AIR METHODS CC Paramedic Exam

The patient's arterial blood gas (ABG) values on room air are PaO2, 70 mm Hg; pH, 7.31; PaCO2, 52 mm Hg; and HC03-, 24 mEq/L. What is the interpretation of the patient's ABG? a. Uncompensated metabolic alkalosis. b. Uncompensated respiratory acidosis. c. Compensated respiratory acidosis. d. Compensated respiratory alkalosis. - Answer: b. Uncompensated respiratory acidosis. Rationale: The pH is closer to the acidic level, so the primary disorder is acidosis. Uncompensated respiratory acidosis values include a pH below 7.35, PaCO2 above 45 mm Hg, and HC03- of 22 to 26 mEq/L. Compensated respiratory acidosis values include a pH of 7.35 to 7.39, PaCO2 greater than 45 mm Hg, and HC03- greater than 26 mEq/L. Compensated respiratory alkalosis values include a pH of 7.41 to 7.45, PaCO2 below 35 mm Hg, and HC03- below 22 mEq/L. Uncompensated metabolic alkalosis values include a pH above 7.45, PaCO2 of 35 to 45 mm Hg, and HC03- above 26 mEq/L. On admission, a patient presents with a respiratory rate of 24 breaths/min, pursedlip breathing, heart rate of 96 beats/min in sinus tachycardia, and a blood pressure of 110/68 mm Hg. The patient's arterial blood gas (ABG) values on room air are PaO2, 70 mm Hg; pH, 7.38; PaCO2, 52 mm Hg; and HC03- , 34 mEq/L. What diagnoses would be most consistent with the above arterial blood gas values? a. Acute pulmonary embolism. b. Acute myocardial infarction. c. Congestive heart failure. d. Chronic obstructive pulmonary disease. - Answer: d. Chronic obstructive pulmonary disease. Rationale: The fact that the HC03- level has increased enough to compensate for the increased pCO2 level indicates that this is not an acute condition because the kidneys can take several days to adjust. The other choices would present with a lower HC03- level. The values indicate respiratory acidosis, and one of the potential causes is chronic obstructive pulmonary disease. Potential causes for respiratory alkalosis are pulmonary embolism, acute myocardial infarction, and congestive heart failure. On admission, a patient presents with a respiratory rate of 28 breaths/min, heart rate of 108 beats/min in sinus tachycardia, and a blood pressure of 140/72 mm Hg. The patient's arterial blood gas (ABG) values on room air are PaO2, 60 mm Hg; pH, 7.32; PaCO2, 45 mm Hg; and HC03- , 26 mEq/L. What action should the nurse anticipate for this patient? a. Initiate oxygen therapy. b. Prepare for emergency intubation. c. Administer 1 ampule of sodium bicarbonate. d. Initiate capnography. - Answer: a. Initiate oxygen therapy. Rationale: The patient is hypoxemic and oxygen therapy should be initiated at this time. The patient's arterial blood gas (ABG) values do not warrant intubation at this time. Sodium bicarbonate is not indicated because this patient has a normal bicarbonate level. Capnography would not be indicated at this time as the patient's CO2 is normal. A repeat ABG may be ordered to assess the patient's ongoing respiratory status. The patient's arterial blood gas (ABG) values on room air are PaO2, 40 mm Hg; pH, 7.10; PaCO2, 44 mm Hg; and HC03- , 16 mEq/L. What is the interpretation of the patient's ABG? a. Uncompensated respiratory acidosis. b. Uncompensated metabolic acidosis. c. Compensated metabolic acidosis. d. Compensated respiratory acidosis. - Answer: b. Uncompensated metabolic acidosis. Rationale: The pH is below normal range (7.35 to7.45), so this is uncompensated acidosis. The PaCO2 normal and the HC03- is markedly low. This indicates uncompensated metabolic acidosis. Uncompensated metabolic acidosis values include a pH below 7.35, PaCO2 of 35 to 45 mm Hg, and HC03- below 22 mEq/L. Uncompensated respiratory acidosis values include a pH below 7.35, PaCO2 above 45 mm Hg, and HC03- 22 to 26 mEq/L. Compensated metabolic acidosis values include a pH of 7.35 to 7.39, PaCO2 below 35 mm Hg, and HC03- below 22 mEq/L. Compensated respiratory acidosis values include a pH of 7.35 to 7.35, PaCO2 above 45 mm Hg, and HC03- above 26 mEq/L. In a patient who is hemodynamically stable, which procedure can be used to estimate the PaCO2 levels? a. PaO2/FiO2 ratio. b. A-a gradient. c. Residual volume (RV). d. End-tidal CO2. - Answer: d. End-tidal CO2. Rationale: Capnography is the measurement of exhaled carbon dioxide (CO2) gas; it is also known as end-tidal CO2 monitoring. Normally, alveolar and arterial CO2 concentrations are equal in the presence of normal ventilation-perfusion (V/Q) relationships. In a patient who is hemodynamically stable, the end-tidal CO2 (PetCO2) can be used to estimate the PaCO2. Normally, the PaO2/FiO2 ratio is greater than 286; the lower the value, the worse the lung function. The A-a gradient is normally less than 20 mm Hg on room air for patients younger than 61 years. This estimate of intrapulmonary shunting is the least reliable clinically, but it is used often in clinical decision making. Residual volume is the amount of air left in the lung after maximal exhalation. A normal value is 1200 to 1300 mL. A patient presents with the following arterial blood gas (ABG) values: pH, 7.20; PaO2, 106 mm Hg; PaCO2, 35 mm Hg; and HC03-, 11 mEq/L. What is the interpretation of the patient's ABG? a. Uncompensated respiratory acidosis. b. Uncompensated metabolic acidosis. c. Uncompensated metabolic alkalosis. d. Uncompensated respiratory alkalosis. - Answer: b. Uncompensated metabolic acidosis. Rationale: The pH indicates acidosis, and the HC03- is markedly decreased, indicating a metabolic disorder. Uncompensated metabolic acidosis values include a pH below 7.35, PaCO2 of 35 to 45 mm Hg, and HC03- below 22 mEq/L. Uncompensated respiratory acidosis values include a pH below 7.35, PaCO2 above 45 mm Hg, and HC03- of 22 to 26 mEq/L. Uncompensated respiratory alkalosis values include a pH above 7.45, PaCO2 below 35 mm Hg, and HC03- of 22 to 26 mEq/L. Uncompensated metabolic alkalosis values include a pH above 7.45, PaCO2 of 35 to 45 mm Hg, and HC03- above 26 mEq/L A patient has the following arterial blood gas (ABG) values: pH, 7.20; PaO2, 106 mm Hg; pCO2, 35 mm Hg; and HC03- , 11 mEq/L. What symptom would be most consistent with the ABG values? a. Diarrhea. b. Shortness of breath. c. Central cyanosis. d. Peripheral cyanosis. - Answer: a. Diarrhea. Rationale: Diarrhea is one mechanism by which the body can lose large amounts of HC03-. The other choices are indications of hypoxia, which is not indicated with a PaO2 of 106 mm Hg. A bronchoscopy is indicated for a patient with what condition? a. Pulmonary edema. b. Ineffective clearance of secretions. c. Upper gastrointestinal bleed. d. Instillation of surfactant. - Answer: b. Ineffective clearance of secretions. Rationale: Bronchoscopy visualizes the bronchial tree. If secretions are present, they can be removed by suctioning and sent for culture to help adjust antibiotic therapy. A 75-kg patient is on a ventilator and may be ready for extubation. A respiratory therapist assesses the patient's rapid shallow breathing index (RSBI). Which result best suggests that the patient is ready for a spontaneous breathing trial? a. RSBI = 150 b. RSBI = 125 c. RSBI = 110 d. RSBI = 90 - Answer: d. RSBI = 90 Rationale: The rapid, shallow breathing index (RSBI) can predict weaning success. An RSBI of less than 105 is considered predictive of weaning success. If the patient is receiving sedation, the medication is discontinued at least 1 hour before the RSBI is measured. If the patient meets criteria for weaning readiness and has an RSBI of less than 105, a spontaneous breathing trial can be performed. Ventilation-perfusion (V/Q) scans are ordered to evaluate the possibility of which of the following? a. Pulmonary emboli. b. Acute myocardial infarction. c. Emphysema. d. Acute respiratory distress syndrome. - Answer: a. Pulmonary emboli. Rationale: This test is ordered for the evaluation of pulmonary emboli. Electrocardiography or cardiac enzymes are ordered to evaluate for myocardial infarction; arterial blood gas analysis, chest radiography, and pulmonary function tests are ordered to evaluate for emphysema. Chest radiography and hemodynamic monitoring are ordered for evaluation of acute respiratory distress syndrome. A patient presents with absent lung sounds in the left lower lung fields, moderate shortness of breath, and dyspnea. The nurse suspects pneumothorax and notifies the practitioner. Orders for a STAT chest radiography and reading are obtained. Which finding best supports the nurse's suspicions? a. Blackness in the left lower lung area. b. Whiteness in the left lower lung area. c. Blunted costophrenic angles. d. Elevated left hemidiaphragm. - Answer: a. Blackness in the left lower lung area. Rationale: With a pneumothorax, the pleural edges become evident as one looks through and between the images of the ribs on the film. A thin line appears just parallel to the chest wall, indicating where the lung markings have pulled away from the chest wall. In addition, the collapsed lung will be manifested as an area of increased density separated by an area of radiolucency (blackness). A patient with chronic obstructive pulmonary disease (COPD) requires intubation. After the practitioner intubates the patient, the nurse auscultates for breath sounds. Breath sounds are questionable in this patient. Which action would best assist in determining endotracheal tube placement in this patient? a. Stat chest radiographic examination. b. End-tidal CO2 monitor. c. Ventilation-perfusion (V/Q) scan. d. Pulmonary artery catheter insertion. - Answer: b. End-tidal CO2 monitor. Rationale: Although a stat chest radiography examination would be helpful, it has a long turnaround time, and the patient's respiratory status can deteriorate quickly. An end-tidal CO2 monitor gives an immediate response, and the tube can then be reinserted without delay if incorrectly placed. The other tests are not for endotracheal tube placement.