Deck 41: Respiratory Failure and the Need for Ventilatory Support

Question 1

All of the following are associated with hypercapnic respiratory failure due to increased work of breathing except:

A)asthma
B)myasthenia gravis
C)obesity
D)kyphoscoliosis

Answer 1

B

Question 2

Which of the following clinical signs suggest more severe hypoxemia?

A)tachycardia
B)cyanosis with polycythemia
C)central nervous system dysfunction
D)use of accessory muscles

Answer 2

C

Question 3

Which of the following are associated with hypercapnic respiratory failure due to decreased ventilatory drive?
I)brainstem lesions
II)encephalitis
III)hypothyroidism
IV)asthma

A)I, II, and III
B)II and IV
C)III and IV
D)I, II, III, and IV

Answer 3

A

Question 4

All of the following are associated with hypercapnic respiratory failure due to respiratory muscle weakness or fatigue except:

A)hyperthyroidism
B)myasthenia gravis
C)amyotrophic lateral sclerosis
D)Guillain-Barré syndrome

Question 5

Hypercapnic (type II) respiratory failure is a synonym for which one of the following terms?

A) $\dot { V } / \dot { Q }$ mismatching
B)shunt
C)diffusion impairment
D)ventilatory failure

Question 6

All of the following would tend to cause hypercapnic respiratory failure except:

A)smoke inhalation
B)opiate drug overdose
C)chronic obstructive pulmonary disease
D)hypothyroidism

Question 7

What type of disease is associated with perfusion/diffusion impairment?

A)liver disease
B)renal disease
C)neuromuscular disease
D)vascular disease

Question 8

What is the most common cause of low mixed venous oxygen?

A)liver disease
B)cardiac disease
C)neuromuscular disease
D)vascular disease

Question 9

Which of the following best describes the difference between mismatch and shunt when supplemental oxygen is administered?
A.Both will respond equally well.
B. mismatch will respond well but shunt will not.
C. mismatch will not respond but shunt will respond well.
D.Neither will respond to the administration of supplemental oxygen.

Question 10

What is the optimal treatment of intrapulmonary shunt?

A)increase the FIO₂
B)decrease the FIO₂
C)surgery
D)alveolar recruitment

Question 11

What is the normal P(A-a)O₂ range while breathing room air?

A)25 mm Hg to 50 mm Hg
B)10 mm Hg to 25 mm Hg
C)greater than 25 mm Hg
D)less than 10 mm Hg

Question 12

What is respiratory failure due to inadequate ventilation?

A)hypoxemic
B)hypercapnic
C)compensated
D)chronic

Question 13

Which of the following information best helps to distinguish chronic hypercapnic respiratory failure from acute hypercapnic respiratory failure?

A)long-standing dyspnea that worsens on exertion
B)forced expiratory volume in 1 second-to-forced vital capacity ratio (FEV₁/FVC) of less than 75% predicted
C)kidneys retaining bicarbonate to elevate the blood pH
D)physical signs of hypoxemia, such as cyanosis and clubbing

Question 14

Which of the following clinical signs is most often associated with hypoxemia due to shunt?

A)diffuse wheezing
B)"white" chest radiograph
C)stridor
D)loud P2

Question 15

A diagnosis of respiratory failure can be made if which of the following are present?
I.PaO₂ 55 mm Hg, FIO₂ 0.21, P_B 760 mm Hg
II.PaCO₂ 57 mm Hg, FIO₂ 0.21, P_B 760 mm Hg
III.P(A-a)O₂ 45 mm Hg, FIO₂ 1.0, P_B 760 mm Hg
IV.PaO₂/FIO₂ 400, P_B 750 mm Hg

A)I and II
B)I, III, and IV
C)III and IV
D)I, II, III, and IV

Question 16

A patient with interstitial lung disease who presents with hypoxemia due to diffusion defect would have which of the following clinical signs?
I)fine bibasilar crackles
II)clubbing of the finger nail beds
III)jugular venous distention
IV)increased P2

A)I and II
B)I, III, and IV
C)III and IV
D)I, II, III, and IV

Question 17

What happens to the P(A-a)O₂ with $\dot { V } / \dot { Q }$ mismatch and shunt?

A)increases with $\dot { V } / \dot { Q }$ mismatch and decreases with shunt
B)decreases with both $\dot { V } / \dot { Q }$ mismatch and shunt
C)increases with both $\dot { V } / \dot { Q }$ mismatch and shunt
D)it does not change

Question 18

Hypoxemia can be caused by which of the following?
I.diffusion impairment
II.alveolar hypoventilation
III. $\dot { V } / \dot { Q }$ mismatch
IV.intrapulmonary shunting

A)I, II, and III
B)I, III, and IV
C)I, II, III, and IV
D)II, III, and IV

Question 19

Which of the following is a feature of Guillain-Barré?

A)ascending muscle weakness
B)descending muscle weakness
C)limited to lower extremities
D)limited to trunk

Question 20

A patient with an opiate drug overdose is unconscious and exhibits the following blood gas results breathing room air: pH = 7.19; PCO₂ = 89; HCO₃^- = 27; PO₂ = 48. 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

Question 21

What is the normal range of maximum inspiratory pressure, or MIP (also called negative inspiratory force, or NIF), generated by adults?

A)-80 to -100 cm H₂O
B)-50 to -80 cm H₂O
C)-30 to -50 cm H₂O
D)-20 to -30 cm H₂O

Question 22

A patient with a 10-year history of chronic bronchitis and an acute viral pneumonia exhibits the following blood gas results breathing room air: pH = 7.22; PCO₂ = 67; HCO₃^- = 26; PO₂ = 60. Which of the following best describes this patient's condition?

A)chronic hypoxemic respiratory failure
B)acute hypercapnic respiratory failure
C)chronic hypercapnic respiratory failure
D)acute hypoxemic respiratory failure

Question 23

Which of the following patients has the most serious problem with the adequacy of oxygenation?

Question 24

Which of the following MIP measures taken on an adult patient indicates inadequate respiratory muscle strength?

A)-90 cm H₂O
B)-70 cm H₂O
C)-40 cm H₂O
D)-15 cm H₂O

Question 25

Which of the following is the cardinal sign of increased work of breathing?

A)hyperventilation
B)retractions
C)bradycardia
D)tachypnea

Question 26

Because an elevated PaCO₂ increases ventilatory drive in normal subjects, the clinical presence of hypercapnia indicates which of the following?
I)inability of the stimulus to get to the muscles
II)weak or missing central nervous system response to the elevated PCO₂
III)pulmonary muscle fatigue

A)I and II
B)I and III
C)II and III
D)I, II, and III

Question 27

Common bedside measures used to assess the adequacy of lung expansion include all of the following except:

A)VC
B)respiratory rate
C)V_T
D)V_D/V_T

Question 28

What is the normal range for PaO₂/FIO₂?

A)350 to 450
B)250 to 350
C)150 to 250
D)75 to 150

Question 29

Ventilatory support may be indicated when the VC falls below what level?

A)45 ml/kg
B)65 ml/kg
C)10 ml/kg
D)30 ml/kg

Question 30

Which of the following indicators are useful in assessing respiratory muscle strength?
I. maximum voluntary ventilation (MVV)
II. forced vital capacity (FVC)
III. dead space?to?tidal volume ratio (VD/V_T)
IV. maximum inspiratory pressure (MIP)

A)I and III
B)II and IV
C)III and IV
D)I, II, and IV

Question 31

Which of the following measures is/are useful indicators in assessing the adequacy of a patient's oxygenation?
I.PaO₂-PaO₂
II.PaO₂-to-FIO₂ ratio
III.V_D/V_T
IV.pulmonary shunt ( $\dot { Q }$ _s/ $\dot { Q }$ _t)

A)I and II
B)I and III
C)II and III
D)I, II, and III

Question 32

Breathing 100% O₂, a patient has a PaO₂-PaO₂ of 60 mm Hg. Based on this information, what might you conclude?

A)The patient has severe hypoxemia.
B)The patient has an excessive work of breathing.
C)The patient has acceptable oxygenation.
D)The patient has inadequate ventilation.

Question 33

You determine that an acutely ill patient can generate an MIP of -18 cm H₂O. Based on this information, what might you conclude?

A)The patient has inadequate respiratory muscle strength.
B)The patient has inadequate alveolar ventilation.
C)The patient has an excessive work of breathing.
D)The patient has an unstable or irregular ventilatory drive.

Question 34

A need for some form of ventilatory support is usually indicated when an adult's rate of breathing rises above what level?

A)35/min
B)30/min
C)25/min
D)20/min

Question 35

Which of the following measures should be used in assessing the adequacy of a patient's alveolar ventilation?
I)PaO₂
II)arterial pH
III)PaCO₂

A)I and II
B)I and III
C)II and III
D)I, II, and III

Question 36

In patients suffering from acute respiratory acidosis, below what pH level are intubation and ventilatory support generally considered?

A)7.2
B)7.3
C)7.1
D)7.0

Question 37

Which of the following measures taken on adult patients indicate unacceptably high ventilatory demands or work of breathing?

A)V_E of 17 L/min
B)breathing rate of 22/min
C)V_D/V_T of 0.45
D)MIP of -40 cm H₂O

Question 38

Which of the following indicate severely impaired oxygenation requiring high FIO₂s and positive end-expiratory pressure?
I)PaO₂-PaO₂ greater than 350 mm Hg on 100% O₂
II)VC less than 10 ml/kg
III)PaO₂/FIO₂ less than 200

A)I and II
B)I and III
C)II and III
D)I, II, and III

Question 39

Inadequate respiratory muscle strength is likely when a patient's MVV is which of the following?

A)<2 times the resting V_E
B)>3 times the resting V_E
C)<200 L/min
D)>120 L/min

Question 40

Which of the following is false about the "acute-on-chronic" form of respiratory failure?

A)It usually involves patients with hypoxemic respiratory failure.
B)It is most common in patients with chronic airway obstruction.
C)Bacterial or viral infections are common precipitating factors.
D)Mortality is associated with severity of acidosis.

Question 41

What are some causes of dynamic hyperinflation?
I)increased expiratory time
II)increased airway resistance
III)decreased expiratory flow rate

A)I and II
B)I and III
C)II and III
D)I, II, and III

Question 42

In intubated patients, what do sources of increased imposed work of breathing include?
I)endotracheal tube
II)ventilator circuit
III)auto-PEEP

A)I and II
B)I and III
C)II and III
D)I, II, and III

Question 43

Strategies to reduce auto-PEEP in mechanically ventilated patients with obstructive lung disease include all of the following except which one?

A)Use high inspiratory flows (60 to 100 L/min).
B)Apply extrinsic PEEP.
C)Use low V_T values (8 to 10 ml/kg).
D)Use high respiratory rates (greater than 25/min).

Question 44

When is respiratory muscle fatigue likely to occur?

A)when V_E exceeds 20% of the maximum voluntary ventilation (MVV)
B)when V_E exceeds 40% of the MVV
C)when V_E exceeds 60% of the MVV
D)when V_E exceeds 80% of the MVV

Question 45

A patient develops acute hypercapnic respiratory failure due to muscle fatigue. Which of the following modes of ventilatory support would you consider for this patient?
I)assist-control ventilation with adequate backup
II)continuous positive airway pressure
III)synchronized intermittent mandatory ventilation with adequate backup rate
IV)bilevel pressure support by mask

A)II and IV
B)III and IV
C)I, II, and III
D)I, III, and IV

Question 46

A patient who just suffered severe closed-head injury and has a high intracranial pressure (ICP) is about to be placed on ventilatory support. Which of the following strategies could help to lower the ICP?

A)Maintain a PaCO₂ from 25 to 30 mm Hg (deliberate hyperventilation).
B)Allow as much spontaneous breathing as possible (SIMV).
C)Maintain a high mean pressure using PEEP levels of 10 to 15 cm H₂O.
D)Maintain a PaCO₂ of 50 to 60 mm Hg (deliberate hypoventilation).

Question 47

Which of the following modes of ventilatory support would you recommend for a hypoxemic patient with congestive heart failure?

A)continuous positive airway pressure (CPAP)
B)intermittent mandatory ventilation (IMV)
C)inverse-ratio pressure control ventilation (PCV)
D)high-level pressure support ventilation (PSV)

Question 48

Which of the following patients are at greatest risk for developing auto-PEEP during mechanical ventilation?

A)those with acute lung injury
B)those with COPD
C)those with congestive heart failure
D)those with bilateral pneumonia

Question 49

A reversible impairment in the response of an overloaded muscle to neural stimulation best describes which of the following?

A)central respiratory muscle fatigue
B)transmission respiratory muscle fatigue
C)contractile respiratory muscle fatigue
D)chronic respiratory muscle fatigue

Question 50

Which of the following modes of ventilatory support would you recommend for a severely hypoxemic patient with acute lung injury or acute respiratory distress syndrome (ARDS)?

A)continuous positive airway pressure
B)high V_T volume-cycled ventilation
C)pressure-controlled ventilation
D)bilevel pressure support by mask