CCRN Respiratory questions with complete solutions

CCRN Respiratory questions with complete solutions Which of the following is not a cause of water gain in a mechanically ventilated patient? - Answer- Loss of protein Positive pressure ventilation causes ADH secretion, which causes water retention. Positive pressure ventilation decreases venous return to the heart and decreases cardiac output and perfusion to the kidney. The kidney secretes renin, which leads to angiotensin and aldosterone. Aldosterone causes the retention of sodium and water by the kidney. The closed ventilation system causes elimination of the insensible loss of water through the respiratory system. Mechanical ventilation does not directly cause loss of protein. Altering the pH of the gastric secretions through the use of H2 receptor antagonists, antacids, and proton pump inhibitors contributes to which potential complication? - Answer- Pneumonia Gastric colonization is likely with a gastric pH of greater than 4. Pneumonia rates of patients receiving mechanical ventilation correlate directly with increased gastric pH levels. This is one of the risks of the use of H2 receptor antagonists, antacids, and proton pump inhibitors to prevent stress ulcers in intubated patients. Colonization of the stomach with microorganisms leads to silent aspiration of these organisms into the lungs. Continuous aspiration of subglottic secretions is one method to reduce this silent aspiration. A patient had a thoracotomy yesterday and weaning efforts are to begin this morning. Which of the following spontaneous parameters indicate that the patient is ready for weaning? A. Tidal volume, 300 mL; vital capacity, 650 mL; respiratory rate, 28 breaths/min; maximum inspiratory pressure (MIP), −10 cm H2O; arterial oxygen saturation (SaO2), 92%; patient drowsy B. Tidal volume, 450 mL; vital capacity, 900 mL; respiratory rate, 22 breaths/min; MIP, −25 cm H2O; SaO2, 95%; patient awake C. Tidal volume, 500 mL; vital capacity, 750 mL; respiratory rate, 28 breaths/min; MIP, −25 cm H2O; SaO2, 88%; patient drowsy D. Tidal volume, 250 mL; vital capacity, 450 mL; respiratory rate, 24 breaths/min; MIP, −10 cm H2O; SaO2, 88%; patient awake - Answer- B The patient weighs 70 kg. Tidal volume should be at least 5 mL/kg, vital capacity should be at least 10 mL/kg, maximal inspiratory pressure should be at least −20 cm H2O, arterial blood gases and oxygen saturation should be acceptable (SaO2 greater than 90%), respiratory rate should not be excessive (less than 25 breaths/min), and, if possible, the patient should be awake and cooperative. Only option b meets these criteria. If a patient is breathing room air and his PaCO2 level is elevated, must his PaO2 be reduced? - Answer- Yes, because of Dalton's law of partial pressure If the patient is breathing room air and the PaCO2 is elevated, the PaO2 must be reduced because of Dalton's law, which basically says that all the partial pressures cannot add up to more than atmospheric pressure. A 22-year-old man is admitted with spontaneous pneumothorax. He is extremely dyspneic and anxious. He also is complaining of tingling around his mouth and his fingertips and feeling light-headed. Blood pressure is 120/82 mm Hg, heart rate is 110 beats/min, respiratory rate is 36 breaths/min and deep, and temperature is 37° C (98.6° F). Arterial blood gases probably would reveal which of the following? - Answer- Res. Alkalosis with Hypoxemia The patient is hyperventilating, which causes hypocapnia and respiratory alkalosis. Pneumothorax causes a shunt (ventilation is less than perfusion) and, therefore, hypoxemia. This is an example of a type I acute respiratory failure (hypoxemia and normal or decreased PaCO2). A 60-year-old man is admitted with a diagnosis of squamous cell carcinoma. He had a pneumonectomy today and has just arrived in the surgical intensive care unit. What is the emergent treatment for tension pneumothorax? - Answer- Insertion of a large-bore needle into the chest on the affected side Tension pneumothorax is treated emergently by insertion of a large-bore needle into the second or third intercostal space on the affected side. This is followed by insertion of a chest tube. A 54-year-old man has just returned to the critical care unit from the postanesthesia care unit. He has a 60-pack-year history of cigarette smoking and had a right lower lobectomy performed earlier today for treatment of lung cancer. He is still intubated and on a positive pressure mechanical ventilator. Which of the following would be the best position for this patient to optimize ventilation and perfusion? - Answer- Nonoperative side Putting the operative lung up encourages ventilation and reexpansion of the operative lung. Putting the nonoperative lung down enhances blood flow to the "good lung." Turning should still be performed but from the nonoperative lung to the back during the initial recovery phase. Prone position is recommended for acute respiratory distress syndrome. Prone is not a position used for postthoracotomy pa