Ch 4 and 5

A patient with inadequate oxygenation of the brain may display which of the following conditions? 1. Confusion 2. Excitement 3. Somnolence 4. Compliance

1 and 3

A 45-year-old woman arrives in the emergency department after ingesting an unknown quantity of pain medication and alcohol. She was found unconscious in her apartment by her friend. She is currently unresponsive to verbal stimuli. Vital signs reveal: pulse 56/min, respiratory rate 10 and shallow, BP 90/50. Her arterial blood gas on room air reveals: pH 7.21, partial pressure of carbon dioxide (PaCO2) 64 mm Hg, partial pressure of oxygen (PaO2) 52 mm Hg, bicarbonate (HCO3-) 24 mEq/L. The appropriate treatment for this patient includes which of the following?

1 and 4

The disorders that cause respiratory failure due to increased work of breathing include which of the following? 1. Myasthenia gravis 2. Cardiogenic pulmonary edema 3. Interstitial pulmonary fibrosis 4. Amyotrophic lateral sclerosis

2 and 3

Partial ventilatory support can be provided by which of the following ventilator modes? 1. Pressure Controlled Continuous Mandatory Ventilation (PC-CMV) set rate 8 breaths/minute 2. Volume Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV) set rate 4 breaths/minute 3. Pressure Controlled Synchronized Intermittent Mandatory Ventilation (PC-SIMV) set rate 10 breaths/minute 4. VC- MMV set Ve8 L/minute

2 and 4

Which of the following values are indicative of acute respiratory failure and the need for ventilatory support? 1. Maximum inspiratory pressure (MIP) = -38 cm H2O 2. Vital capacity (VC) = 650 mL for a 70 kg male 3. Alveolar-to-arterial partial pressure of oxygen [P(A-a)O2] = 150 on 100% oxygen 4. Maximum expiratory pressure (MEP) = 25 cm H2O

2 and 4

Which of the following values are indicative of acute respiratory failure and the need for ventilatory support? 1. Maximum inspiratory pressure (MIP) = - 25 cm H2O 2. Dead space to tidal volume ration (VD/VT) = 0.4 3. Vital capacity (VC) = 8 mL/kg IBW 4. pH = 7.20

3 and 4

Which of the following is the minimum ventilator rate that is considered full ventilatory support?

8 breaths/minute

A patient with an opiate drug overdose is unconscious and has the following arterial blood gas results on room air: pH 7.20; partial pressure of carbon dioxide (PaCO2) 88 mm Hg; partial pressure of oxygen (PaO2) 42 mm Hg; bicarbonate (HCO3-) 25 mEq/L. Which of the following best describes this patient's condition?

Acute hypercapnic respiratory failure

A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath. Physical assessment reveals: pulse 102, blood pressure 138/80, respiratory rate 25 with accessory muscle use, and breath sounds are decreased with bilateral inspiratory and expiratory wheezing with a prolonged expiratory phase. The peak expiratory flow rate is 100 L/min. The immediate action by the respiratory therapist should include which of the following?

Administer continuous bronchodilator therapy

A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented. His physical examination reveals: heart rate (HR) 120 and regular, blood pressure (BP) 146/88, temperature 38° C, respiratory rate (RR) 28 shallow and labored. Breath sounds are decreased throughout with fine late crackles on inspiration, chest expansion is decreased in both bases. The patient is not coughing. The arterial blood gas (ABG) on room air is: pH 7.52, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2 ) 42 mm Hg, Hb-O2 80%, bicarbonate (HCO3-) 24 mEq/L. This patient is retired after working in a steel factory for 38 years and he has a 50 pack-year history of smoking. The most appropriate action for the respiratory therapist to take is which of the following?

Administer oxygen via a high flow nasal cannula.

The underlying physiological process leading to pure hypercapnic respiratory failure is which of the following?

Alveolar hypoventilation

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

Asthma exacerbation

A hemodynamically unstable patient being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode is triggering inspiration at a rate of 25 breaths/minute and has the following arterial blood gas results: pH 7.50, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2) 98 mm Hg, arterial oxygen saturation (SaO2)100%, bicarbonate (HCO3-) 24 mEq/L. The respiratory therapist should peform which of the following?

Change the mode to Volume-Controlled Synchronized Intermittent Mandatory Ventilation (VC-SIMV).

An 80-year-old female with a diagnosis of pneumonia was admitted to the hospital 2 days ago from a nursing home. The patient is responsive only to painful stimuli. She has a peripheral IV and a feeding tube in place. Physical examination reveals: pulse 98 bpm, respiratory rate 24 and shallow, blood pressure 100/48, and temperature 39.2° C. Auscultation reveals decreased breath sounds with crackles in the bases. The patient has an occasional weak, nonproductive cough. Arterial blood gas on NC 4 L/min is pH 7.42, partial pressure of carbon dioxide (PaCO2) 38 mmHg, partial pressure of oxygen (PaO2) 40 mm Hg, arterial oxygen saturation (SaO2) 76%, bicarbonate (HCO3-) 24 mEq/L. A portable chest x-ray shows patchy basilar infiltrates in both lungs. The most appropriate action to take at this time is which of the following?

Change the nasal cannula to a nonrebreather mask.

A patient has recently been diagnosed with obstructive sleep apnea. The most appropriate treatment includes which of the following?

Continuous Positive Airway Pressure (CPAP)

A breath that is patient triggered, pressure targeted, and time cycled is which of the following?

Correcta. Assisted breath

A breath that is triggered, limited, and cycled by the mechanical ventilator is which of the following?

Correctb. Mandatory breath

When a patient is to be switched from continuous mandatory ventilation (CMV) to synchronized intermittent mandatory ventilation (SIMV) to facilitate weaning from mechanical ventilation, which of the following could be used in addition to SIMV to assist this process?

Correctb. Pressure Support (PS)

The ventilator mode that would be most appropriate to iatrogenically induce hyperventilation to manage a closed head injury patient with severely elevated intracranial pressure (ICP) is which of the following?

Correctb. Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV)

A patient triggered, pressure limited, flow cycled breath describes which of the following?

Correctb. Pressure-support breath

If flow or sensitivity is set incorrectly, which of the following is most likely to occur during the continuous mandatory ventilation (CMV) mode?

Correctc. Ventilator dysynchrony

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

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

Respiratory failure due to inadequate ventilation is known as which of the following?

Hypercapnic

A 28-year-old man is admitted to the emergency department with suspected drug overdose. The patient is obtunded and slightly cyanotic. The arterial blood gas results obtained while the patient was breathing room air were: pH 7.24; partial pressure of carbon dioxide (PaCO2) 58 mm Hg; partial pressure of oxygen (PaO2) 52 mm Hg; bicarbonate (HCO3-) 24 mEq/L. The most appropriate interpretation of these results is which of the following?

Hypercapnic respiratory failure

During volume control ventilation a patient's airway resistance increases. This change will cause which of the following to occur?

Increase in peak airway pressure

A 64-year-old female patient having an acute exacerbation of chronic obstructive pulmonary disease (COPD) was admitted to the hospital yesterday. During rounds today the respiratory therapist finds the patient to be difficult to arouse and has the following physical findings: heart rate 102, respiratory rate 23 shallow and slightly labored, breath sounds are bilaterally decreased with rhonchi in both bases. The patient has a frequent, but weak cough. The respiratory therapist draws an arterial blood gas with the following results on a 2 L/min nasal cannula: pH 7.52, partial pressure of carbon dioxide (PaCO2) 30 mm Hg, partial pressure of oxygen (PaO2) 45 mm Hg, arterial oxygen saturation (SaO2) 86%, bicarbonate (HCO3-) 24 m Eq/L. The most appropriate action is which of the following?

Increase the nasal cannula to 4 L/min.

A postoperative patient complaining of dyspnea is found to have tachypnea and tachycardia, and is somewhat confused. Breath sounds reveal end inspiratory crackles in both lung bases. An arterial blood gas is drawn and reveals the following: pH 7.49; partial pressure of carbon dioxide (PaCO2) 33 mm Hg; partial pressure of oxygen (PaO2) 51 mm Hg; arterial oxygen saturation (SaO2) 87%; bicarbonate (HCO3-) 25 mEq/L while on a 30% air entrainment mask. The most appropriate respiratory therapy intervention includes which of the following?

Initiate continuous positive airway pressure (CPAP) by mask.

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?

Intubate and initiate mechanical ventilation

The first arterial blood gas for an asthma patient in the emergency department reveals: pH 7.49; partial pressure of carbon dioxide (PCO2) 30; partial pressure of oxygen (PO2) 82; oxygen saturation (SO2) 95%; bicarbonate (HCO3-) 24 on a nasal cannula 3 L/min. The patient's peak expiratory flow rate was 165 L/min, respiratory rate was 16, and pulse 106. After continuous aerosolized albuterol over the last hour patient'scurrent arterial blood gas results are as follows: pH 7.34; PCO2 45; PO2 49; SO2 79%; HCO3- 25 on a high flow nasal cannula 15 L/min. The patient's peak expiratory flow rate is 95 L/min, respiratory rate 35, pulse 128, and the patient is diaphoretic. The respiratory therapist should suggest which of the following at this time?

Intubate and initiate mechanical ventilation

A 52-year-old male with a medical history of congestive heart failure and hypertension arrives in the emergency department because of an acute onset of dyspnea. The patient has pink frothy secretions at the mouth. A rapid physical assessment reveals a pulse of 128, respiratory rate 28 breaths/min and labored, and blood pressure 82/56 mm Hg. Bilateral coarse crackles are heard in the lung bases. Arterial blood gas results on a 12 L/min nonrebreather mask are: pH 7.32, partial pressure of carbon dioxide (PaCO2) 49 mm Hg, partial pressure of oxygen (PaO2) 50 mm Hg, arterial oxygen saturation (SaO2) 74%. The most appropriate immediate action for this patient is which of the following?

Intubation and mechanical ventilation

The respiratory assessment of a 44-year-old female patient diagnosed with myasthenia gravis shows: vital capacity 475 mL, maximum inspiratory pressure (MIP) -18 cm H2O. The patient is 5 feet 6 inches tall and weighs 188 lbs. The most recent arterial blood gas on a 2 L/min nasal cannula is pH 7.32, partial pressure of carbon dioxide (PaCO2) 49 mm Hg, partial pressure of oxygen (PaO2) 77 mm Hg, arterial oxygen saturation (SaO2) 95%, bicarbonate (HCO3-) 24 mEq/L.The most appropriate recommendation for this patient is which of the following?

Intubation and mechanical ventilation

What type of breath occurs when the ventilator controls the timing, tidal volume, or inspiratory pressure?

Mandatory

A 28-year-old male has arrived in the emergency department following a motor vehicle accident. He has a Glasgow Coma Score of 14. Chest x-ray reveals 5 ribs broken anteriorly in 2 areas each. Physical assessment reveals paradoxical movement of the chest. Breath sounds are diminished and the trachea is midline. Arterial blood gas on nonrebreathing mask is: pH 7.53, partial pressure of carbon dioxide (PaCO2) is 25 mm Hg, partial pressure of oxygen (PaO2) is 59 mm Hg, arterial oxygen saturation (SaO2) 93%, bicarbonate (HCO3-) 23 mEq/L. The respiratory therapist should recommend which of the following for this patient?

Mask Continuous Positive Airway Pressure (CPAP) with supplemental oxygen

A 59-year-old patient is in severe respiratory distress in the emergency department. The patient is being treated for congestive heart failure and pulmonary edema. Vital signs are pulse 98/min, respiratory rate 23/min, and BP 138/98. The patient's arterial blood gas results on a nonrebreather mask are as follows: pH 7.35, partial pressure of carbon dioxide (PaCO2) 45 mm Hg, partial pressure of oxygen (PaO2) 49 mm Hg, arterial oxygen saturation (SaO2) 79%, and bicarbonate (HCO3-) 24 mEq/L. The respiratory therapy that is most appropriate at this time is which of the following?

Mask continuous positive airway pressure (CPAP) with 100% oxygen

A 68-year-old female admitted for congestive heart failure is in respiratory distress and is being seen by the hospital's medical emergency team in her regular room. The patient is in obvious respiratory distress and is immediately placed on a nonrebreathing mask. Physical assessment reveals: pulse 138 and thready; respiratory rate 30, shallow and labored; temperature 37° C; blood pressure 110/68. Breath sounds are bilaterally decreased with coarse crackles on inspiration. EKG shows normal sinus rhythm with widened cardiac output (QT) interval and an occasional irregular beat. No coughing is noted. The arterial blood gas on the nonrebreathing mask is: pH 7.34; PCO2 46 mm Hg; partial pressure of oxygen in the arteries (PO2) is 52 mm Hg; oxygen saturation is 86%; bicarbonate (HCO3-) is 24 mEq/L. The patient is diaphoretic. The most appropriate ventilator mode to manage this patient initially is which of the following?

Noninvasive Positive Pressure Ventilation (NPPV)

A home care patient diagnosed with central sleep apnea would benefit from which of the following modes of ventilation?

Noninvasive Positive Pressure Ventilation (NPPV)

Which of the following patients is showing the signs of acute respiratory distress?

One in the high Fowler position, diaphoretic, anxious and unable to complete a sentence

Of the following breath descriptions, which one is considered spontaneous?

Patient triggered, patient cycled, baseline pressure +5 cm H2O

An assisted breath in the pressure-controlled continuous mandatory ventilation (PC-CMV) mode can be described by which of the following?

Patient triggered, pressure limited, time cycled

The ventilator mode that delivers pressure breaths that are patient- or time-triggered, volume targeted, time cycled, and where the pressure is automatically adjusted to maintain delivery of the targeted volume is which of the following?

Pressure Regulated Volume Control (PRVC)

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

Pressure-Controlled Continuous Mandatory Ventilation (PC-CMV)

Acute hypercapnic respiratory failure may be caused by which of the following?

Respiratory muscle fatigue

A patient with Acute Respiratory Distress Syndrome (ARDS) has developed a pneumothorax from elevating peak and plateau pressures. The patient is currently being ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode with a set rate of 12 bpm. However, the patient is triggering the ventilator at a rate of 25 bpm. The arterial blood gas reveals ventilator induced hyperventilation with corrected hypoxemia. The most appropriate recommendation to manage this patient on the ventilator is which of the following?

Switch the mode to pressure-controlled synchronized mandatory ventilation (PC-SIMV).

The ventilator mode that allows the patient to breathe spontaneously between operator selected time-triggered volume or pressure-targeted breaths is which of the following?

Synchronized Intermittent Mandatory Ventilation (SIMV)

A patient, who is nasally intubated, due to facial surgery, has been successful on her spontaneous breathing trial. She currently has moderate hypoxemia, despite a fractional inspired oxygen (FIO2) of 40% and positive-end-expiratory pressure (PEEP) of 5 cm H2O while on volume-controlled continuous mandatory ventilation (VC-CMV). The most appropriate ventilator mode for this patient is which of the following?

Synchronized Intermittent Mandatory Ventilation (SIMV) with Pressure Support Ventilation (PSV) and Positive-End-Expiratory Pressure (PEEP)

If lung compliance decreases while a patient is receiving mechanical ventilation with pressure-controlled continuous mandatory ventilation (PC-CMV) which of the following would occur?

Tidal volume decreases

A leak around a patient's ET tube cuff during pressure support ventilation (PSV) will cause which of the following to occur?

Time cycle

A 28-year-old female was admitted last night for weakness and what appears to be ascending muscle paralysis. The patient is alert and oriented. Physical findings reveal: pulse 96, regular; blood pressure (BP) 134/83; temperature 37° C; respiratory rate (RR) 24 shallow with bilateral decrease in air entry, and no adventitious breath sounds. The patient's arterial blood gas (ABG) results on room air are: pH 7.46; partial pressure of carbon dioxide (PaCO2) 39 mmHg; partial pressure of oxygen (PaO2) 80 mmHg; Sat 97%; bicarbonate (HCO3-) 26 mEq/L on room air. The most appropriate suggestion that the respiratory therapist should make for this patient includes which of the following?

Vital capacity every two hours

The ventilator mode where every breath is patient triggered, pressure targeted, flow cycled with a volume target is which of the following?

Volume Support Ventilation (VSV)