Acute Care Nurse Practitioner Mechanical Ventilation and Respiratory Support 2

Question 1

Prone positioning in ARDS is recommended when PaO₂/FiO₂ ratio is below which threshold?

Accepted Answer

150 mmHg

Answer

Prone positioning is recommended for moderate-to-severe ARDS when PaO₂/FiO₂ <150 mmHg despite optimal ventilator settings.

Question 2

Which ventilator setting should be adjusted to correct hypercapnia in a patient on volume control ventilation?

Accepted Answer

Increase respiratory rate or tidal volume

Answer

CO₂ elimination depends on minute ventilation; increasing respiratory rate or tidal volume will increase minute ventilation and lower PaCO₂.

Question 3

A spontaneous breathing trial (SBT) should be attempted when which criteria are met?

Accepted Answer

FiO₂ ≤0.40, PEEP ≤5, hemodynamically stable, able to follow commands

Answer

Standard SBT readiness criteria include FiO₂ ≤40%, PEEP ≤5 cmH₂O, hemodynamic stability, and ability to follow simple commands.

Question 4

Which parameter is MOST predictive of successful extubation?

Accepted Answer

Rapid shallow breathing index (RSBI) <105

Answer

RSBI (f/Vt) <105 breaths/min/L is the best validated predictor of successful extubation from mechanical ventilation.

Question 5

An ACNP manages a patient with severe bronchospasm on mechanical ventilation. Which strategy minimizes air trapping?

Accepted Answer

Decrease respiratory rate and increase expiratory time

Answer

In obstructive disease, decreasing RR and prolonging expiratory time (I:E ratio 1:4 or greater) prevents breath stacking and auto-PEEP.

Acute Care Nurse Practitioner Practice Test