 2/min. D) Decrease the pressure support level to 3 cm H₂O.

Accepted Answer

In general, patients who can spontaneously breathe comfortably at this level of pressure support can be extubated without problems.

Question 13

Which of the following ventilator modes can ensure delivery of a preset V_T during spontaneous breathing? 1) Volume support 2) Volume-assured pressure support 3) Mandatory minute ventilation A)2 and 3 only B)1 and 2 only C)1 and 3 only D)1, 2, and 3

Accepted Answer

Both volume support and volume-assured pressure support modes can deliver a preset tidal volume (V_T) during spontaneous breathing. Mandatory minute ventilation mode, on the other hand, delivers a preset minute ventilation, not a specific tidal volume. Therefore, options A and C are incorrect, and the correct answer is B.

Question 14

An alert patient receiving intermittent mandatory ventilation at a rate of 8/min and V_T 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 V_T to 500 ml.

Accepted Answer

At this point, the rate is reduced in a stepwise manner until complete spontaneous breathing can be achieved.

Question 15

In most weaning protocols, what minimum blood gas parameters are needed to start the process? A) PaO₂ greater than 70 mm Hg and PaCO₂ less than 50 mm Hg on FiO₂ less than 0.6 and PEEP less than 5 cm H₂O B) PaO₂greater than 70 mm Hg and PaCO₂ less than 50 mm Hg on FiO₂ less than 0.4 and PEEP 5 cm H₂O or greater C) PaO₂ greater than 50 mm Hg and PaCO₂ less than 50 mm Hg on FiO₂ less than 0.6 and PEEP less than 10 cm H₂O D) PaO₂greater than 70 mm Hg and PaCO₂ less than 70 mm Hg on FiO₂ less than 0.6 and PEEP 5 cm H₂O or greater

Accepted Answer

The weaning protocol typically requires a minimum PaO2 of 70 mm Hg and a maximum PaCO2 of 50 mm Hg on an FiO2 of less than 0.4 and a PEEP of 5 cm H2O or greater to start the process. Option A is incorrect because it requires a PEEP of less than 5 cm H2O, which is insufficient for adequate oxygenation. Option C is incorrect because it allows for a PaO2 of less than 70 mm Hg. Option D is incorrect because it allows for a PaCO2 of greater than 50 mm Hg.

Question 16

A physician orders a T tube trial for a patient receiving ventilatory support in the assist-control mode with an FiO₂ of 0.4. What FiO₂ would you recommend for this patient during the spontaneous breathing period? A) 0.3 B) 0.4 C) 0.5 D) 0.6

Accepted Answer

During a T-tube trial, the patient is breathing spontaneously. To maintain adequate oxygenation, the FiO2 should be increased to 0.5 during this period.

Question 17

Which of the following electrolyte imbalances can hinder weaning from ventilatory support?
1) Hypochloremia
2) Hypomagnesemia
3) Hypokalemia
4) Hyponatremia
A)2 and 3 only
B)1 and 2 only
C)3 and 4 only
D)1 and 4 only

Accepted Answer

Electrolyte imbalances such as hypomagnesemia and hypokalemia can affect muscle function, including the respiratory muscles, making it difficult to wean a patient from ventilatory support.

Question 18

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 V_T of 3 to 5 ml/kg of predicted body weight (PBW) B) Pressure sufficient to overcome the imposed workload C) Pressure sufficient to obtain a V_T of 4 to 8 ml/kg PBW D) Pressure equal to 30% of the volume-cycled peak inspiratory pressure

Accepted Answer

For initial ventilator setup in the pressure support mode, the beginning pressure level can be adjusted to deliver an appropriate tidal volume, usually approximately 4 to 8 ml/kg of PBW.

Question 19

Which of the following is false about noninvasive positive-pressure ventilation (NIV)?
A) NIV can support ventilation without a tracheal airway.
B) NIV should not be used with patients at risk for aspiration.
C) Patients likely to fail weaning are good candidates for NIV.
D) NIV can be used to prevent reintubation when weaning fails.

Accepted Answer

Patients who are likely to be unsuccessful at weaning are not good candidates for NIV.

Question 20

Which of the following weaning methods provides the best respiratory muscle strength conditioning?
A) Pressure-supported ventilation
B) T tube
C) Intermittent mandatory ventilation
D) Volume-assured pressure support

Accepted Answer

The answer of Which of the following weaning methods provides...

Quiz 52: Discontinuing Ventilatory Support

Which of the following health care disciplines should be involved in the care of a patient who is considered difficult to wean? 1) Physical therapy 2) Speech therapy 3) Social services 4) Occupational therapy

Which of the following cardiovascular signs would indicate that a patient's cardiovascular status is unstable and that weaning should not begin at this time?

Which of the following must you verify when considering weaning an obtunded patient? 1) Adequate gag reflex 2) No depressant drugs 3) Adequate cough

Prerequisites for successful weaning include: 1) psychological readiness. 2) adequate gag and swallow reflexes. 3) ability to follow instructions. 4) adequate cough.

Which of the following drug categories can depress ventilatory drive and hinder weaning? 1) Analgesics 2) Narcotics 3) Hypnotics 4) Antibiotics

Advantages of adding continuous positive airway pressure (CPAP) to T tube weaning include which of the following? 1) Improved blood oxygenation 2) Decreased work of breathing 3) Compensation for auto-PEEP 4) Faster weaning or extubation

Common approaches used to wean patients from ventilatory support include which of the following? 1) T tube alternating with mechanical ventilation 2) Pressure-supported ventilation (PSV) 3) Intermittent mandatory ventilation

Which of the following ventilator modes can ensure delivery of a preset V_T during spontaneous breathing? 1) Volume support 2) Volume-assured pressure support 3) Mandatory minute ventilation

An alert patient receiving intermittent mandatory ventilation at a rate of 8/min and V_T 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?

In most weaning protocols, what minimum blood gas parameters are needed to start the process?

A physician orders a T tube trial for a patient receiving ventilatory support in the assist-control mode with an FiO₂ of 0.4. What FiO₂ would you recommend for this patient during the spontaneous breathing period?

Which of the following electrolyte imbalances can hinder weaning from ventilatory support? 1) Hypochloremia 2) Hypomagnesemia 3) Hypokalemia 4) Hyponatremia

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?

Which of the following is false about noninvasive positive-pressure ventilation (NIV) ?

Which of the following weaning methods provides the best respiratory muscle strength conditioning?