RRT RRT Ultimate 2 — Questions and Answers
Question 1: A patient on volume-controlled ventilation has a sudden rise in peak airway pressure with no change in plateau pressure. What is the most likely cause?
- Pneumothorax
- Increased secretions in the airway (Correct answer)
- Decreased lung compliance
- Auto-PEEP
Correct answer: Increased secretions in the airway
A rise in peak pressure with an unchanged plateau pressure indicates increased airway resistance, most commonly from secretions.
Question 2: Which arterial blood gas pattern is consistent with acute respiratory acidosis?
- pH 7.48, PaCO2 30, HCO3 22
- pH 7.30, PaCO2 58, HCO3 27 (Correct answer)
- pH 7.35, PaCO2 48, HCO3 28
- pH 7.52, PaCO2 28, HCO3 22
Correct answer: pH 7.30, PaCO2 58, HCO3 27
Acute respiratory acidosis shows low pH and elevated PaCO2 with near-normal bicarbonate (little renal compensation yet).
Question 3: A patient is receiving 60% FiO2 via mechanical ventilator. ABG shows PaO2 of 65 mmHg. What is the calculated P/F ratio?
- 65
- 108 (Correct answer)
- 390
- 650
Correct answer: 108
P/F ratio = PaO2 / FiO2 = 65 / 0.60 = 108, indicating severe hypoxemia consistent with ARDS.
Question 4: Which of the following is the MOST appropriate initial ventilator setting for a 70 kg IBW patient with ARDS?
- Tidal volume 700 mL, RR 12
- Tidal volume 420 mL, RR 18 (Correct answer)
- Tidal volume 560 mL, RR 14
- Tidal volume 840 mL, RR 10
Correct answer: Tidal volume 420 mL, RR 18
ARDSnet protocol recommends 6 mL/kg IBW, so 70 kg × 6 = 420 mL with a higher RR to maintain adequate ventilation.
Question 5: A patient's spontaneous breathing trial (SBT) is terminated after 15 minutes due to RR of 36 and SpO2 of 88%. What is the BEST next step?
- Extubate immediately
- Resume full ventilatory support and reassess in 24 hours (Correct answer)
- Increase sedation and retry in 1 hour
- Perform a tracheotomy
Correct answer: Resume full ventilatory support and reassess in 24 hours
A failed SBT warrants returning to full support; 24 hours of recovery is recommended before the next attempt.
Question 6: Which drug is used to reverse neuromuscular blockade caused by vecuronium?
- Flumazenil
- Naloxone
- Neostigmine (Correct answer)
- Protamine
Correct answer: Neostigmine
Neostigmine (an anticholinesterase) reverses non-depolarizing neuromuscular blockers like vecuronium.
Question 7: What is the primary indication for prone positioning in a mechanically ventilated patient?
- Cardiogenic pulmonary edema
- Moderate-to-severe ARDS with P/F ratio < 150 (Correct answer)
- Acute exacerbation of COPD
- Pulmonary embolism
Correct answer: Moderate-to-severe ARDS with P/F ratio < 150
Prone positioning improves V/Q matching and oxygenation in moderate-to-severe ARDS (P/F < 150 on adequate PEEP).
RRT RRT Ultimate 2
A patient on volume-controlled ventilation has a sudden rise in peak airway pressure with no change in plateau pressure.
What is the most likely cause?