Question 1

Which of the following is most likely to precipitate respiratory failure in a patient with borderline pulmonary function?
A)Hypertension
B)Severe fever
C)Hypothermia
D)Tachycardia

Accepted Answer

Severe fever can cause an increase in metabolic demands and oxygen consumption, leading to respiratory distress and possible failure. Hypertension, hypothermia, and tachycardia may contribute to respiratory compromise but are less likely to precipitate respiratory failure in a patient with already compromised pulmonary function.

Question 2

Your patient has a PaO₂ of 39 mmHg.How would you classify this level of oxygenation? A)Mild hypoxemia B)Moderate hypoxemia C)Severe hypoxemia D)Depends on the FIO₂

Accepted Answer

A PaO2 of 39 mmHg classifies as severe hypoxemia, which is categorized as arterial blood gas values less than 60 mmHg. It is critical to identify the underlying cause and provide immediate intervention to improve oxygenation. The FIO2 could affect the PaO2 level, but severe hypoxemia denotes a life-threatening condition that requires prompt treatment.

Question 3

Which of the following is least likely to be associated with ventilatory failure?
A)Neuromuscular disease
B)Cervical spinal cord injury
C)Drug overdose
D)Pneumonia

Accepted Answer

Pneumonia is more likely to cause respiratory distress rather than ventilatory failure as it primarily affects gas exchange in the lungs rather than the muscles involved in breathing. The other options (neuromuscular disease, cervical spinal cord injury, and drug overdose) can all lead to ventilatory failure by affecting the muscles required for breathing or the neural control of these muscles.

Question 4

What is the primary response of the brain to severe ventilatory failure with respiratory acidosis? A)Somnolence and potentially coma B)Excitement C)Depends on the PaO₂ D)Depends on the blood pressure

Accepted Answer

Severe ventilatory failure with respiratory acidosis, typically due to inadequate removal of CO2, causes an increase in carbonic acid in the blood leading to a decrease in pH. This can result in symptoms such as somnolence or even coma due to depression of the central nervous system.

Question 5

What causes hypoxemia that typically does not respond well to oxygen therapy?
A)Shunt
B)  mismatching
C)Hypoventilation
D)None of the above

Accepted Answer

Hypoxemia that does not respond well to oxygen therapy is typically caused by a shunt. A shunt refers to blood that is not able to be oxygenated because it is bypassing normal lung tissue and flowing directly into the systemic circulation. Despite oxygen therapy, this blood will not become oxygenated and the patient will continue to experience hypoxemia.

Question 6

What would be the proper classification for a 70-year-old male with a PaO₂ of 55 mmHg? A)Mild hypoxemia B)Moderate hypoxemia C)Severe hypoxemia D)Depends on the FIO₂

Accepted Answer

Mild hypoxemia is defined as a PaO2 of 55-59 mmHg.

Question 7

Your patient has severe hypoxemia due to postoperative atelectasis.What treatment should be applied initially?
A)Oxygen by nasal cannuala
B)Oxygen with CPAP
C)Intubation and mechanical ventilation
D)Hyperbaric oxygen therapy

Accepted Answer

Oxygen with Continuous Positive Airway Pressure (CPAP) is the initial treatment of choice for severe hypoxemia due to postoperative atelectasis. CPAP helps to open collapsed alveoli, improving oxygenation and ventilation without the need for invasive mechanical ventilation.

Question 8

What mode of mechanical ventilation allows the patient to breathe spontaneous breaths between each mechanical breath?
A)Assist control mode
B)IMV mode
C)Control mode
D)CPAP mode

Accepted Answer

IMV (intermittent mandatory ventilation) mode allows the patient to breathe spontaneously between each mechanical breath. In this mode, the ventilator delivers a set number of breaths per minute, but the patient is free to take additional breaths as desired. This mode is useful for patients who are able to breathe on their own, but need additional support to maintain adequate ventilation.

Question 9

Which of the following can contribute to diaphragm dysfunction and lead to ventilatory failure?
A)Emphysema
B)Malnutrition
C)Electrolyte abnormalities
D)All the above

Accepted Answer

Various factors such as chronic lung diseases like emphysema, malnutrition causing muscle weakness, and electrolyte abnormalities causing neuromuscular dysfunction can contribute to diaphragm dysfunction and lead to ventilatory failure. Therefore, all the given options can contribute to diaphragm dysfunction and ventilatory failure.

Question 10

You are monitoring a patient during mechanical ventilation and the peak pressure is reaching 55 cm H₂0.What problem does this potentially cause? A)Barotrauma B)Renal failure C)Hypertension D)Auto-PEEP

Accepted Answer

Peak pressures of 55 cm H2O can potentially cause barotrauma, which is damage to the lungs caused by excessive pressure. This can result in pneumothorax, lung parenchymal injury, or air leak syndromes. It is important to monitor and manage peak pressures to prevent barotrauma.

Question 11

Your patient has COPD and has been told he has cor pulmonale.Which of the following findings is NOT consistent with this patient?
A)JVD
B)Hepatomegaly
C)Bradycardia
D)Pedal edema

Accepted Answer

Bradycardia is not a common finding in cor pulmonale. Increased heart rate is usually seen due to compensatory mechanisms in response to the increased pulmonary vascular resistance. JVD, hepatomegaly, and pedal edema are all common findings in cor pulmonale.

Question 12

Which of the following findings represents the body's compensatory mechanism for chronic hypoxemia?
A)Leukocytosis
B)Hypokalemia
C)Polycythemia
D)Hypernatremia

Accepted Answer

Polycythemia is a compensatory mechanism for chronic hypoxemia where the body produces more red blood cells in order to increase the amount of oxygen carried in the bloodstream. Leukocytosis, hypokalemia, and hypernatremia are not compensatory mechanisms for hypoxemia.

Question 13

Inverse ratio ventilation (IRV)would be most useful for patients with which of the following illnesses?
A)Drug overdose
B)Lobar pneumonia
C)ARDS
D)Polio

Accepted Answer

Inverse ratio ventilation (IRV) is a ventilation technique that involves delivering a prolonged inspiratory phase followed by a shorter expiratory phase. This technique is most useful for patients with ARDS (Acute Respiratory Distress Syndrome) as it helps to improve oxygenation by increasing the mean airway pressure and recruiting collapsed alveoli. It is not typically used for drug overdose, lobar pneumonia or polio.

Question 14

What range is normally used for determining the appropriate tidal volume during initial mechanical ventilation?
A)4-8 mL/kg of ideal body weight
B)5-10 mL/kg of ideal body weight
C)10-15 mL/lb of ideal body weight
D)10-15 mL/kg of actual body weight

Accepted Answer

The normal range for determining tidal volume during initial mechanical ventilation is 5-10 mL/kg of ideal body weight. This range is based on current evidence-based guidelines and has been shown to be effective in ensuring proper gas exchange while minimizing the risk of lung injury. Option A is too narrow, while options C and D use outdated or inaccurate measurements.

Question 15

What clinical finding(s)is (are)consistent with diaphragm fatigue?
A)Tachypnea
B)Respiratory alterans
C)Abdominal paradox
D)All the above

Accepted Answer

Tachypnea, respiratory alternans, and abdominal paradox are all clinical findings consistent with diaphragm fatigue. Tachypnea refers to rapid breathing, which may indicate the body's attempt to compensate for weakened respiratory muscles. Respiratory alternans is a shift in breathing pattern from one side of the body to the other, also indicating respiratory muscle weakness. Abdominal paradox occurs when the abdomen moves inwards during inspiration, suggesting that the diaphragm is fatigued and unable to generate sufficient inspiratory force.

Question 16

What term is used to describe the condition of right heart failure due to chronic pulmonary hypertension?
A)Congestive heart failure
B)Cor pulmonale
C)Cardiac tamponade
D)ARDS

Accepted Answer

Cor pulmonale is the term used to describe right heart failure due to chronic pulmonary hypertension. Congestive heart failure may also occur, but it is not specific to this condition. Cardiac tamponade and ARDS (acute respiratory distress syndrome) are not related to chronic pulmonary hypertension.

Question 17

Your patient has severe hypoxemia according to the blood gas analysis,but cyanosis is not seen.What may explain this?
A)Hypotension
B)Anemia
C)Leukocytosis
D)Fever

Accepted Answer

Cyanosis is only visible when deoxygenated hemoglobin exceeds 5 g/dL, which may not occur in anemic patients with low total hemoglobin levels.

Question 18

Which of the following modes of therapy is most likely to be effective when the patient has hypoxemia due to physiologic shunting?
A)Simple oxygen mask
B)Nasal cannula
C)Air entrainment mask
D)Positive pressure ventilation

Accepted Answer

Positive pressure ventilation can help increase the patient's oxygen levels by providing a higher level of pressure to push oxygen into the lungs, helping to overcome the hypoxemia caused by physiologic shunting. The other options may not provide enough oxygen or pressure to effectively treat this condition.

Question 19

Your patient has severe pneumonia and the blood gas measurements reveal a PaCO₂of 51 mmHg and a PaO₂ of 55 mmHg.The patient is breathing with an air entrainment mask at an FIO₂of 0.60.What conclusion(s)can you reach? A)The patient has ventilatory failure B)The patient has oxygenation failure C)The patient has respiratory failure D)All the above

Accepted Answer

The patient has both ventilatory failure (indicated by a PaCO2 greater than 45 mmHg) and oxygenation failure (indicated by a PaO2 less than 60 mmHg), which together constitute respiratory failure.

Question 20

The patient with inadequate oxygenation of the brain will usually display what symptom(s)?
A)Confusion
B)Excitement
C)Diminished cognitive function
D)A and C only

Accepted Answer

Inadequate oxygenation of the brain can lead to confusion and diminished cognitive function, but not necessarily excitement. Therefore, options A and C are the best choices.

Quiz 2: Introduction to Respiratory Failure

Which of the following is most likely to precipitate respiratory failure in a patient with borderline pulmonary function?

Your patient has a PaO₂ of 39 mmHg.How would you classify this level of oxygenation?

Which of the following is least likely to be associated with ventilatory failure?

What is the primary response of the brain to severe ventilatory failure with respiratory acidosis?

What causes hypoxemia that typically does not respond well to oxygen therapy?

What would be the proper classification for a 70-year-old male with a PaO₂ of 55 mmHg?

Your patient has severe hypoxemia due to postoperative atelectasis.What treatment should be applied initially?

What mode of mechanical ventilation allows the patient to breathe spontaneous breaths between each mechanical breath?

Which of the following can contribute to diaphragm dysfunction and lead to ventilatory failure?

You are monitoring a patient during mechanical ventilation and the peak pressure is reaching 55 cm H₂0.What problem does this potentially cause?

Your patient has COPD and has been told he has cor pulmonale.Which of the following findings is NOT consistent with this patient?

Which of the following findings represents the body's compensatory mechanism for chronic hypoxemia?

Inverse ratio ventilation (IRV) would be most useful for patients with which of the following illnesses?

What range is normally used for determining the appropriate tidal volume during initial mechanical ventilation?

What clinical finding(s) is (are) consistent with diaphragm fatigue?

What term is used to describe the condition of right heart failure due to chronic pulmonary hypertension?

Your patient has severe hypoxemia according to the blood gas analysis,but cyanosis is not seen.What may explain this?

Which of the following modes of therapy is most likely to be effective when the patient has hypoxemia due to physiologic shunting?

Your patient has severe pneumonia and the blood gas measurements reveal a PaCO₂of 51 mmHg and a PaO₂ of 55 mmHg.The patient is breathing with an air entrainment mask at an FIO₂of 0.60.What conclusion(s) can you reach?

The patient with inadequate oxygenation of the brain will usually display what symptom(s) ?