Question 1

Which of the following are contraindications for noninvasive ventilation?
1) Facial and head trauma
2) Community-acquired pneumonia
3) Copious, viscous sputum
4) Severe upper GI bleeding

A)1
B)2, 3
C)2, 3, 4
D)1, 3, 4

1, 3, 4

Accepted Answer

Noninvasive ventilation (NIV) is contraindicated in patients with facial and head trauma due to the risk of improper mask fit and potential for worsening injuries. Copious, viscous sputum can obstruct the airway or the NIV device, making it difficult to manage airway secretions. Severe upper GI bleeding poses a risk of aspiration and further complicates the use of NIV. Community-acquired pneumonia, on the other hand, is not a contraindication and NIV can be beneficial in certain cases of respiratory failure due to pneumonia.

Question 2

What is the primary pathophysiologic mechanism in alveolar hypoventilation?&#10;A) Decreased minute ventilation&#10;B) Increased ventilation/perfusion ratio&#10;C) Decreased venous admixture&#10;D) Decreased inspired oxygen pressure

Accepted Answer

Alveolar hypoventilation primarily occurs due to decreased minute ventilation, which leads to inadequate air exchange and insufficient removal of carbon dioxide from the blood.

Question 3

Which of the following are causes of hypercapnic respiratory?
1) Impending ventilatory failure
2) Apnea
3) Severe refractory hypoxemia
4) Acute ventilatory failure

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

1, 2, 4

Accepted Answer

Hypercapnic respiratory failure is characterized by an elevated level of carbon dioxide (CO2) in the blood, which can result from conditions that impair ventilation. Impending ventilatory failure (1), apnea (2), and acute ventilatory failure (4) directly affect the body's ability to ventilate properly, leading to an accumulation of CO2. Severe refractory hypoxemia primarily affects oxygen levels rather than CO2 levels directly, making choices 1, 2, and 4 correct.

Question 4

What V_D/V_T ratio range would you expect to see in a patient receiving mechanical ventilation? A) 20% and 40% B) 30% and 50% C) 40% and 60% D) 50% and 70%

Accepted Answer

The V_D/V_T ratio, which refers to the ratio of dead space ventilation to tidal volume in a patient receiving mechanical ventilation, is expected to be in the range of 40% to 60%. This range indicates the proportion of each breath that does not participate in gas exchange, which is a critical factor in assessing and optimizing mechanical ventilation settings.

Question 5

You are the respiratory therapist managing an adult male patient receiving mechanical ventilation as a result of hypoxemic respiratory failure. The patient has a pressure time index of 0.16, and rapid shallow breath index of 95, and the cuff-leak test demonstrated the patient could breathe when it was deflated. What would your recommendations to the physician be regarding weaning this patient based on this data?

A) Do not attempt to wean.
B) Attempt to wean.
C) Reattempt a spontaneous breathing trial to see if RSBI improves before weaning.
D) Cannot determine.

Accepted Answer

The rapid shallow breathing index (RSBI) of 95 is below the threshold of 105, indicating the patient may be ready to wean. The pressure time index and successful cuff-leak test further support this.

Question 6

What effect would a pulmonary embolism have on the V_D/V_T and the ratios? A) The V_D/V_T would increase and the would decrease. B) The V_D/V_T would decrease and the would increase. C) The V_D/V_T and the ratios would both increase. D) The V_D/V_T and the ratios would both decrease.

Accepted Answer

The answer of What effect would a pulmonary embolism have...

Question 7

Which of the following are clinical indicators of type I respiratory failure? 1) Decreased PaO₂ 2) Increased P(A-a)O₂ 3) Decreased PaO₂/FIO₂ 4) Decreased A)1, 2 B)2, 4 C)1, 2, 3 D)2, 3, 4

Accepted Answer

The answer of Which of the following are clinical indicators...

Question 8

Which of the following is a critical value for the key clinical indicators in hypercapnic respiratory failure in an adult?
1) pH 7.19
2) Ventilatory rate 35 breaths/min
3) MIP 80 cm H₂O
4) V_D/V_T 35%

A)1, 4
B)2, 3
C)1, 2
D)3, 4

Accepted Answer

Hypercapnic respiratory failure is characterized by an inability to adequately remove carbon dioxide from the blood, leading to elevated levels of CO2 and often a decrease in blood pH. A pH of 7.19 indicates significant acidosis, often seen in hypercapnic respiratory failure. A ventilatory rate of 35 breaths/min is indicative of increased respiratory effort, which can be a response to hypercapnia.

Question 9

Which of the following values is the V_D/V_T value if the PaCO₂ is 40 mm Hg and the is 30 mm Hg? A) 0.25 or 25%. B) 0.33 or 33%. C) 0.4 or 40%. D) Need more information to determine the value.

Accepted Answer

The answer of Which of the following values is the...

Question 10

Which of the following are abnormal causes of anatomic shunt?
1) Bronchial venous drainage
2) Congenital heart disease
3) Intrapulmonary fistula
4) Vascular lung tumors

A)1, 3
B)1, 2, 4
C)2, 3, 4
D)1, 2, 3

Accepted Answer

2, 3, 4Bronchial venous drainage is a normal anatomic shunt, whereas congenital heart disease, intrapulmonary fistula, and vascular lung tumors are abnormal causes of anatomic shunts. These conditions allow blood to bypass the gas exchange process in the lungs, leading to hypoxemia.

Deck 11: Respiratory Insufficiency, Respiratory Failure and Ventilatory Management Protocols