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A year ago
How does the success of long-term weaning in acute care hospitals compare with that in long-term acute care (LTAC) hospitals?
 
  A. acute care hospitals: 25 to 39; LTAC hospitals: 42 to 53
  B. acute care hospitals: 41 to 55; LTAC hospitals: 55 to 68
  C. acute care hospitals: 57 to 80; LTAC hospitals: 70 to 90
  D. acute care hospitals: 80 to 90; LTAC hospitals: >90



Q. 2  Which of the following advantages are associated with tracheostomy versus endotracheal intubation for patients who are expected to require long-term ventilatory support? I. Less patient sedation is required. II. Less endotracheal suctioning is needed. III. The patient's work of breathing is decreased. IV. Communication is facilitated.
 
  A. I, II only
  B. II, III only
  C. I, III, IV only
  D. I, II, III, IV



Q. 3  For which of the following types of patients is a conventional surgical tracheostomy better suited than a percutaneous dilatational tracheostomy? I. patients with high Vd/Vt ratios II. COPD III. obesity IV patients with deviant anatomy
 
  A. III, IV only
  B. I, II, III only
  C. I, II, IV only
  D. II, III, IV only



Q. 4  How can the therapist help reduce the risk for developing PMV among patients in an ICU?
 
  A. Progressively increase respiratory muscle loading.
  B. Work to prevent ventilator-associated pneumonia.
  C. Use APRV at the earliest opportunity.
  D. Recommend early intervention with systemic corticosteroids.
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A year ago
(Answer to Q. 1)  ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The success of long-term weaning in acute care hospitals ranges from 57 to 80 of hospital survivors, depending on access to weaning facilities. Weaning success in LTAC hospitals ranges from 70 to 90 of survivors, and time to weaning averages 40 days in most series.
D. Incorrect response: See explanation C

(Answer to Q. 2)  ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: For patients who require, or are expected to require, ventilatory support for longer than average, placement of a tracheostomy has the attraction of enabling reduction in sedation, easier patient communication, decreased work of breathing (lower airway resistance), and enhanced airway clearance with suctioning.
D. Incorrect response: See explanation C

(Answer to Q. 3)  ANS: A
A. Correct response: Patients who have deviant anatomy or who are obese are better suited for conventional surgical tracheostomies.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A

(Answer to Q. 4)  ANS: B
A. Incorrect response: See explanation B.
B. Correct response: The prevention of ICU-associated complications is known to decrease the duration of mechanical ventilation, especially prevention of ventilator-associated pneumonia and catheter-associated blood stream infection. Handwashing, barrier protocols and checklists, and sterile maintenance of ventilator components and tubing are simple measures that can have a significant impact on ventilator days in an ICU.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.
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