A ventilator bundle may include which of the following?
1. Keeping the head of the bed at 30 degrees from the horizontal.
2. Changing the ventilator circuits every 48 hours.
3. Using heated humidifiers whenever possible.
4. Using noninvasive positive pressure ventilation (NPPV) whenever possible.
a. 1 and 3 only
b. 1 and 4 only
c. 2 and 3 only
d. 1, 2, and 4 only
Q. 2 Critically ill patients receiving invasive mechanical ventilation have been found to have which of the following microorganisms not typically present in healthy individuals?
a. Anaerobes
b. Haemophilus species
c. Gram-negative bacilli
d. Viridans group of streptococci
Q. 3 A 63-year-old male, post head trauma, is intubated and has been mechanically ventilated for 78 hours.
The respiratory therapist notes the following during ICU rounds: partial pressure of oxygen in the arteries (PaO2) is 82 mm Hg on 60 supplemental oxygen with a positive end-expiratory pressure (PEEP) of 8 cm H2O; static compliance is averaging 38-41 cm H2O/L; breath sounds are dimin-ished bilaterally. Bronchoalveolar lavage (BAL) results are pending, but MRSA is suspected. Chest radiograph shows bilateral, patchy infiltrates. Patient has a temperature of 38.8 C, and the most recent white blood cell (WBC) count is 11,300 L. The most appropriate recommendation for this patient is which of the following?
a. Monotherapy with an antipseudomonal carbepenem
b. Monotherapy with an antipseudomonal fluoroquinolone
c. Combination therapy with two types of antipseudomonal agents and vancomycin
d. Combination therapy with ampicil-lin/sulbactam and linezolid
Q. 4 Reasons for the shift in oropharyngeal flora in patients receiving invasive mechanical ventilation with endotracheal tubes include which of the following?
a. Lowered pH levels
b. Increase in mucus-producing cells
c. Decreased production of proteases
d. Decreased mucosal immunoglobulin A
Q. 5 Relying on clinical findings for the treatment of ventilator-associated pneumonia may do which of the following?
a. Decrease the morbidity of VAP.
b. Decrease the mortality of VAP.
c. Create multidrug-resistant organisms.
d. Reduce the need for invasive microbio-logic procedures.
Q. 6 The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with late-onset VAP is which of the following?
a. Linezolid
b. Gentamicin
c. Tobramycin
d. Ciprofloxacin
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