Exam 4: Establishing the Need for Mechanical Ventilation

A patient with an opiate drug overdose is unconscious and has the following ABG results on room air: pH 7.20; P_aCO₂ 88 mm Hg; P_aO₂ 42 mm Hg; HCO₃⁻ 25 mEq/L.Which of the following best describes this patient's condition?

A 46-year-old male presents to the emergency department with a chief complaint of shortness of breath.Physical assessment reveals: pulse 102 beats/min,blood pressure 138/80 mm Hg,respiratory rate 25 breaths/min 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?

A 55-year-old male with acute dyspnea is admitted to the hospital. He is alert and oriented. His physical examination reveals: heart rate 120 beats/min and regular; blood pressure 146/88 mm Hg; temperature 38° C; respiratory rate 28 breaths/min 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 ABG on room air is: pH 7.52; PaCO₂ 30 mm Hg; PaO₂ 42 mm Hg; Hb-O₂ 80%; 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?

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

After oxygen is administered,a patient's heart rate changes from 110 to 85 beats/min.The initial tachycardia was most likely caused by which of the following?

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 beats/min,regular; blood pressure 134/83 mm Hg; temperature 37° C; respiratory rate 24 breaths/min shallow with bilateral decrease in air entry; and no adventitious breath sounds.The patient's ABG results on room air are: pH 7.46; PₐCO₂ 39 mm Hg; PₐO₂ 80 mm Hg; Sat 97%; and 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?

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 are pending.The physician suspects Guillain-Barré syndrome.The most appropriate action at this time is which of the following?

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 beats/min,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,PₐCO₂ 49 mm Hg,PₐO₂ 50 mm Hg,arterial SₐO₂ 74%.The most appropriate immediate action for this patient is which of the following?

Which of the following are goals of mechanical ventilation? 1)To provide support to the pulmonary system to maintain an adequate level of alveolar ventilation 2)To reduce the WOB until the cause of respiratory failure can be eliminated 3)To restore ABG levels to normal 4)To prevent or treat atelectasis with adequate end-inspiratory lung inflation

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

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 (ABG)is drawn and reveals the following: pH 7.49; P_aCO₂ 33 mm Hg; P_aO₂ 51 mm Hg; S_aO₂ 87%; HCO₃⁻ 25 mEq/L while on a 30% air entrainment mask.The most appropriate respiratory therapy intervention includes which of the following?

The first arterial blood gas for an asthma patient in the emergency department reveals: pH 7.49; PₐCO₂ 30; PₐO₂ 82; SₐO₂ 95%; HCO₃⁻ 24 on a nasal cannula 3 L/min.The patient's peak expiratory flow rate was 165 L/min,respiratory rate was 16 breaths/min,and pulse 106 beats/min.After continuous aerosolized albuterol over the past hour,the patient's current ABG results are as follows: pH 7.34; PₐCO₂ 45; PₐO₂ 49; SₐO₂ 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 breaths/min,pulse 128 beats/min,and the patient is diaphoretic.The respiratory therapist should suggest which of the following at this time?

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

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

A 45-year-old woman arrives in the emergency department after ingesting an unknown quantity of pain medication and alcohol.Her friend found her unconscious in her apartment.She is currently unresponsive to verbal stimuli.Vital signs reveal: pulse 56 beats/min; respiratory rate 10 breaths/min and shallow; and BP 90/50 mm Hg.Her ABG on room air reveals: pH 7.21; PₐCO₂ 64 mm Hg; PₐCO₂ 52 mm Hg,HCO3 -24 mEq/L.The appropriate treatment for this patient includes which of the following? 1)Naloxone hydrochloride (Narcan) 2)Nasal cannula 4 L/min 3)Nonrebreather mask 4)Intubation and ventilatory support

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 beats/min,respiratory rate 23 breaths/min,and BP 138/98 mm Hg.The patient's ABG results on a nonrebreather mask are as follows: pH 7.35; partial PₐCO₂ 45 mm Hg; PₐO₂ 49 mm Hg; SₐO₂ 79%; and HCO₃⁻ 24 mEq/L.The respiratory therapy that is most appropriate at this time is which of the following?

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

A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis.The respiratory therapist has been monitoring the patient's MIP and VC every 2 hours.The most recent results show that the patient continues to deteriorate: MIP = -27 cm H₂O,VC = 32 mL/kg.Which of the following could be appropriately recommended?

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 beats/min; respiratory rate 24 breaths/min and shallow; blood pressure 100/48 mm Hg; 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,PₐCO₂ 38 mm Hg,PₐO₂ 40 mm Hg,SₐO₂ 76%,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?

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