A 62-year-old male patient with COPD is being seen in the pulmonary clinic for dyspnea at rest and daytime hypersomnolence.
The patient has been hospitalized three times in the past year for COPD exacerbations and once for pneumonia. He currently uses 2 L/min oxygen from a concentrator all the time. The patient reports that he is able to sleep only about 2 hours each night and that he has a headache every morning. Which of the following should be recommended to the physician?
a. Chest cuirass
b. Nocturnal NIV
c. Nocturnal CPAP
d. Tracheostomy and ventilation
Q. 2 A patient who was diagnosed 1 year ago with amyotrophic lateral sclerosis is being seen in his primary care physician's office. The patient is complaining of fatigue and inability to concentrate at work.
The patient's FVC is 45 of predicted, the PaCO2 is 47 mm Hg, and the MIP is 54 cm H2O. Which of the following should be considered for this patient?
a. Continuation of current therapy
b. Supplemental home oxygen
c. Nocturnal CPAP
d. Nocturnal NIV
Q. 3 A patient with acute cardiogenic pulmonary edema is to be placed on CPAP. What should the initial setting be?
a. 3-5 cm H2O
b. 5-7 cm H2O
c. 10-12 cm H2O
d. 15-20 cm H2O
Q. 4 One of the physiological goals of NIV in acute respiratory failure is to improve gas exchange by ______________.
a. resting the respiratory muscles
b. decreasing the effect of secretions
c. increasing right ventricular preload
d. decreasing the functional residual capacity
Q. 5 The primary goal of NIV in the acute care setting is to do which of the following?
a. Improve sleep quality.
b. Decrease muscle fatigue.
c. Avoid invasive ventilation.
d. Eliminate nocturnal hypopnea.
Q. 6 Patients with chronic hypoventilation disorders typically need a minimum of _________ hours of NIV to experience improved quality of life.
a. 2-4
b. 4-6
c. 6-8
d. 8-10
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