Acute Care Medicine Exam Practice Tests - 684 Verified Questions

Acute Care Medicine Exam Practice Tests

Course Introduction

Acute Care Medicine is a dynamic field focused on the timely recognition, evaluation, and management of patients with urgent or life-threatening medical conditions. This course equips students with in-depth knowledge of pathophysiology, diagnosis, and evidence-based interventions for acute illnesses and injuries commonly encountered in emergency departments, intensive care units, and other critical care settings. Emphasis is placed on rapid clinical assessment, prioritization of care, interdisciplinary teamwork, advanced resuscitation skills, and ethical considerations in acute medical situations, preparing learners to deliver effective, compassionate care in high-pressure environments.

Recommended Textbook

Pilbeams Mechanical Ventilation Physiological and Clinical Applications 5th Edition by J M Cairo

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23 Chapters

684 Verified Questions

684 Flashcards

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Chapter 1: Basic Terms and Concepts of Mechanical

Ventilation

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Sample Questions

Q1) The respiratory therapist should expect which of the following findings while ventilating a patient with acute respiratory distress syndrome (ARDS)?

A) An elevated plateau pressure (P_plateau)

B) A decreased elastic resistance

C) A low peak inspiratory pressure (PIP)

D) A large transairway pressure (P_TA)gradient

Answer: A

Q2) Based upon the following patient information calculate the patient's static lung compliance: exhaled tidal volume (V_T)is 675 mL,peak inspiratory pressure (PIP)is 28 cm H₂O,plateau pressure (P_plateau)is 8 cm H₂O,and PEEP is set at 5 cm H₂O.

A) 0.02 L/cm H₂O

B) 0.03 L/cm H₂O

C) 0.22 L/cm H₂O

D) 0.34 L/cm H₂O

Answer: C

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Chapter 2: How Ventilators Work

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Sample Questions

Q1) Modern intensive care units' (ICU)ventilators regulate gas flow to the patient by using which of the following?

A) Rotary drive pistons

B) Linear drive pistons

C) Proportional solenoids

D) Spring-loaded bellows

Answer: C

Q2) The power transmission and conversion system of a ventilator is defined as which of the following?

A) A mechanical device that produces gas flow to the patient

B) An electrical motor that is connected by a special gearing mechanism

C) The system that interprets the settings and produces or regulates the desired output

D) Internal hardware that changes electrical or pneumatic energy into mechanical energy

Answer: D

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4

Chapter 3: How a Breath Is Delivered

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Sample Questions

Q1) Calculate the transrespiratory pressure given the following information: volume 0.6 L;compliance 1 L/cm H₂O;airway resistance 3 cm H₂O/L/sec;flow 1 L/sec.

A) 0.9 cm H₂O

B) 1.8 cm H₂O

C) 3.6 cm H₂O

D) 4.6 cm H₂O

Answer: C

Q2) The trigger variable in the controlled mode is which of the following?

A) Flow

B) Time

C) Pressure

D) Volume Answer: B

Q3) How many variables can a ventilator control at one time?

A) One

B) Two

C) Three

D) Four

Answer: A

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Chapter 4: Establishing the Need for Mechanical Ventilation

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Sample Questions

Q1) A patient seen in the emergency department exhibits paralysis of the lower extremities that is getting progressively worse.Vital capacity is 6 mL/kg,maximum inspiratory pressure (MIP)is -17 cm H₂O,and oxygen saturation measured by pulse oximeter (SpO₂)is 89%.Arterial blood gases (ABGs)are pending.The physician suspects Guillain-Barré syndrome.The most appropriate action at this time is which of the following?

A) Intubate and mechanically ventilate.

B) Place patient on a nonrebreather mask.

C) Initiate continuous positive airway pressure.

D) Initiate noninvasive positive pressure ventilation.

Q2) Hypercapnic respiratory failure due to increased work of breathing will be caused by which of the following?

A) Drug overdose

B) Myasthenia gravis

C) Asthma exacerbation

D) Pulmonary embolism

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Chapter 5: Selecting the Ventilator and the Mode

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Sample Questions

Q1) Full ventilatory support is provided by which of the following modes?

A) Pressure Support Ventilation (PSV)with Continuous Positive Airway Pressure (CPAP)

B) Volume Support Ventilation (VSV)with Continuous Positive Airway Pressure (CPAP)

C) Volume-Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV)rate 6 with pressure support (PS)

D) Pressure-Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV)rate 12 with pressure support (PS)

Q2) Every breath from the ventilator is time or patient triggered,pressure limited,and time cycled.This describes which of the following ventilator modes?

A) Pressure Support Ventilation (PSV)

B) Continuous Positive Airway Pressure (CPAP)

C) Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV)

D) Volume-Controlled Synchronized Mandatory Ventilation (VC-SIMV)

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Chapter 6: Initial Ventilator Settings

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Sample Questions

Q1) Calculate the inspiratory time (T_I)when a ventilator is set at a tidal volume (V_T)of 800 mL and a constant flow rate of 40 L/min.

A) 0.02 second

B) 0.5 second

C) 1.2 seconds

D) 3.2 seconds

Q2) Calculate the inspiratory to expiratory (I:E)ratio for a ventilator that is set to deliver 850 mL at a frequency of 15 bpm with a flow rate of 45 L/min.

A) 1:1.1

B) 1:2.5

C) 1:3.5

D) 1:4

Q3) A patient has a body temperature of 40° C.How should the initial minute ventilation setting be adjusted?

A) Increase it by 15%

B) Decrease it by 18%

C) Decrease it by 25%

D) Increase it by 30%

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8

Chapter 7: Final Considerations in Ventilator Setup

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Sample Questions

Q1) A patient set up on pressure support ventilation (PSV)has an average minute volume of 5.8 L.What should the low exhaled minute volume alarm be set at?

A) 5 L

B) 4 L

C) 3 L

D) 2 L

Q2) The application of positive pressure for patients with left ventricular failure is beneficial because of which of the following?

A) Increases venous return

B) Decreases preload to the heart

C) Increases afterload to the heart

D) Improves perfusion to the myocardium

Q3) The ventilator volume is set at 575 mL.The low exhaled tidal volume (V_T)alarm should be set at which of the following?

A) 150 mL

B) 350 mL

C) 400 mL

D) 500 mL

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Chapter 8: Initial Patient Assessment

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Sample Questions

Q1) A pathophysiologic condition that causes an increase in peal inspiratory pressure (PIP)while transairway pressure (P_TA)remains the same is which of the following?

A) Acute respiratory distress syndrome (ARDS)

B) Asthma

C) Emphysema

D) Chronic Bronchitis

Q2) The respiratory therapist is monitoring the cuff pressure of a tracheostomy tube inserted in a patient who is receiving mechanical ventilation.The cuff pressure is measured at 41 cm H₂O.The respiratory therapist should immediately do which of the following?

A) Inject more air through the pilot balloon.

B) Release some of the air from the cuff.

C) Insert a new tracheostomy tube.

D) Do nothing;everything is acceptable.

Q3) The normal airway resistance range is which of the following?

A) 0.6 to 2.4 cm H₂O/L/sec

B) 16 to 24 cm H₂O/L/sec

C) 26 to 34 cm H₂O/L/sec

D) 70 to 100 cm H₂O/L/sec

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Chapter 9: Ventilator Graphics

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Sample Questions

Q1) During a patient-ventilator system check the respiratory therapist notices that the pressure-volume loop begins at zero on the x-axis but does not return to zero during expiration.The cause of this is which of the following?

A) Active exhalation

B) Inadequate sensitivity

C) Ventilator circuit leak

D) Decreased compliance

Q2) The type of flow curve produced by volume ventilation with constant flow is which of the following?

A) Sinusoidal

B) Rectangular

C) Descending ramp

D) Exponential decay

Q3) The most important factor to affect the degree of resistance in the airways is which of the following?

A) Flow rate of the gas

B) Viscosity of the gas

C) Length of the airways

D) Diameter of the airways

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Chapter 10: Assessment of Respiratory Function

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Sample Questions

Q1) The best assessment of the function of the diaphragm during inspiration is obtained by measuring which of the following?

A) Airway resistance

B) Pressure-time product

C) Pressure-volume curve

D) Maximum inspiratory pressure

Q2) Calculate the airway resistance given the following clinical data: flow rate 60 L/min,peak inspiratory pressure (PIP)42 cm H₂O,plateau pressure (P_plateau)15 cm H₂O,positive-end-expiratory pressure (PEEP)5

cm H₂O.

A) 10 cm H₂O/L/sec

B) 30 cm H₂O/L/sec

C) 37 cm H₂O/L/sec

D) 42 cm H₂O/L/sec

Q3) What type of electrode is used by a transcutaneous partial pressure of oxygen (PtcO₂)device?

A) Galvanic

B) Polarographic

C) Paramagnetic

D) Stow-Severinghaus

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Chapter 11: Hemodynamic Monitoring

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Sample Questions

Q1) The hemodynamic values for a patient in the cardiovascular care unit are: blood pressure (BP)96/60 mm Hg,pulmonary artery pressure (PAP)29 mm Hg,pulmonary capillary wedge pressure (PCWP)14 mm Hg,stroke volume (SV)50 mL.The patient has a body surface area of 1.6 m².Calculate the patient's left ventricular stroke work (LVSW).

A) 12.3 g-m/m²

B) 30.6 g-m/m²

C) 33.2 g-m/m²

D) 49 g-m/m²

Q2) Calculate the cardiac index using the following data: Cardiac output = 4.6 L/min

Body surface area = 1.2 m²

A) 0.26 m^2/L/min

B) 3.8 L/min/m²

C) 5.5 L/min-m²

D) 5.8 m²/L/min

Q3) A pulmonary artery catheter must be wedged in which of the following locations?

A) Zone 1

B) Zone 2

C) Zone 3

D) Doesn't matter

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Chapter 12: Methods to Improve Ventilation in Patient-Ventilator Management

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Sample Questions

Q1) A 45-year-old female (58-kg IBW)with a past medical history of asthma arrives at the emergency department short of breath,anxious,diaphoretic,and unable to perform a peak expiratory flow measurement.She also has a combined acidosis.Breath sounds reveal the patient is not moving much air.The patient is intubated,stabilized,and transported to the ICU.The ventilator settings are: PC-CMV,f = 12/min,PIP = 30 cm H₂O,F_IO₂ = 0.6,and PEEP = 3 cm H₂O.The patient is sedated and paralyzed;the resulting ABGs are: pH 7.17,PaCO₂69.3 mm Hg,PaO₂ 90 mm Hg,and HCO₃^-21 mEq/L after continuous bronchodilator therapy.The respiratory rate is increased to 20/min,and the next ABG results are: pH 7.26,PaCO₂ 58 mm Hg,PaO₂ 96 mm Hg,and HCO₃^- 22 mEq/L.The respiratory therapist should suggest which of the following at this time?

A) Increase PIP to 38 cm H₂O

B) Decrease PIP to 25 cm H₂O

C) Continue with current therapy

D) Change to VC-CMV,f = 12/ min,V_T = 700 mL

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14

Chapter 13: Improving Oxygenation and Management of Ards

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Sample Questions

Q1) Patients with which of the following clinical disorders may benefit from PEEP?

A) COPD

B) Asthma

C) ARDS

D) Cystic fibrosis

Q2) Assessing the outcome of PEEP at levels set above 15 to 20 cm H₂O is best done using which of the following?

A) Static compliance measurements

B) Pressure-volume loop graphics

C) Pulmonary artery occlusion pressure

D) Central venous pressure measurements

Q3) PEEP therapy is indicated for patients with which of the following?

A) PaO₂of 95 mm Hg while receiving an F_IO₂ of 0.3

B) PaO₂of 100 mm Hg while receiving an F_IO₂ of 0.8

C) Returned V_T of 600 mL with a P_plateau of 12 cm H₂O

D) Returned V_T of 800 mL with a P_plateau of 15 cm H₂O

Page 15

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Chapter 14: Ventilator-Associated Pneumonia

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Sample Questions

Q1) 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

Q2) To avoid ventilator-associated pneumonia,how often should ventilator circuits be changed?

A) Every 24 hours

B) Every 48 hours

C) Once weekly

D) Not unless visibly dirty

Q3) The initial empiric antibiotic used to treat suspected methicillin-resistant Staphylococcus aureus in a patient with early-onset VAP is which of the following?

A) Linezolid

B) Vancomycin

C) Gentamicin

D) Levofloxacin

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Chapter 15: Sedatives,Analgesics,and Paralytics

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Sample Questions

Q1) Neuromuscular blocking agents are commonly used in mechanically ventilated patients when which of the following occurs?

A) The patient is in severe pain.

B) Cardiac arrhythmias are present.

C) The patient develops anxiety as a result of ICU psychosis.

D) Patient-ventilator dyssynchrony cannot be corrected.

Q2) The neuromuscular blocking agent that resembles acetylcholine in chemical structure is which of the following?

A) Succinylcholine

B) Pancuronium

C) Vecuronium

D) Cisatracurium

Q3) A patient with head trauma and an elevated ICP is being ventilated postoperatively and shows signs of asynchrony with the mechanical ventilator.The most appropriate medication to sedate this patient is which of the following?

A) Morphine

B) Propofol

C) Propofol and morphine

D) Fentanyl

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Chapter 16: Extrapulmonary Effects of Mechanical

Ventilation

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Sample Questions

Q1) The conditions that must exist to cause the interventricular septum to move to the left during positive pressure ventilation include which of the following?

A) Volume overload

B) Cardiac tamponade

C) Mean airway pressure >15 cm H₂O

D) Decreased coronary artery perfusion

Q2) The most likely cause of uneven ventilation includes which of the following?

A) Low set tidal volumes

B) High inspiratory flow rates

C) High mean airway pressures

D) Elevated peak inspiratory pressures

Q3) Mechanical ventilation has an effect on the hormone _____________,which causes a decrease in urinary output.

A) cortisol

B) arginine vasopressin

C) parathyroid hormone

D) thyroid-stimulating hormone

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Page 18

Chapter 17: Effects of Positive Pressure Ventilation on the Pulmonary

System

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Sample Questions

Q1) Which of the following mechanically ventilated patients shows clinical signs of hypoventilation?

A) A patient who is cool to the touch and has negative T waves on the ECG.

B) A patient who has twitchy extremities and also atrial flutter on the ECG.

C) A patient who is anxious and hypertensive and has elevated T waves on the ECG.

D) A patient who has cool,twitchy extremities and also low,rounded T waves on the ECG.

Q2) Shear stress is most likely to affect a patient with which of the following?

A) P_A = 35 cm H₂O;P_pl = 21 cm H₂O

B) P_A = 35 cm H₂O;P_pl = 12 cm H₂O

C) P_A = 45 cm H₂O;P_pl = 33 cm H₂O

D) P_A = 50 cm H₂O;P_pl = 38 cm H₂O

Q3) Prolonged ventilator-induced hyperventilation can lead to which of the following?

A) Hypokalemia

B) Hyperkalemia

C) Increased ICP

D) Headaches

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Page 19

Chapter 18: Troubleshooting and Problem Solving

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Sample Questions

Q1) Reduction of preload and afterload is important in the management of which of the following?

A) Pulmonary embolism

B) Dynamic hyperinflation

C) Cardiogenic pulmonary edema

D) Noncardiogenic pulmonary edema

Q2) The respiratory therapist enters the room of an intubated and mechanically ventilated patient to find the low pressure,low exhaled volume,and low V_E alarms active.The ventilator circuit is connected to the patient's endotracheal tube.This situation could be caused by which of the following?

A) Improper flow rate and flow pattern.

B) Poorly responsive internal demand valve.

C) Migration of the ET tube into the upper airway.

D) The patient is continuing to actively inhale.

Q3) An apnea alarm may be activated by which of the following?

A) Secretions

B) Auto PEEP

C) Loss of PEEP

D) Active inhalation

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Page 20

Chapter 19: Basic Concepts of Noninvasive Positive

Pressure Ventilation

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Sample Questions

Q1) A 61-year-old female was admitted last night with shortness of breath.She currently is alert and oriented,but very anxious.Her latest arterial blood gas values,on a nasal cannula at 3L/min,show: pH = 7.39;PaCO₂= 41 mm Hg;PaO₂ = 40 mm Hg;SaO₂ = 74%;HCO₃^- = 24 mEq/L.Breath sounds are decreased throughout with fine late crackles on inspiration.The current chest x-ray shows an enlarged heart with bilateral vascular congestion.The most appropriate therapy for this patient is _________.

A) NIPPV

B) mask CPAP

C) invasive ventilation

D) nonrebreather mask

Q2) A patient with acute respiratory failure requires NPPV.The patient is very dyspneic.Which of the following patient interfaces is most appropriate?

A) Nasal mask

B) Mini mask

C) Nasal pillows

D) Oronasal mask

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Chapter 20: Discontinuation and Weaning From Mechanical

Ventilation

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Sample Questions

Q1) An SBT should not continue for longer than _____ minutes.

A) 30

B) 60

C) 120

D) 180

Q2) A postoperative patient,still under anesthesia,is being ventilated with VC-CMV with Automode.After 2 hours the patient is waking up and beginning to breathe spontaneously.The ventilator will respond by _____________________.

A) switching to the pressure support mode.

B) switching to the volume support mode.

C) delivering time-triggered,pressure-limited breaths.

D) ensuring minimum mandatory minute ventilation.

Q3) A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until ________ month(s)has/have passed and all weaning attempts during that time have failed.

A) 1

B) 3

C) 6

D) 9

22

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Chapter 21: Long Term Ventilation

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Sample Questions

Q1) Which site for mechanical ventilation of patients provides the least patient independence and quality of life?

A) Intensive care unit

B) Skilled nursing facility

C) Long-term care hospital

D) Chronic assisted ventilator unit

Q2) The most important factors to consider when choosing a ventilator for home use include which of the following?

1)Sophistication

2)Reliability

3)Versatility

4)Cost

A) 1,2,and 4

B) 2,3,and 4

C) 1,2,and 3

D) 1 and 2

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Chapter 22: Neonatal and Pediatric Ventilation

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Sample Questions

Q1) Calculate the percent leak when the V_Tinsp is 45 mL and the V_Texp is 37 mL.

A) 0.8%

B) 1.2%

C) 17.8%

D) 21.6%

Q2) Newer ventilators allow neonates to use what type of trigger for better synchronization with the ventilator?

A) Time

B) Flow

C) Pressure

D) Volume

Q3) A neonate is being ventilated with PRVC.The respiratory therapist responds to a low volume alarm.After checking the patient and the ventilator,the respiratory therapist finds no disconnects.The most appropriate action is which of the following?

A) Draw a sample for arterial blood gas evaluation.

B) Increase the target volume.

C) Put the patient in the PC-CMV mode.

D) Recommend surfactant replacement therapy.

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Page 24

Chapter 23: Special Techniques in Ventilatory Support

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Sample Questions

Q1) An adult patient with ARDS is being ventilated with VC-CMV.The settings are: f = 14 breaths/min;V_T = 375 mL;PEEP = 16 cm H₂O;and F_IO₂ = 0.8.The patient's ABG values are: pH = 7.40;PaCO₂ = 56 mm Hg;PaO₂ = 48 mm Hg;and SaO₂ = 83%;the mean airway pressure is 18 cm H₂O.The patient's physician decides on a trial of HFOV.What initial ventilator settings should be used?

A) Bias flow = 30 L/min;mP_aw= 23 cm H₂O;set power to obtain

\(\Delta\)P = 76 cm H₂O;f = 6 Hz;T_I = 33%;F_IO₂ = 1.0

B) Bias flow = 35 L/min;mP_aw = 76 cm H₂O;set power to obtain

\(\Delta\)P = 33 cm H₂O;f = 10 Hz;T_I = 50%;F_IO₂ = 1.0

C) Bias flow = 20 L/min;mP_aw= 18 cm H₂O;set power to obtain \(\Delta\)P = 76 cm H₂O;f = 8 Hz;T_I = 33%;F_IO₂ = 1.0

D) Bias flow = 30 L/min;mP_aw = 30 cm H₂O;set power to obtain

\(\Delta\)P = 56 cm H₂O;f = 6 Hz;T_I = 50%;F_IO₂ = 1.0

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Page 25