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When the maximum pressure limit is reached during volume ventilation, which of the following occurs?
  1. Inspiratory time is decreased.
  2. Volume delivered is decreased.
  3. Inspiration continues until volume is delivered.
  4. Pressure is held and the breath is volume cycled.
  a. 3 only
  b. 4 only
  c. 1 and 2 only
  d. 2 and 4 only

Q. 2  The variable that a ventilator uses to end inspiration is known as which of the following?
  a. Cycle
  b. Limit
  c. Trigger
  d. Baseline

Q. 3  The control variables most often used to ventilate infants are which of the following?
  a. Volume limited, time cycled ventilation
  b. Pressure limited, time cycled ventilation
  c. Pressure limited, pressure cycled ventila-tion
  d. Volume limited, volume cycled ventilation

Q. 4  The respiratory therapist enters the room of a patient being mechanically ventilated with volume ventilation. The high pressure alarm is sounding and the measured exhaled tidal volume is signif-icantly lower than what is set.
  The variable that is ending inspiration is which of the following?
  a. Time
  b. Flow
  c. Pressure
  d. Volume

Q. 5  A patient is receiving volume-controlled ventilation. The respiratory therapist notes the pres-sure-time scalar on the ventilator screen, shown in the figure. The most appropriate action to take includes which of the following?
  a. Increase the rate setting.
  b. Increase the baseline setting.
  c. Decrease the volume setting.
  d. Increase the sensitivity setting.

Q. 6  The inspiratory and expiratory flow sensors are reading a base flow of 5 L/min. The flow trigger is set to 2 L/min. The expiratory flow sensor must read what flow to trigger inspiration?
  a. 1 L/min
  b. 2 L/min
  c. 3 L/min
  d. 4 L/min
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(Answer to Q. 1)  ANS: C
The maximum pressure limit is a safety mechanism used during volume ventilation to avoid ex-cessive pressure in the lungs. When the pressure measured by the ventilator reaches the maximum pressure limit inspiration ends. This means that the inspiratory time will be decreased and the volume delivered will be less than the set volume. Therefore, reaching maximum pressure limit causes the delivered breath to be pressure cycled.

(Answer to Q. 2)  ANS: B
Cycle is the term used to call the variable that is used to end inspiration. Limit is the maximum setting for a variable. Trigger is the term used to call the variable that is used to begin inspiration. Baseline is the pressure at the end of inspiration.

(Answer to Q. 3)  ANS: B
Infant ventilators most often limit the pressure delivered and end inspiration using inspiratory time. Volume limited, volume cycled ventilation is volume-controlled ventilation. Pressure lim-ited, pressure cycled ventilation is the type of breath used during intermittent positive pressure breathing (IPPB).

(Answer to Q. 4)  ANS: C
Volume ventilation is cycled by volume. However, to protect the patient's lungs from high pres-sures a maximum high pressure limit is set (usually 10 cm H2O above the average peak inspiratory pressure). Inspiration ends prematurely when the high pressure limit is reached, independent of the set volume. This is the reason why the exhaled tidal volume reading is significantly lower than the set volume. Therefore, the variable ending inspiration in this instance is pressure.

(Answer to Q. 5)  ANS: D
What is being shown in the figure is a trigger pressure of 5 cm H2O below the baseline setting of 5 cm H2O. This is seen during the pressure trigger dropping down to 0 cm H2O during the trig-ger. In this situation the machine is not sensitive enough to the patient's effort. The patient is working too hard to trigger the ventilator breath. The respiratory therapist needs to increase the ventilator sensitivity control. Changing any of the other parameters will not decrease the work that the patient is doing to trigger inspiration.

(Answer to Q. 6)  ANS: C
Base flow minus flow trigger setting is equal to the flow needed to be sensed at the expiratory flow sensor to trigger inspiration.
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