In considering a patient for endotracheal tube extubation, which of the following procedures would you recommend to determine the risk of postextubation upper airway obstruction?
a. Methylene blue test
b. Pre- and postbronchodilator
c. Cuff leak test
d. Forced vital capacity
Q. 2 Which of the following is false about artificial tracheal airways and weaning?
a. There are decreases in tube inner diameter (ID) and increases in VE increase the work of breathing.
b. The added work due to artificial airways can increase ventilator dependence.
c. Artificial airways can increase the work of breathing nearly three-fold.
d. Tracheostomy tubes increase the work of breathing more than can endotracheal tubes.
Q. 3 What is the best way to decrease the work of breathing imposed by an artificial airway on a pa-tient receiving ventilatory support?
a. Provide pressure support.
b. Decrease inspiratory flow.
c. Lower the minute ventilation.
d. Use low rates of breathing.
Q. 4 What are some factors that indicate a patient's readiness for extubation?
1. Adequate oxygenation or ventilation with spontaneous breathing
2. Minimal risk for upper airway obstruction
3. Adequate airway protection or minimal aspiration risk
4. Adequate clearance of pulmonary secretions
a. 2 and 4 only
b. 1, 2, and 3 only
c. 3 and 4 only
d. 1, 2, 3, and 4
Q. 5 While monitoring a patient during a T tube weaning trial, you notice the following: increased pa-tient agitation; increased heart rate (from 90 to 118/min);
increased respiratory rate (from 17 to 33/min with some paradoxical motion); and premature ven-tricular contractions (PVCs) increasing to an average of 5/min. Which of the following actions would be appropriate at this time?
a. Reconnect the patient to the ventilator with prior settings.
b. Encourage the patient to relax, and con-tinue careful monitoring.
c. Request that the patient be given a stat (immediate) bolus of lidocaine.
d. Request that the patient be given a strong sedative or hypnotic.
Q. 6 While monitoring a patient during a T tube weaning trial, you notice the following: an increase in heart rate from 86 to 100/min; an increase in respiratory rate from 12 to 23/min;
an increase in PaCO2 from 39 to 45 mm Hg; and a decrease in PaO2 from 82 to 73 mm Hg. Which of the following actions would be appropriate at this time?
a. Reconnect the patient to the ventilator with prior settings.
b. Request that the patient be administered a mild sedative.
c. Suction the patient after manual hyperin-flation or oxygenation.
d. Encourage the patient to relax, and con-tinue careful monitoring.
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