Deck 4: Establishing the Need for Mechanical Ventilation

Question 1

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 (P_aCO₂)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?

A) Chronic hypoxemic respiratory failure
B) Chronic hypercapnic respiratory failure
C) Acute hypoxemic respiratory failure
D) Acute hypercapnic respiratory failure

Answer 1

Acute hypercapnic respiratory failure

Question 2

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?

A) Intubate and mechanically ventilate.
B) Administer oxygen via nonrebreather mask.
C) Administer continuous bronchodilator therapy.
D) Initiate noninvasive positive pressure ventilation.

Answer 2

Administer continuous bronchodilator therapy.

Question 3

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

A) Ventilation/perfusion mismatch
B) Intrapulmonary shunting
C) Diffusion impairment
D) Alveolar hypoventilation

Answer 3

Alveolar hypoventilation

Question 4

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 (P_aCO₂) 49 mm Hg,partial pressure of oxygen (P_aO₂)77 mm Hg,arterial oxygen saturation (S_aO₂)95%,bicarbonate (HCO₃^-)24 mEq/L.The most appropriate recommendation for this patient is which of the following?

A) 50% air entrainment mask
B) Continuous positive airway pressure
C) Noninvasive positive pressure ventilation
D) Intubation and mechanical ventilation

Question 5

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?

A) Vital capacity every two hours
B) Continuous positive airway pressure
C) Noninvasive positive pressure ventilation
D) Peak expiratory flow rate y

Question 6

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?

A) Change to a nonrebreather mask.
B) Begin continuous positive airway pressure.
C) Intubate and initiate mechanical ventilation.
D) Initiate noninvasive positive pressure ventilation.

Question 7

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

Question 8

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.

Question 9

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

A) 1 and 2 only
B) 1 and 3 only
C) 2 and 4 only
D) 3 and 4 only

Question 10

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

A) Decrease fractional inspired oxygen (FIO₂)
B) Pulmonary shunt
C) Respiratory muscle fatigue
D) Perfusion/diffusion impairment

Question 11

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

A) 1 and 2 only
B) 2 and 3 only
C) 3 and 4 only
D) 1 and 4 only

Question 12

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 (P_aCO₂)58 mm Hg;partial pressure of oxygen (P_aO₂)52 mm Hg;bicarbonate (HCO₃^-)24 mEq/L.The most appropriate interpretation of these results is which of the following?

A) Chronic respiratory failure
B) Hypoxemic respiratory failure
C) Hypercapnic respiratory failure
D) Acute orchronic respiratory failure

Question 13

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?

A) Initiate noninvasive positive pressure ventilation (NPPV).
B) Initiate continuous positive airway pressure (CPAP)by mask.
C) Administer bronchodilator therapy.
D) Intubate and mechanically ventilate.

Question 14

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 (P_aCO₂)30 mm Hg,partial pressure of oxygen (P_aO₂)45 mm Hg,arterial oxygen saturation (S_aO₂)86%,bicarbonate (HCO₃^-)24 m Eq/L.The most appropriate action is which of the following?

A) Intubate and mechanically ventilate.
B) Increase the nasal cannula to 4 L/min.
C) Administer incentive spirometry.
D) Begin noninvasive positive pressure ventilation.

Question 15

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

A) 1 and 2 only
B) 2 and 4 only
C) 1 and 3 only
D) 3 and 4 only

Question 16

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?

A) Intubate and initiate positive pressure ventilation.
B) Initiate noninvasive positive pressure ventilation.
C) Administer oxygen via a high flow nasal cannula.
D) Initiate bronchodilator and mucolytic therapy.

Question 17

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 (P_aCO₂)38 mmHg,partial pressure of oxygen (P_aO₂)40 mm Hg,arterial oxygen saturation (S_aO₂)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?

A) Intubate and initiate mechanical ventilation.
B) Administer a bronchodilator and mucolytic.
C) Initiate noninvasive positive pressure ventilation.
D) Change the nasal cannula to a nonrebreather mask.

Question 18

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 (V_D/V_T)= 0.4
3)Vital capacity (VC)= 8 mL/kg IBW
4)pH = 7.20

A) 1 and 2 only
B) 2 and 3 only
C) 3 and 4 only
D) 1 and 4 only

Question 19

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

A) Hypoxemic
B) Hypercapnic
C) Compensated
D) Chronic

Question 20

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?

A) Intubation and mechanical ventilation
B) Increase flow to the nonrebreather mask
C) Continuous positive airway pressure via mask
D) Nasotracheal suctioning and a high flow nasal cannula

Question 21

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)Naloxone hydrochloride (Narcan)
2)Nasal cannula 4 L/min
3)Nonrebreathing mask
4)Intubation and ventilatory support

A) 2 only
B) 4 only
C) 1 and 3 only
D) 1 and 4 only

Question 22

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

A) One who is in a semi-Fowler position,watching TV,with a 2 L/min nasal cannula
B) One in the high Fowler position,diaphoretic,anxious and unable to complete a sentence
C) One who is leaning forward on a table,using accessory muscles,and purse-lip breathing
D) One in the high Fowler position,with a 2 L/min nasal cannula,eating breakfast

Question 23

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?

A) 6 L/min nasal cannula
B) 50% air entrainment mask
C) Mask continuous positive airway pressure (CPAP)with 100% oxygen
D) Intubate and mechanically ventilate