Question 1

Which of the following measures should be used in assessing the adequacy of a patient's alveolar ventilation? 1) PaO₂ 2) Arterial pH 3) PaCO₂ 4) HCO₃^-

Accepted Answer

The adequacy of a patient's alveolar ventilation is best assessed by measures related to the partial pressure of carbon dioxide (PCO2) in the blood, as this is the primary stimulus for respiratory drive. Arterial pH would reflect changes in PCO2 levels and is therefore a useful measure. The two options that mention PCO2 levels are 2) arterial pH and 3) PaCO2, so choices 2 and 3 are the best options for assessing the adequacy of a patient's alveolar ventilation. Option 1 represents an incorrect code. Option 4 includes an incorrect term (HCO3) and a formatting error (mixing superscript and subscript symbols).

Question 2

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

Accepted Answer

In this question, FVC (forced vital capacity) represents the strength of respiratory muscles. As the FVC decreases, it indicates inadequate respiratory muscle strength. Therefore, the best choice is D, as it has the lowest FVC value of 1015 cm.

Question 3

Which of the following measures are useful indicators in assessing the adequacy of a patient's oxygenation? 1) PaO₂-PaO₂ 2) PaO₂-to-FiO₂ ratio 3) V_D/V_T 4) Pulmonary shunt

Accepted Answer

1) PaO₂-PaO₂ is a measure of the difference between the partial pressure of oxygen in arterial blood and the partial pressure of oxygen in alveolar gas. This difference is normally around 10 mmHg. A decrease in PaO₂-PaO₂ may indicate inadequate oxygenation.2) PaO₂-to-FiO₂ ratio is a measure of the ratio of the partial pressure of oxygen in arterial blood to the fraction of inspired oxygen. This ratio is normally around 400. A decrease in the PaO₂-to-FiO₂ ratio may indicate inadequate oxygenation.

Question 4

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?

Accepted Answer

Assessment of the pH allows a determination of whether the problem is acute or chronic.

Question 5

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

Accepted Answer

MIP is a measure of the strength of the inspiratory muscles. The normal range for MIP in adults is -80 to -100 cm H2O.

Question 6

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

Accepted Answer

A minute ventilation (V_E) of 17 L/min is considered high for an adult, indicating increased ventilatory demands or work of breathing.

Question 7

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

Accepted Answer

An MIP (maximum inspiratory pressure) value of F1F1F1S1F1F1F1018 cm H2O indicates that the patient has inadequate respiratory muscle strength. MIP is a measure of the maximum pressure generated by inspiratory muscles during a forced inspiratory maneuver. A low MIP value indicates that the patient is unable to generate adequate negative pressure to overcome the resistance of the airway and inflate the lungs adequately. This is often seen in patients with respiratory muscle weakness due to neuromuscular disease, chronic obstructive pulmonary disease (COPD), or other conditions that impair respiratory muscle function.

Question 8

Because an elevated PaCO₂increases ventilatory drive in normal subjects, the clinical presence of hypercapnia indicates which of the following? 1) Inability of the stimulus to get to the muscles 2) Weak or missing central nervous system response to the elevated PCO₂ 3) Pulmonary muscle fatigue

Accepted Answer

Hypercapnia, which is an elevated level of carbon dioxide (CO2) in the blood, typically stimulates an increase in ventilation to expel the excess CO2. If hypercapnia is present clinically, it suggests that there may be a failure in the normal response mechanisms. This could be due to an inability of the stimulus (high CO2 levels) to reach the muscles responsible for breathing (1), a weak or absent response from the central nervous system to the elevated CO2 levels (2), or fatigue of the respiratory muscles (3), preventing effective ventilation despite the stimulus.

Question 9

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

Accepted Answer

In patients with acute respiratory acidosis, intubation and ventilatory support are generally considered when the pH level falls below 7.2. This is because a pH level below 7.2 indicates a significant acidemia, which can compromise organ function and necessitate mechanical ventilation to correct the acid-base disturbance.

Question 10

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

Accepted Answer

Contractile respiratory muscle fatigue is a reversible impairment in the contractile response to a neural impulse in an overloaded muscle.

Question 11

Common bedside measures used to assess the adequacy of lung expansion include which of the following? 1) VC 2) Respiratory rate 3) V_T 4) V_D/V_T

Accepted Answer

Vital capacity (VC) and respiratory rate are direct measures related to lung expansion and function. The other options (3 and 4) seem to be incorrectly formatted or refer to non-standard abbreviations not commonly used in assessing lung expansion.

Question 12

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

Accepted Answer

A need for some form of ventilatory support is usually indicated when an adult's rate of breathing rises above 35 breaths per minute. This is because such a high respiratory rate may indicate respiratory distress or failure, making it difficult for the patient to maintain adequate gas exchange without assistance.

Question 13

What is the normal range for PaO₂/FiO₂?

Accepted Answer

The normal range for PaO2/FiO2, often referred to as the P/F ratio, is 350 to 450. This ratio is used to assess the efficiency of oxygen exchange in the lungs and is important in diagnosing and managing conditions like acute respiratory distress syndrome (ARDS).

Question 14

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

Accepted Answer

Ventilatory support is typically indicated when the vital capacity (VC) falls below 10 ml/kg, as this level suggests significant respiratory muscle weakness and impaired ventilation.

Question 15

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

Accepted Answer

Inadequate respiratory muscle strength is indicated when the Maximum Voluntary Ventilation (MVV) is less than 2 times the resting minute ventilation (V_E), suggesting the muscles are not strong enough to meet increased demands.

Question 16

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

Accepted Answer

The patient has acceptable oxygenation because the PaO2-PaO2 is 60 mm Hg, which is within the normal range of 50-100 mm Hg.

Question 17

Which of the following indicate severely impaired oxygenation requiring high FiO₂s and positive end expiratory pressure? 1) PaO₂-PaO₂ greater than 350 mm Hg on 100% O₂ 2) VC less than 10 ml/kg 3) PaO₂/FiO₂ less than 200 4) PaCO₂ greater than 45 mm Hg

Accepted Answer

Option 1 indicates severe hypoxemia with the requirement for high FiO₂s, but the value given for PaO₂-PaO₂ is not physiologically possible. Option 2 indicates severe lung dysfunction with low lung volumes. Option 3 indicates severe hypoxemia with PaO₂/FiO₂ ratio less than 200. Option 4 indicates severe hypercapnia. Therefore, options 1 and 4 are incorrect, and options 2 and 3 are the correct choices for severely impaired oxygenation requiring high FiO₂s and positive end-expiratory pressure.

Question 18

Mr. Adam is in the ICU on an FiO₂ of 100%. An arterial blood gas reveals the following information: pH of 7.18, PaCO₂ of 59 mm Hg, PaO₂ of 65 mm Hg, HCO₃ of 24 mEq/L What action would you recommend?

Accepted Answer

The patient is in hypoxic (type I) and hypercapnic (type II) acute respiratory failure. Providing full mechanical ventilatory support will provide the ventilator support needed to normalize pH and improve oxygenation.

Question 19

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

Accepted Answer

Tachypnea is the cardinal sign of increased work of breathing.

Question 20

Your patient is hypoventilating. Which of the following would be likely findings?

Accepted Answer

The answer of Your patient is hypoventilating. Which of the...

Quiz 44: Respiratory Failure and the Need for Ventilatory Support

Which of the following measures should be used in assessing the adequacy of a patient's alveolar ventilation? 1) PaO₂ 2) Arterial pH 3) PaCO₂ 4) HCO₃^-

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

Which of the following measures are useful indicators in assessing the adequacy of a patient's oxygenation? 1) PaO₂-PaO₂ 2) PaO₂-to-FiO₂ ratio 3) V_D/V_T 4) Pulmonary shunt

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?

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

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

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

Because an elevated PaCO₂increases ventilatory drive in normal subjects, the clinical presence of hypercapnia indicates which of the following? 1) Inability of the stimulus to get to the muscles 2) Weak or missing central nervous system response to the elevated PCO₂ 3) Pulmonary muscle fatigue

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

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

Common bedside measures used to assess the adequacy of lung expansion include which of the following? 1) VC 2) Respiratory rate 3) V_T 4) V_D/V_T

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

What is the normal range for PaO₂/FiO₂?

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

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

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

Which of the following indicate severely impaired oxygenation requiring high FiO₂s and positive end expiratory pressure? 1) PaO₂-PaO₂ greater than 350 mm Hg on 100% O₂ 2) VC less than 10 ml/kg 3) PaO₂/FiO₂ less than 200 4) PaCO₂ greater than 45 mm Hg

Mr. Adam is in the ICU on an FiO₂ of 100%. An arterial blood gas reveals the following information: pH of 7.18, PaCO₂ of 59 mm Hg, PaO₂ of 65 mm Hg, HCO₃ of 24 mEq/L What action would you recommend?

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

Your patient is hypoventilating. Which of the following would be likely findings?

Quiz 44: Respiratory Failure and the Need for Ventilatory Support

Which of the following measures should be used in assessing the adequacy of a patient's alveolar ventilation? 1) PaO2 2) Arterial pH 3) PaCO2 4) HCO3-

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

Which of the following measures are useful indicators in assessing the adequacy of a patient's oxygenation? 1) PaO2-PaO2 2) PaO2-to-FiO2 ratio 3) VD/VT 4) Pulmonary shunt

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?

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

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

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

Because an elevated PaCO2 increases ventilatory drive in normal subjects, the clinical presence of hypercapnia indicates which of the following? 1) Inability of the stimulus to get to the muscles 2) Weak or missing central nervous system response to the elevated PCO2 3) Pulmonary muscle fatigue

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

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

Common bedside measures used to assess the adequacy of lung expansion include which of the following? 1) VC 2) Respiratory rate 3) VT 4) VD/VT

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

What is the normal range for PaO2/FiO2?

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

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

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

Which of the following indicate severely impaired oxygenation requiring high FiO2s and positive end expiratory pressure? 1) PaO2-PaO2 greater than 350 mm Hg on 100% O2 2) VC less than 10 ml/kg 3) PaO2/FiO2 less than 200 4) PaCO2 greater than 45 mm Hg

Mr. Adam is in the ICU on an FiO2 of 100%. An arterial blood gas reveals the following information: pH of 7.18, PaCO2 of 59 mm Hg, PaO2 of 65 mm Hg, HCO3 of 24 mEq/L What action would you recommend?

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

Your patient is hypoventilating. Which of the following would be likely findings?

Which of the following measures should be used in assessing the adequacy of a patient's alveolar ventilation? 1) PaO₂ 2) Arterial pH 3) PaCO₂ 4) HCO₃^-

Which of the following measures are useful indicators in assessing the adequacy of a patient's oxygenation? 1) PaO₂-PaO₂ 2) PaO₂-to-FiO₂ ratio 3) V_D/V_T 4) Pulmonary shunt

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?

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

Because an elevated PaCO₂increases ventilatory drive in normal subjects, the clinical presence of hypercapnia indicates which of the following? 1) Inability of the stimulus to get to the muscles 2) Weak or missing central nervous system response to the elevated PCO₂ 3) Pulmonary muscle fatigue

Common bedside measures used to assess the adequacy of lung expansion include which of the following? 1) VC 2) Respiratory rate 3) V_T 4) V_D/V_T

What is the normal range for PaO₂/FiO₂?

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

Which of the following indicate severely impaired oxygenation requiring high FiO₂s and positive end expiratory pressure? 1) PaO₂-PaO₂ greater than 350 mm Hg on 100% O₂ 2) VC less than 10 ml/kg 3) PaO₂/FiO₂ less than 200 4) PaCO₂ greater than 45 mm Hg

Mr. Adam is in the ICU on an FiO₂ of 100%. An arterial blood gas reveals the following information: pH of 7.18, PaCO₂ of 59 mm Hg, PaO₂ of 65 mm Hg, HCO₃ of 24 mEq/L What action would you recommend?