Fundamentals of Respiratory Care Part 2

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Review 2

Under what conditions will the alveolar PACO2 rise above normal?

if VA decreases relative to carbon dioxide production

A 70-kg male patient has a VCO2 of 200 ml/min and a VA of 9 L/min. From this information, what can you infer?

The patient will have a lower than normal PACO2.

What is the primary determinant of the PAO2?

PO2 in the inspired gas

A normal person breathing 100% oxygen at sea level would have PAO2 of about what level?

670 mm Hg

What is the highest PAO2 one could expect to observe in an individual breathing room air at sea level?

110 to 120 mm Hg

When is the rate of gaseous diffusion across a biological membrane decreased?

The partial pressure gradient is low.

What is the primary factor that maintains the pressure gradient that drives oxygen from the capillaries into the interstitial spaces and into the cells?

cellular consumption of oxygen

What occurs in the bases of the upright lung?

The V/Q is lower than the average.

If the total hemoglobin content (Hb + HbO2) of a sample of blood is 20 g/dl and the oxyhemoglobin (HbO2) content is 15 g/dl, what is the HbO2 saturation?

75%

At a PaO2 of 65 mm Hg, what is the approximate saturation of Hb with oxygen?

80%

What is the approximate normal CaO2 - Cmc013-1.jpgO2 in a healthy adult at rest?

5 ml/dl

According to the Fick principle, if oxygen consumption remains constant, an increase in cardiac output will manifest itself as which of the following?

decrease in the CaO2

What role does the Bohr effect play in oxygen transport?

enhances oxygen delivery to tissues and oxygen pickup at lungs

A patient has a P50 value of 29 mm Hg. What does this indicate?

decreased affinity of Hb for oxygen

Which of the following statements is true regarding the Haldane effect?

At high SaO2 levels, the capacity of blood to hold carbon dioxide decreases.

Which of the following equations best describes oxygen delivery to the tissues?

arterial oxygen content ´ cardiac output

A patient with a normal PaO2 and cardiac output is exhibiting signs and symptoms of tissue hypoxia. What is the most likely cause?

hemoglobin deficiency

What is a uniform distribution of large molecules that attract and hold water?

colloid

Gas transport in the body is most affected by changes in which of the following variables?

ambient pressure.

A solution holding the maximum amount of solute in a given volume at a constant temperature is said to be what?

saturated

The most important physiological characteristic of solutions is their ability to exert pressure.

true

Which of the following is true regarding osmotic pressure?

Osmotic pressure depends on the number of particles in solution.

Which of the following is an isotonic solution?

0.90% NaCl

Positive ions are referred to as what?

cations

What is the gEq weight of an acid?

amount of the acid containing 1 mol of replaceable H+ ions

What type of solution could have 1 gEq of solute per L of solution?

normal

You add 50 ml of water to 150 ml of a 6% solution. What is the new concentration?

4.5%

What is a characteristic of an acid?

is a proton donor

Where does ammonia play its most important role as a base buffer?

kidney

Which of the following describes an aspect of pH?

Any solution with a pH of 7 is neutral.

An adult's insensible water through the lungs averages what level?

200 ml/day

What best describes an aspect of the movement of fluid and solutes between the capillaries and the interstitial space?

Electrolytes move freely across the capillary wall into the interstitium.

What does the Donnan effect describe?

how proteins attract cations, which increase capillary osmotic pressure.

Describe the normal pressures or flows at the arterial end of the capillary.

Plasma minus the proteins flows into the interstitium.

Which of the following correctly describes a facet of chloride?

Cl- levels vary inversely with HCO3- levels.

What cation is the most prominent in the intracellular compartment?

K+

What is a normal K+ blood level?

3.5 to 5.0 mEq/L.

What is the normal serum calcium concentration?

8.7 to 10.4 mg/dl

What is hypercalcemia most often associated with?

hypoparathyroidism

What is the normal range for serum phosphate?

1.2 to 2.3 mEq/L.

By comparison, how much fixed acid is produced in any given period compared to the volatile acid CO2?

less fixed than volatile

When a strong acid is added to the bicarbonate buffer system, what is the result?

weak acid and neutral salt

What affect does hyperventilation have on the closed buffer systems?

causes them to release more H+

A patient has a PCO2 of 80 mm Hg. What is the concentration of dissolved CO2 (in mM/L) in the blood?

2.4 mmol/L

Of the nonbicarbonate buffer systems, which one is the most important?

hemoglobin

Which of the following systems is primarily responsible for the buffering of fixed acids?

HCO3-

Which of the following acts as the "first-line" or immediate defense against the accumulation of H+ ions?

blood buffer systems

The majority of the acid the body produces in a day is excreted through the lungs as CO2. What happens to the H+ ions?

They bind to an OH-forming H2O.

If the blood PCO2 is high, the kidneys will do which of the following?

excrete more H+ and reabsorb more HCO3-

Which organ system maintains the normal level of HCO3- at 24 mEq/L?

renal

The numerator of the Henderson-Hasselbalch (H-H) equation (HCO3-) relates to which of the following?

renal buffering and excretion of fixed acids

What is the primary chemical event in metabolic alkalosis?

increase in blood HCO3- levels

Compensation for metabolic acidosis occurs through which of the following?

decrease in blood CO2 levels

An ABG result shows pH of 7.35, PaCO2 of 30 mm Hg, and HCO3- of 18 mEq/L. What compensatory measure has the body taken to at least partially compensate for the acid-base disorder?

blown off CO2

A decrease in the H+ ion concentration [H+] of the blood caused by a low PaCO2 best describes which of the following?

respiratory alkalosis

What is the most common cause of respiratory alkalosis?

hypoxemia

Compensation for respiratory alkalosis occurs through which of the following?

renal excretion of HCO3-

What is the main compensatory mechanism for metabolic acidosis?

hyperventilation

What is the treatment for severe metabolic acidosis?

NaHCO3- infusion

Based on the following ABG results, what is the most likely acid-base diagnosis?pH = 7.43, PCO2 = 39 mm Hg, HCO3- = 25.1 mEq/L

acid-base status within normal limits

Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.62, PCO2 = 41 mm Hg, HCO3- = 40.9 mEq/L

acute (uncompensated) metabolic alkalosis

Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.08, PCO2 = 39 mm Hg, HCO3- = 11.8 mEq/L

acute metabolic acidosis

Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.28, PCO2 = 53 mm Hg, HCO3- = 25.8 mEq/L

acute respiratory acidosis

Based on the following ABG results, what is the most likely acid-base diagnosis? pH = 7.35, PCO2 = 68 mm Hg, HCO3- = 34.3 mEq/L

fully compensated respiratory acidosis

What is the normal range for BE?

±2 mEq/L

In acute respiratory acidosis, what would you expect the BE range to be?

+2 to -2 mEq/L

Using the Henderson-Hasselbalch equation, determine the accuracy of the gas below. To be considered accurate, it must be within 0.03 pH unit. pH = 7.35, PCO2 = 77 mm Hg, HCO3- = 41 mEq/L

This gas is completely accurate.

What receptors cause a rapid shallow breathing pattern when stimulated by pulmonary disease?

J receptors

What receptors are known to cause an increase in ventilation when the patient's limbs are moved or cold water is splashed on the patient's face?

peripheral proprioceptors

Which receptors are primarily responsible for the initial increase in ventilation that occurs at the beginning of exercise?

proprioceptors

Which of the following is indirectly responsible for minute-to-minute control of breathing?

CO2 levels

In the face of chronically elevated levels of CO2, what happens to the response mediated by the central chemoreceptors?

It is muted or decreased.

Both anemia and carbon monoxide (CO) poisoning can cause severe hypoxia, yet neither condition results in a major stimulation of breathing. Why is this so?

The peripheral chemoreceptors do not respond to low oxygen content.

In the face of hyperoxia, what is the response of the peripheral chemoreceptors to hypercapnia?

There is virtually no response.

Coexisting arterial hypoxemia, acidemia, and high PaCO2 (i.e., asphyxia) will have what affect on the peripheral chemoreceptors?

There is a maximal increased drive to breathe.

How should oxygen therapy be administered to chronically hypercapnic patients?

give as much oxygen as required to maintain adequate oxygenation

While observing a patient's breathing, you note that the depth and rate first increase, then decrease, followed by a period of apnea. Which of the following terms would you use in charting this observation?

Cheyne-Stokes breathing

You observe a patient's breathing pattern as very irregular, with periods of breathing interspersed with long periods of apnea. Which of the following terms would you use in charting this observation?

Biot's respiration

In patients with closed-head injuries, what may happen if the patient has hypercapnia?

Vasodilation causes increased intracranial pressure and possibly stops blood flow.

What is the normal range for systolic blood pressure in the adult patient?

90 to 140 mm Hg

What artery is most often used to assess arterial blood pressure?

brachial

What is indicated by the presence of central cyanosis?

respiratory failure

What is the most common cause of jugular venous distention (JVD)?

right-sided heart failure

What term is used to describe an abnormal anteroposterior curvature of the spine?

kyphosis

What term is used to describe the breathing pattern seen in COPD patients in which the lower costal margins of the chest wall draw inward with each inspiration?

Hoover's sign

On palpating the neck region of a patient on a mechanical ventilator, you notice a crackling sound and sensation. What is the most likely cause of this observation?

subcutaneous emphysema

To minimize bony interference with percussion on the posterior chest wall, the practitioner should have the patient do which of the following?

Raise his arms above his shoulders.

A creaking or grating sound that increases in intensity with deep breathing and is similar to coarse crackles, but is not affected by coughing, best describes which of the following?

friction rub

What is the area of the anterior chest wall overlying the heart is called?

precordium

Where is the normal apical impulse (point of maximal impulse [PMI]) usually identified?

fifth left intercostal space, midclavicular line

In auscultating the heart sounds of a patient with chronic hypoxemia, you notice a marked increase in the intensity of the second heart sound (S2) and no splitting during inhalation. This finding is most consistent with which of the following?

pulmonary hypertension

What term is used to describe a white blood cell (WBC) count that is below normal values?

leukopenia

What type of white blood cell increases in response to viral infections?

lymphocytes

What is the name used for immature neutrophils?

bands

What term is used to describe the increase in neutrophils due to recruitment of marginated cells back into the circulating blood?

pseudoneutrophilia

What term is used to describe a red blood cell (RBC) count that is below normal values?

anemia

What term is used to describe a potassium concentration that is below normal in the blood serum?

hypokalemia

In which of the following clinical settings would hyperkalemia be a significant problem?

during weaning from mechanical ventilation

Your patient has an elevated aspartate aminotransferase (AST). What two organs are most likely diseased?

heart and liver

Your patient has an elevated creatine kinase level. What two organs are most likely diseased?

heart and skeletal muscle

What is the upper limit of normal for the fasting blood glucose level?

140 mg/dl

Which of the following symptoms is least often associated with hypoglycemia?

shortness of breath

Valvular defects in the heart can be detected with a 12-lead ECG.

false

What term is used to define the ability of certain cardiac cells to depolarize without stimulation?

automaticity

What structure normally paces the healthy heart?

sinoatrial (SA) node

At what part of the cardiac conduction system does the electrical impulse travel most rapidly?

Purkinje fibers

What is the normal maximum length of the P wave?

3 mm

What is the normal period of time for the PR interval?

not longer than 0.20 second

What is implied by an abnormally prolonged PR interval?

atrioventricular block

What parameter is measured on the vertical axis of the ECG paper?

voltage

The QRS of an ECG falls on a dark vertical line of the ECG paper. Subsequent QRS complexes fall on every other dark line (10 mm apart). What is the ventricular rate?

150/min

What is suggested by inverted T waves on the ECG?

myocardial ischemia

For which of the following arrhythmias would an electronic pacemaker be indicated?

third-degree block

Atrial flutter is considered to be a life-threatening arrhythmia True or false

false

What is a possible serious complication associated with atrial fibrillation?

atrial thrombi

Sources for the electrical impulse that triggers cardiac contraction that lie outside the sinoatrial node are referred to as ectopic foci.

true

Under ideal conditions, electrochemical oxygen (O2) analyzers have approximately what degree of accuracy?

2%

You are asked to provide continuous monitoring of the FIO2 provided by a humidified O2 delivery system using a galvanic cell analyzer. Where would you install the analyzer's sensor?

proximal to the heated humidifier

After obtaining an arterial blood sample through percutaneous puncture using a syringe that does not have a capping safety device, what should you do?

"Scoop" the needle cap up with one hand, then plug the syringe.

When performing a percutaneous needle puncture of the radial artery, you get only a small spurt of blood. Which of the following is the best action at this time?

Slowly withdraw the needle until a pulsatile flow fills the syringe.

A PaO2 below what value would be considered severe hypoxemia?

40 mm Hg

What is a normal level for CaO2?

18 to 20 ml/100 ml

To assess gas exchange at the tissues, you would obtain a blood sample from which of the following?

pulmonary artery (balloon-inflated)

What is the best site for capillary puncture in an infant?

lateral aspect of the heel's plantar surface

What media are used to calibrate a blood gas analyzer's gas electrodes?

precision mixtures of O2 and CO2

Statistically derived limits for internal quality control of blood gas samples are usually set at what appropriate level?

2 standard deviations from the mean

Oximetry is the measurement of blood hemoglobin saturations using what technique?

spectrophotometry

For continuous monitoring of adults and children, you should set a pulse oximeter's low alarm in what range?

88% to 92%

What is the most common source of error and false alarms with pulse oximetry?

patient motion artifact

You obtain an SpO2 reading of 100% on a patient receiving O2 through a nonrebreathing mask. What range of PaO2 levels is possible in this patient?

100 to 600 mm Hg

What is the primary problem in obstructive lung disease?

increased airway resistance

What is the American Thoracic Society standard for volumetric accuracy of spirometers?

±3% error, or within 50 ml of the reference value

What is the American Thoracic Society standard for accuracy when measuring flows during pulmonary function testing?

95% accuracy or within 0.20 L/sec, whichever is greater

To ensure validity of the forced vital capacity (FVC) measurement, how many attempts should the patient perform?

three that are acceptable

What is the minimum objective standard for the volume exhaled during the final 1 second of an acceptable forced vital capacity effort?

0.025 L

What is the minimum percent of the forced vital capacity that healthy people can exhale in the first 1 second?

70%

During a helium (He) dilution functional residual capacity (FRC) measurement, the technologist first bleeds in 500 ml of He (He Vol) and obtains an initial reading of 4.0% (FiHe). After equilibration, the second He reading is 3.2% (FfHe). What is the patient's FRC?

3125 ml

When used to determine functional residual capacity, the body plethysmograph operates on which of the following physical principles?

Boyle's law

What is the normal average inspiratory capacity (IC)?

3600 ml

Which of the following statements is TRUE when comparing the pulmonary function test results of men versus women?

Males have larger predicted volumes when corrected for height.

What is the normal predicted total lung capacity (TLC) for adults?

about 6 L

What is a normal single-breath diffusing capacity for carbon monoxide for a young, healthy man of average size?

40 ml/min/mm Hg

What lung problem is ventilation/perfusion (mc212-1.jpg) scanning used to detect?

pulmonary embolism

In what pulmonary condition does the chest radiograph often "lag behind" the clinical status of the patient?

pneumonia

Which radiographic view of the chest allows the physician to read the best quality film?

posteroanterior

Your patient just had an anteroposterior chest film taken. When you view the film, what may be a consideration?

The heart may appear larger then it really is.

What is indicated by the presence of gas bubbles within the pleural fluid without prior surgery or needle insertion?

empyema

What term is used to describe the shadows seen on the chest film when the alveoli fill with pus, fluid, or blood?

infiltrates

What is the most common cause of cephalization as seen on the upright chest film?

left heart failure

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