CCRN Mechanical Ventilation Management 2 — Questions and Answers
Question 1: A patient on volume-control ventilation suddenly shows a rising peak inspiratory pressure with an unchanged plateau pressure. What does this indicate?
- An airway resistance problem such as secretions or bronchospasm (Correct answer)
- Decreased lung compliance
- Pneumothorax
- Auto-PEEP
Correct answer: An airway resistance problem such as secretions or bronchospasm
A rise in peak pressure with a stable plateau pressure reflects increased airway resistance, not a compliance change.
Question 2: Which finding best confirms correct endotracheal tube placement after intubation?
- Sustained waveform capnography (ETCO2) (Correct answer)
- Equal chest rise
- Auscultation of breath sounds
- Improving SpO2
Correct answer: Sustained waveform capnography (ETCO2)
Sustained ETCO2 on waveform capnography is the most reliable confirmation of tracheal placement.
Question 3: A patient develops auto-PEEP (intrinsic PEEP). Which ventilator change most directly addresses it?
- Decrease respiratory rate to lengthen expiratory time (Correct answer)
- Increase tidal volume
- Increase set PEEP above auto-PEEP only
- Increase inspiratory flow to extremes
Correct answer: Decrease respiratory rate to lengthen expiratory time
Lowering the rate (and thus extending expiratory time) allows fuller exhalation, reducing air trapping.
Question 4: In ARDS, lung-protective ventilation targets which tidal volume?
- 6 mL/kg of predicted body weight (Correct answer)
- 10 mL/kg of actual body weight
- 12 mL/kg of predicted body weight
- 4 mL/kg of actual body weight
Correct answer: 6 mL/kg of predicted body weight
ARDSNet protocol uses 6 mL/kg of predicted body weight to limit volutrauma.
Question 5: Plateau pressure should be maintained below which value to limit ventilator-induced lung injury?
- 30 cm H2O (Correct answer)
- 40 cm H2O
- 50 cm H2O
- 20 cm H2O
Correct answer: 30 cm H2O
Keeping plateau pressure under 30 cm H2O reduces alveolar overdistension and barotrauma.
Question 6: A ventilated patient becomes acutely hypotensive with distended neck veins, absent breath sounds on one side, and tracheal deviation. What is the priority intervention?
- Immediate needle decompression for tension pneumothorax (Correct answer)
- Increase PEEP
- Administer a fluid bolus and reassess
- Obtain a chest x-ray before acting
Correct answer: Immediate needle decompression for tension pneumothorax
These signs indicate tension pneumothorax, a life threat requiring immediate decompression, not imaging delay.
Question 7: Which intervention is a core component of the ventilator-associated pneumonia (VAP) prevention bundle?
- Elevate the head of bed 30–45 degrees (Correct answer)
- Keep the patient supine and flat
- Routine daily prophylactic antibiotics
- Change the ventilator circuit every 24 hours
Correct answer: Elevate the head of bed 30–45 degrees
Semi-recumbent positioning reduces aspiration risk and is a key VAP bundle element.
CCRN Mechanical Ventilation Management 2
A patient on volume-control ventilation suddenly shows a rising peak inspiratory pressure with an unchanged plateau pressure.
What does this indicate?