Pulmonary CCRN study Questions and Answers well Explained Latest 2024/2025 Update 100% Correct.

Which of the following is considered to be an absolute contraindication for anticoagulation therapy in managing a VTE? A. Hypertensive patient B. Intracranial hemorrhage C. Postoperative patient D. Presence of epidural catheter - B Intracranial hemorrhage is an absolute contraindication to receiving anticoagulation or antithrombolytic therapy. Hypertension should be managed prior to initiation of anticoagulation therapy. Uncontrolled hypertension is a relative contraindication and can increase the risk of bleeding. Postoperative patients may receive anticoagulation therapy to prevent or manage a VTE unless actively bleeding or determined to be at a higher risk of bleeding. Anticoagulation therapy should be held at least 12 hours before or after placement of an epidural catheter. Which of the following findings would indicate the presence of obstructive airway disease? A. FEV1/FVC ratio of < 60% B. FEV1/FVC ratio 75% to 80% C. FEV1/FVC ratio > 80% D. Normal FEV1/FVC ratio - A An obstructive airway disease causes a decrease in FEV1 with a relatively normal FVC resulting in a decrease in the FEV1/FVC ratio. A normal ratio is 75% to 80%. The lower the ratio, the greater the obstruction of airflow. This test is used to assess asthma patients during bronchodilator treatments. A normal FEV1/FVC ratio would indicate a restrictive airway disease. Which of the following signs would be the most significant finding in a COPD patient indicating the need for ventilatory support? A. PaCO2 > 55 mmHg B. Production of purulent sputum C. Inspiratory wheezing D. Paradoxical breathing - DParadoxical breathing indicates diaphragmatic fatigue, impending ventilatory failure, and respiratory arrest. The patient requires ventilatory support at this time due to the ventilatory fatigue. Hypercapnia and sputum production occur chronically in a COPD patient and by themselves are not indications for ventilation. Inspiratory wheezing needs to be managed in a COPD patient but does not necessarily indicate the need for ventilation. A patient presents with labored breathing and an RR of 40 beats per minute (bpm). The following ABG is obtained: PaO2 68 PaCO2 50 pH 7.34 SaO2 91% HCO3 22 Which of the following is the most accurate interpretation of the above situation? A. Normal ABG for COPD patient B. Respiratory failure due to metabolic acidosis C. Obstructive upper airway most likely causing respiratory failure D. Respiratory failure due to dead space - D Normally, as the minute ventilation (MV) increases, the PaCO2 should decrease. The normal pattern is an inverse relationship. In dead space, the alveolar ventilation decreases even as the respiratory rate increases. This results in an increase in CO2 and an abnormal relationship between MV and PaCO2. The patient has respiratory acidosis, not metabolic acidosis. It is not a normal blood gas for a patient with COPD because the pH is abnormal. There is no indication in this scenario that this would be an upper airway obstruction. What is the compensatory mechanism for VQ shunting? A. Decrease MV B. Bronchoconstriction C. Pulmonary vasoconstriction D. Increase cardiac output - C VQ shunting is perfusion without ventilation. A compensatory mechanism for the VQ shunt is pulmonary vasoconstriction to redistribute blood flow to ventilated alveolar units. In VQ shunts, patients increase their respiratory rate, causing an increase in min- ute ventilation. Bronchoconstriction occurs with deadspace in an attempt to shunt ven- tilation to perfused alveoli. An increase in cardiac output can occur in response to tissue hypoxia but is not considered a compensatory mechanism for a pulmonary shunt. A patient in the ICU is diagnosed with ARDS. The following are the ventilator settings and ABG results: SIMV 550 mL TV, Rate 16, 40%, PEEP 5 7.46 pH 48 PaCO2 82 PaO2 94% SaO2 What is the calculated PaO2/FiO2 ratio? A. 120 B. 20 C. 235 D. 205 - D To calculate, take the PaO2 from the ABG and divide by the FiO2 the patient was on when ABG was drawn. The PaO2 of 82 divided by 0.4 equals 205. A patient on a ventilator diagnosed with ARDS experiences a worsening hypoxia. On obtaining an ABG, it is noted that the patient has a PaO2/FiO2 ratio of 84. What does this ratio indicate regarding the severity of the patient's impaired oxygenation? A. Normal oxygenation B. Mild impairment C. Moderate impairment D. Severe impairment - D According to the Berlin definition of ARDS, a PaO2/FiO2 ratio less than 100 is considered to be a severe oxygenation impairment. Moderate is 100 to 200 and mild is 200 to 300. Normal PaO2 ratio is greater than 300. Shearing injury to the lung during mechanical ventilation of an ARDS patient, which is a result of repeated cycles of recruitment and derecruitment, is calledA. Barotrauma B. Volutrauma C. Atelectrauma D. Biotrauma - C Atelectrauma is injury caused by the repeated cycles of recruitment and derecruitment during mechanical ventilation of an ARDS patient. Barotrauma is injury to the lungs due to high ventilatory pressures, and volutrauma is caused by high volumes. Biotrauma is related to release of mediators in the lungs. A patient is on pressure-controlled ventilation for ARDS. The physician has stated that he wants the patient's TVs to be more than 250 mL/breath. On assessment, it is noted that the average TV is 200 mL/breath. Which of the following ventilator settings can be changed to increase the TV? A. Increase pressure limit B. Decrease RR C. Decrease the flow rate D. Increase PEEP levels - A The inspiratory volume is determined by the preset inspiratory pressure limit. When the upper pressure limit is reached, the ventilator stops delivering the breath in a pres- sure-controlled mode. To increase the amount of volume delivered, the pressure limit would need to be increased. Increasing PEEP will improve the PaO2/FiO2 ratio and oxygenation. Decreasing respiratory rate will not increase the TV and would actually further decrease the minute ventilation. Decreasing flow rate will not increase TV and may worsen dyspnea. A patient with ARDS is being ventilated in APRV mode. His oxygen saturation has decreased to 87%. The following are the ventilator settings: P high 26 cm H2O P low 0 cm H2O T high 4 seconds T low 0.6 seconds FiO2 100% What ventilator change can be made to improve the oxygen saturation of this patient? A. Increase P highB. Shorten T high C. Increase P low D. Prolong T low - A In the APRV mode of ventilation, there are three ways to increase oxygenation. One is to increase the FiO2. In this patient, the FiO2 was already 100%. The other ways are to increase the high pressure (P high) or to prolong the time in high pressure (T high). This increases the mean airway pressure and oxygenation. An ARDS patient is changed from a conventional ventilator to a HFOV. After 6 hours, the PaCO2 on the ABG was 54. Which of the following ventilator changes can be made to increase elimination of CO2? A. Decreasing the power B. Increasing FiO2 C. Increasing mean airway pressure (mPaw) D. Lowering the frequency (Hz) - D Frequency is measured in hertz (Hz) on an HFOV. By lowering the frequency, the tidal volumes increase, thus increasing the elimination of CO2. Increasing the power would also be a change that can increase CO2 elimination (not decreasing the power). Increasing the mPaw and FiO2 affects the oxygenation, not CO2 elimination. High levels of FiO2 administered to a COPD patient can cause ventilatory abnormali- ties. Which of the following best describes these abnormalities? A. Results in bronchoconstriction and wheezing B. Increases WOB C. Increases dead space and PaCO2 levels D. Increases production of sputum - C Oxygen should be administered to COPD patients to maintain oxygen saturation greater than 90% to 92% but with the lowest FiO2 possible to reach the goals. High levels of FiO2 can increase dead space and worsen hypercapnia. A patient presents with respiratory insufficiency and is admitted to the ICU. He has a significant history of cigarette smoking and COPD. An ABG is obtained. Which of the following would indicate an acute on chronic respiratory failure requiring intubation?A. PaCO2 of 64 mmHg B. PaO2 of 60 mmHg C. SaO2 of 90% D. pH 7.28 - D Patients with COPD have chronic respiratory acidosis (hypercapnia) compensated with an elevation of bicarbonate levels. This corrects the pH to normal. A respiratory acidosis without a normal pH (acidosis) indicates an acute on chronic respiratory fail- ure. The decision to intubate from an ABG is based on the pH, not the PaCO2 levels. A PaCO2 of 64 mmHg, PaO2 of 60 mmHg, and saturation of 90% may be found on a chronic ABG without acute changes. Your mechanically ventilated patient is on the following ventilator settings: AC rate 10 TV of 350 FiO2 of 40% PEEP 5. The patient has been agitated and breathing 18-20. He is now hypotensive and is noted to have excessive auto-PEEP. Which of the following would be the best method to treat the auto-PEEP? A. Decrease TV B. Sedate the patient with propofol C. Increase flow rate D. Administer bronchodilators - B Auto-PEEP can develop in patients breathing at ventilator breath rates, especially on assist control (AC). Unexplained hypotension in a mechanically ventilated patient may indicate presence of auto-PEEP. The best treatment of auto-PEEP is to decrease the total inspiratory time, usually accomplished by decreasing the respiratory rate. In this situation, just decreasing the rate will not necessarily improve the auto-PEEP because the patient is breathing faster than the set rate. Sedation and neuromuscular blocking agents will decrease the spontaneous breaths with better control of the total minute ventilation. Decreasing the TV is effective but less efficient and, in this particular situ- ation, it is not excessively high but the rate is the issue with the minute ventilation. Increasing the flow rate does not effectively decrease the inspiratory time unless set inappropriately to begin with.