Acute Care Nurse Practitioner Mechanical Ventilation and Respiratory Support 1 — Questions and Answers
Question 1: What tidal volume is recommended for lung-protective ventilation in ARDS per the ARDSNet protocol?
- 4–6 mL/kg predicted body weight
- 6–8 mL/kg predicted body weight (Correct answer)
- 10–12 mL/kg predicted body weight
- 12–15 mL/kg predicted body weight
Correct answer: 6–8 mL/kg predicted body weight
ARDSNet recommends tidal volumes of 6 mL/kg predicted body weight (PBW) to prevent ventilator-induced lung injury.
Question 2: A patient on mechanical ventilation has a plateau pressure of 34 cmH₂O. What is the MOST appropriate intervention?
- Increase PEEP
- Decrease tidal volume (Correct answer)
- Increase respiratory rate
- Add pressure support
Correct answer: Decrease tidal volume
Plateau pressure >30 cmH₂O indicates alveolar overdistension; reducing tidal volume is the primary intervention to protect the lungs.
Question 3: Which PEEP strategy is recommended for patients with moderate-to-severe ARDS (PaO₂/FiO₂ <150)?
- Low PEEP (5 cmH₂O)
- PEEP guided by esophageal pressure
- Higher PEEP per ARDS table or titration (Correct answer)
- No PEEP to avoid barotrauma
Correct answer: Higher PEEP per ARDS table or titration
Patients with moderate-severe ARDS benefit from higher PEEP (typically ≥12–14 cmH₂O) to recruit alveoli and improve oxygenation.
Question 4: An ACNP notes increasing peak airway pressures with unchanged plateau pressures in a ventilated patient. What does this indicate?
- Worsening lung compliance
- Increased airway resistance (Correct answer)
- Tension pneumothorax
- Ventilator malfunction
Correct answer: Increased airway resistance
Increased peak pressures with stable plateau pressures indicate elevated airway resistance, suggesting bronchospasm or secretion buildup.
Question 5: Which ventilator mode delivers a set tidal volume regardless of patient effort or airway resistance?
- Pressure support ventilation (PSV)
- Pressure control ventilation (PCV)
- Volume control ventilation (VCV) (Correct answer)
- CPAP
Correct answer: Volume control ventilation (VCV)
VCV delivers a fixed tidal volume with each breath, with pressure varying based on compliance and resistance.
Question 6: What is the most common cause of sudden respiratory deterioration (desaturation) in a mechanically ventilated ICU patient?
- Ventilator circuit disconnection
- Tension pneumothorax
- ETT displacement or obstruction (Correct answer)
- Flash pulmonary edema
Correct answer: ETT displacement or obstruction
ETT displacement (dislodgement, migration, or obstruction) is the most common cause of sudden deterioration and must be ruled out first with the DOPE mnemonic.
Acute Care Nurse Practitioner Mechanical Ventilation and Respiratory Support 1
What tidal volume is recommended for lung-protective ventilation in ARDS per the ARDSNet protocol?