CCRN 2024 LATEST VERSION EXAM 450 QUESTIONS AND
CORRECT ANSWERS//ALREADY GRADED A+
what part of the brain in the primary control of ventilation - CORRECT ANSWER-brain stem
-senses blood pH
-decrease in pH--> ventilation is stimulated (increases RR and depth of breathing)
Peripheral control of ventilation is Pa02. Where is Pa02 senses? - CORRECT ANSWER-aortic arch
-decreased Pa02 = hypoxemia
-decreased Pa02--> ventilation is stimulated
why do chronic PaC02 retainers rely on mild hypoxemia? - CORRECT ANSWER-for ventilator drive
-if Pa02 is corrected to normal, this will result in a decreased drive to breathe
what is the clinical indicator of ventilation? - CORRECT ANSWER-PaC02 (NOT Pa02)
What is minute ventilation? What is the normal? - CORRECT ANSWER-Tidal volume x Respiratory Rate
~4L/minute
An increase in minute ventilation causes - CORRECT ANSWER-an increase in work of breathing
What is the primary muscle of ventilation? - CORRECT ANSWER-diaphragm
anything that affects the health of the diaphragm (deconditioning, hypoxemia, acidosis,
hypophosphatemia) will affect ventilation
what is the position for optimal ventilation? - CORRECT ANSWER-Upright sitting
-supine is NOT good for ventilation
what causes alveolar dead space? - CORRECT ANSWER-PE, non-perfused alveoli
,-no gas exchange, no blood flow to the alveoli past the area of the blood clot
what is pulmonary perfusion - CORRECT ANSWER--movement of blood past alveoli through pulmonary
capillaries
what causes decreased pulmonary perfusion? - CORRECT ANSWER-any decrease in blood flow past the
alveoli
-PE
-low cardiac output
"good" lung up or down? - CORRECT ANSWER-"good" lung down
-gravity increases pulmonary perfusion
what is an example of a respiratory pathological shunt? - CORRECT ANSWER-ARDS- movement of blood
from the right side of the heart to the left side of the heart without getting oxygenates; venous blood
moves to the arterial side. **refractory hypoxemia**
what is the treatment for a respiratory pathological shunt? - CORRECT ANSWER-oxygen and PEEP
how does PEEP help? - CORRECT ANSWER--prevents expiratory pressure from returning to zero
-decreases surface tension of alveoli; preventing atelectasis
-extends time of gas transfer
At the cellular level, sufficient oxygen is needed for the production of - CORRECT ANSWER-ATP
-which is needed for cell energy and life
-aerobic metabolism
without sufficient oxygen at the cellular level, what is produced? - CORRECT ANSWER-lactic acid
-which is evidence of anaerobic metabolism, organ failure, cell death
,what can effect oxygenation that is not related to ventilation? - CORRECT ANSWER--severe anemia
-low cardiac output
-inability to utilize oxygen ex. sepsis (lactate acidosis)
what conditions cause a shift to the left of the oxyhemoglobin dissociation curve? (hemoglobin holds on
to oxygen molecules) - CORRECT ANSWER--alkalosis
-low PaC02
-hypothermia
low 2, 3-DPG
does hemoglobin hold or to or release oxygen molecules when there is a left shift of oxyhemoglobin
dissociation - CORRECT ANSWER-hold on to molecules
does hemoglobin hold or to or release oxygen molecules when there is a right shift of oxyhemoglobin
dissociation - CORRECT ANSWER-release oxygen more easily into the tissues
what conditions cause a shift to the right of the oxyhemoglobin dissociation curve? (hemoglobin
releases oxygen molecules) - CORRECT ANSWER--acidosis
-high PaC02
-fever
-high 2,3-DPG
is a left shift of oxyhemoglobin dissociation good or bad for the tissues - CORRECT ANSWER-bad for the
tissues
hemoglobin holds on to oxygen
is a right shift of oxyhemoglobin good or bad for the tissues - CORRECT ANSWER-good for the tissues
Sa02 is low but 02 is easily released to the tissues
what is 2, 3-DPG - CORRECT ANSWER-2, 3- diphosphoglycerate
, organic phosphate found in RBC that has the ability to alter the affinity of hgb for oxygen
where is 2, 3-DPG found - CORRECT ANSWER-in the RBC
what causes decreased 2, 3-DPG - CORRECT ANSWER--multiple blood transfusion
-hypothyroid
-hypophosphatemia
**hemoglobin holds onto O2 resulting in less 02 available to tissues**
what increases 2, 3-DPG - CORRECT ANSWER--chronic hypoxemia
-anemia
-high altitudes
-chronic HF
-hyperthroid
**hemoglobin more readily releases 02 resulting in more 02 available to tissues)
carbon monoxide has a high or lower affinity for hemoglobin than oxygen - CORRECT ANSWER-high
affinity for hemoglobin than oxygen
--do NOT measure CO poisoning with pulse ox
how do you treat carbon monoxide poisoning - CORRECT ANSWER-100% Fi02 (despite what the pulse ox
reads)
severe cases- hyperbaric oxygen chamber
what is static complaince - CORRECT ANSWER-measurement of elastic properties of the LUNG
-a decrease in compliance increases resistance or stiffness
how will plateau pressures affect static lung compliance - CORRECT ANSWER-an increase in plateau
pressures will decrease static lung compliance
CORRECT ANSWERS//ALREADY GRADED A+
what part of the brain in the primary control of ventilation - CORRECT ANSWER-brain stem
-senses blood pH
-decrease in pH--> ventilation is stimulated (increases RR and depth of breathing)
Peripheral control of ventilation is Pa02. Where is Pa02 senses? - CORRECT ANSWER-aortic arch
-decreased Pa02 = hypoxemia
-decreased Pa02--> ventilation is stimulated
why do chronic PaC02 retainers rely on mild hypoxemia? - CORRECT ANSWER-for ventilator drive
-if Pa02 is corrected to normal, this will result in a decreased drive to breathe
what is the clinical indicator of ventilation? - CORRECT ANSWER-PaC02 (NOT Pa02)
What is minute ventilation? What is the normal? - CORRECT ANSWER-Tidal volume x Respiratory Rate
~4L/minute
An increase in minute ventilation causes - CORRECT ANSWER-an increase in work of breathing
What is the primary muscle of ventilation? - CORRECT ANSWER-diaphragm
anything that affects the health of the diaphragm (deconditioning, hypoxemia, acidosis,
hypophosphatemia) will affect ventilation
what is the position for optimal ventilation? - CORRECT ANSWER-Upright sitting
-supine is NOT good for ventilation
what causes alveolar dead space? - CORRECT ANSWER-PE, non-perfused alveoli
,-no gas exchange, no blood flow to the alveoli past the area of the blood clot
what is pulmonary perfusion - CORRECT ANSWER--movement of blood past alveoli through pulmonary
capillaries
what causes decreased pulmonary perfusion? - CORRECT ANSWER-any decrease in blood flow past the
alveoli
-PE
-low cardiac output
"good" lung up or down? - CORRECT ANSWER-"good" lung down
-gravity increases pulmonary perfusion
what is an example of a respiratory pathological shunt? - CORRECT ANSWER-ARDS- movement of blood
from the right side of the heart to the left side of the heart without getting oxygenates; venous blood
moves to the arterial side. **refractory hypoxemia**
what is the treatment for a respiratory pathological shunt? - CORRECT ANSWER-oxygen and PEEP
how does PEEP help? - CORRECT ANSWER--prevents expiratory pressure from returning to zero
-decreases surface tension of alveoli; preventing atelectasis
-extends time of gas transfer
At the cellular level, sufficient oxygen is needed for the production of - CORRECT ANSWER-ATP
-which is needed for cell energy and life
-aerobic metabolism
without sufficient oxygen at the cellular level, what is produced? - CORRECT ANSWER-lactic acid
-which is evidence of anaerobic metabolism, organ failure, cell death
,what can effect oxygenation that is not related to ventilation? - CORRECT ANSWER--severe anemia
-low cardiac output
-inability to utilize oxygen ex. sepsis (lactate acidosis)
what conditions cause a shift to the left of the oxyhemoglobin dissociation curve? (hemoglobin holds on
to oxygen molecules) - CORRECT ANSWER--alkalosis
-low PaC02
-hypothermia
low 2, 3-DPG
does hemoglobin hold or to or release oxygen molecules when there is a left shift of oxyhemoglobin
dissociation - CORRECT ANSWER-hold on to molecules
does hemoglobin hold or to or release oxygen molecules when there is a right shift of oxyhemoglobin
dissociation - CORRECT ANSWER-release oxygen more easily into the tissues
what conditions cause a shift to the right of the oxyhemoglobin dissociation curve? (hemoglobin
releases oxygen molecules) - CORRECT ANSWER--acidosis
-high PaC02
-fever
-high 2,3-DPG
is a left shift of oxyhemoglobin dissociation good or bad for the tissues - CORRECT ANSWER-bad for the
tissues
hemoglobin holds on to oxygen
is a right shift of oxyhemoglobin good or bad for the tissues - CORRECT ANSWER-good for the tissues
Sa02 is low but 02 is easily released to the tissues
what is 2, 3-DPG - CORRECT ANSWER-2, 3- diphosphoglycerate
, organic phosphate found in RBC that has the ability to alter the affinity of hgb for oxygen
where is 2, 3-DPG found - CORRECT ANSWER-in the RBC
what causes decreased 2, 3-DPG - CORRECT ANSWER--multiple blood transfusion
-hypothyroid
-hypophosphatemia
**hemoglobin holds onto O2 resulting in less 02 available to tissues**
what increases 2, 3-DPG - CORRECT ANSWER--chronic hypoxemia
-anemia
-high altitudes
-chronic HF
-hyperthroid
**hemoglobin more readily releases 02 resulting in more 02 available to tissues)
carbon monoxide has a high or lower affinity for hemoglobin than oxygen - CORRECT ANSWER-high
affinity for hemoglobin than oxygen
--do NOT measure CO poisoning with pulse ox
how do you treat carbon monoxide poisoning - CORRECT ANSWER-100% Fi02 (despite what the pulse ox
reads)
severe cases- hyperbaric oxygen chamber
what is static complaince - CORRECT ANSWER-measurement of elastic properties of the LUNG
-a decrease in compliance increases resistance or stiffness
how will plateau pressures affect static lung compliance - CORRECT ANSWER-an increase in plateau
pressures will decrease static lung compliance
