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Fundamentals of Respiratory Care Part 2

Review 2
STUDY
PLAY
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
What term is used to describe the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs as seen on the chest film?
bat's wing
Which of the following statements best describe the typical findings on a chest radiograph for a patient with interstitial lung disease?
diffuse bilateral infiltrates
Which of the following findings on the chest radiograph is considered a secondary sign of emphysema?
flattening of the diaphragm
Radiographically, into how many compartments is the mediastinum divided?
three
What are the two most common reasons for placing a chest tube?
pneumothorax and empyema
What is the primary purpose of nutrition assessment?
to develop a nutrition care plan
What is the normal BMI for adults?
18.5 to 24.9 kg/m2
Which of the following blood tests is most useful for day to day monitoring of long-term trends in the nutrition status of the patient?
albumin levels
When is the basal metabolic rate (BMR) best obtained?
after 10 hours of fasting
What procedure is used to overcome the limitations associated with estimating resting energy expenditures?
indirect calorimetry
Which of the following has an RQ of 1.0?
carbohydrates
Which of the following is associated with acute cardiac muscle weakness and potential cardiopulmonary failure?
hypophosphatemia
Which of the following statements is NOT true regarding malnutrition in patients with chronic obstructive pulmonary disease (COPD)?
Vitamin deficiencies increased the need for oxygen.
Ideally, approximately what percent of a patient's estimated calorie needs should be provided by protein?
20%
What effect does high carbohydrate intake have on metabolism?
increases CO2 production
What tube feeding method must be used when the food substance is delivered beyond the pylorus?
continuous drip
Why raise the head of the bed during tube feedings?
It reduces the risk of aspiration.
Which of the following pulmonary diseases is similar to chronic obstructive pulmonary disease with regard to metabolic abnormalities?
cystic fibrosis
Which of the following is FALSE about the galvanic fuel cell O2 analyzer?
1. It actually measures the PO2 and not the O2 concentration.
2. Its fuel cells deplete and must be periodically replaced.
3. It requires an external power source (alternating current line or batteries). ***
4. It has a slower response time than the Clark electrode.
Which of the following is FALSE about the galvanic fuel cell O2 analyzer?
1. It actually measures the PO2 and not the O2 concentration.
2. Its fuel cells deplete and must be periodically replaced.
3. It requires an external power source (alternating current line or batteries). ***
4. It has a slower response time than the Clark electrode.
While checking a galvanic fuel cell O2 analyzer, you determine that the device fails to read 100% when exposed to pure O2. Which of the following actions would be the proper first step?
1. Send the device out for repair.
2. Change the analyzer's fuel cell.
3. Replace the analyzer's batteries. ***
4. Check the silica crystals.
Which of the following Centers for Disease Control and Prevention (CDC) barrier precautions would you use when obtaining an arterial blood gas (ABG) through percutaneous puncture?
I. gloves
II. protective eyewear
III. gown or apron
I and II
You return to a patient's room 20 minutes after drawing an ABG. Which of the following should you check at this time?
I. puncture site for hematoma
II. adequacy of distal circulation
III. prothrombin or partial thromboplastin times
I and II
To avoid transmission of blood-borne diseases when handling a used needle, what should you do?
I. Never recap the needle without a safety device (or scoop method).
II. Never handle the needle with both hands, or point it toward the body.
III. Never bend, break, or remove the needle from the syringe by hand.
IV. Always dispose of the syringe or needle in a proper sharps container.
I, II, III, and IV
If patient pain or anxiety occurs during arterial puncture, which of the following will probably occur?
1. respiratory acidosis
2. hyperventilation ***
3. hypoxemia
4. hypoventilation
When analyzing an ABG sample from a patient with acute respiratory distress syndrome and refractory hypoxemia, you notice a PaO2 of 141 mm Hg and a PaCO2 of 14 mm Hg. Which of the following analytic errors should you suspect?
1. exposure of the blood sample to air ***
2. excessive heparin in the sample
3. sample admixture with venous blood
4. excessive time since sample collection
A mixed venous blood sample obtained from a pulmonary artery catheter sample has a PO2 of 85 mm Hg and a hemoglobin saturation of 95%. Which of the following is likely?
I. The pulmonary artery catheter balloon was not deflated.
II. The sample was drawn from the proximal, not distal port.
III. The blood sample was withdrawn too quickly.
I and III
Warming a capillary bed to 42° C has which of the following effects?
I. It constricts the underlying blood vessels.
II. It increases blood flow well above tissue needs.
III. It "arterializes" the capillary blood.
II and III
Possible complications of capillary blood gas sampling include all of the following except:
1. infection
2. hypotension ***
3. hematoma
4. hemorrhage
Before a sample of capillary blood is taken, what should you do to the site?
I. warmed to 42° C for 10 minutes
II. squeezed lightly until blanched
III. cleaned with an antiseptic solution
I and III
A blood gas analyzer measures all of the following except:
1. PO2
2. pH
3. HCO3- ***
4. PCO2
Factors contributing to bias (systematic) errors during blood gas analysis include all of the following except:
1. contaminated buffers
2. component failure
3. incorrect procedures
4. statistical probability ***
Before attaching a transcutaneous blood gas monitor sensor to a patient, what should you do?
I. Provide a specified warm-up time and set the probe temperature.
II. Check the membrane and prepare a sensor with an adhesive ring and gel.
III. Prepare the monitoring site (remove excess hair and clean the skin).
I, II, and III
To avoid thermal injury with transcutaneous blood gas monitor sensors, what should you do?
I. Carefully monitor the sensor temperature.
II. Apply hydrocortisone cream under the sensor.
III. Regularly rotate the sensor site.
I and III
All of the following can result in falsely high HbO2 readings with a laboratory hemoximeter except:
1. high levels of fetal Hb
2. dirty cuvet chamber
3. elevated bilirubin levels
4. sickle cell anemia ***
Continuous SpO2 monitoring (versus a spot check) is indicated in all of the following situations except:
1. O2 therapy ***
2. bronchoscopy
3. exercise testing
4. sleep studies
Before taking a spot reading with a pulse oximeter, what should you do?
I. Allow sufficient response time.
II. Set the low alarm to 88% to 90%.
III. Confirm adequacy of pulse signal.
I, II, and III
Which of the following can cause false high readings when using a pulse oximeter?
1. fetal hemoglobin
2. presence of metHb
3. intravascular dyes
4. carboxyhemoglobin ***
All of the following will tend to cause false low readings when using a pulse oximeter except:
1. anemia
2. dark nail polish ***
3. vascular dyes
4. high metHb
All of the following pulmonary function devices directly collect and measure gas volumes except:
1. water-sealed spirometer
2. dry rolling-seal spirometer
3. bellows spirometer
4. pneumotachometer ***
Which of the following adverse reactions is NOT seen with pulmonary function testing?
1. hemoptysis ***
2. cough
3. chest pain
4. syncope
Which of the following volumes or capacities cannot be measured by simple spirometry?
I. functional residual capacity (FRC)
II. expiratory reserve volume (ERV)
III. residual volume (RV)
IV. inspiratory reserve volume (IRV)
I and III
Which of the following techniques are used to measure residual volume?
I. helium dilution
II. body plethysmography
III. nitrogen washout
IV. flow-volume loops
I, II, and III
The right heart shadow is NOT visible on the chest radiograph. Which of the following pathologies may explain this?
1. bleb in the right lower lobe
2. right middle lobe pneumonia ***
3. right lung pneumothorax
4. bilateral emphysema
In which of the following situations is obtaining a chest radiograph least useful?
1. following intubation
2. following placement of a central venous pressure line
3. when the patient's oxygenation status deteriorates for no known reason
4. when the static pressure drops by 2 cm H2O during CMV ***
Computed tomography (CT) scanning of the chest would be LEAST useful for which of the following?
1. to evaluate the pleura
2. to evaluate the large vessels of the mediastinum
3. to evaluate lung masses
4. to evaluate patients with asthma ***
Which of the following structures in the chest is NOT typically examined using MRI?
1. large vessels in the lung
2. structures in the mediastinum
3. lung parenchyma ***
4. hilar structures
In which of the following would loculation of pleural fluid NOT be as likely to occur?
1. empyema
2. hemothorax
3. congestive heart failure ***
4. exudative fluid
Which of the following statements is NOT true regarding the use of the chest x-ray to detect a pneumothorax?
1. An expiratory film may be best for a small pneumothorax.
2. The lung margin is often visible with a pneumothorax.
3. The standard chest film is of limited use in detecting a pneumothorax. ***
4. The film will show a lack of vascular markings in the affected region.
Which of the following statements is NOT true regarding the recognition and treatment of a tension pneumothorax as seen on the chest radiograph?
1. The mediastinum will be pushed towards the unaffected side.
2. The patient should be intubated. ***
3. It requires immediate insertion of a chest tube.
4. The hemidiaphragm on the affected side will be pushed downward.
Which of the following is NOT true regarding the visualization of air bronchograms on the chest film?
1. They are the hallmark of alveolar consolidation.
2. They signify air space disease.
3. They indicate fluid in the pleura.
4. They are caused by air-filled airways surrounded by consolidation. ***
Which of the following is NOT a typical cause of pulmonary edema as seen on the chest radiograph?
1. fluid overload
2. left heart failure
3. renal failure
4. cor pulmonale ***
Which of the following is NOT a typical cause of atelectasis?
1. rib fracture
2. hepatomegaly ***
3. abdominal surgery
4. pleurisy
Which of the following statements is FALSE regarding energy needs?
1. They increase with sepsis.
2. They vary with state of health.
3. They are increased with obese patients. ***
4. They vary with activity level.
Which of the following illnesses is NOT associated with acute catabolic disease?
1. sepsis
2. trauma
3. pulmonary embolism ***
4. burns
Zinc deficiencies are associated with all the following except:
1. bronchospasm ***
2. impaired wound healing
3. reduced immunity
4. poor blood clotting
Magnesium deficiencies are associated with all the following except:
1. reduced diaphragm strength
2. neurologic abnormalities
3. cardiac abnormalities
4. liver enlargement ***
Which of the following are true regarding the PACO2?
I. directly proportional to whole-body carbon dioxide production
II. inversely proportional to alveolar ventilation (mc001-1.jpgA)
III. normally maintained at about 35 to 45 mm Hg
I, II, and III
Breathing room air, a normal PAO2 - PaO2 of 5 to 10 mm Hg exists due to which of the following?
;
I. anatomical shunts in the pulmonary and cardiac circulations
II. normal limitations to oxygen diffusion in the lung
III. regional differences in pulmonary ventilation and blood flow
I and III
According to the Bohr effect, when the pH drops (blood becomes more acidic), what happens?
;
I. The affinity of Hb for oxygen decreases.
II. The Hb saturation for a given PO2 falls.
III. The Hb saturation for a given PO2 rises.
I and II
Compared to normal levels, a shift in the HbO2 curve to the right has which of the following effects?
;
I. The affinity of Hb for oxygen decreases.
II. The Hb saturation for a given PO2 falls.
III. The Hb saturation for a given PO2 rises.
I and II
In which of the following conditions will erythrocyte concentration of 2,3-DPG be decreased?
1. high pH
2. hypoxemia
3. anemia
Student Response 4. banked blood 100% ***
Which of the following does NOT increase the affinity of Hb for oxygen?
;
Student Response Value Correct Answer Feedback
1. decreased 2,3-DPG
2. increased temperature 100% ***
3. decreased PCO2
4. increased pH
Which of the following are true regarding fetal hemoglobin (HbF)?
;
1. It has a higher P50 than normal Hb.
2. It has a reduced level of 2,3-DPG.
Student Response 3. It delivers more oxygen to tissues at low PaO2 than normal Hb. 100% ***
4. It is replaced in the first month of life.
The conversion of HbO2 to deoxygenated Hb does which of the following?
;
I. decreases blood carbon dioxide content
II. enhances carbon dioxide loading on Hb
III. helps buffer H+ ions
II and III
Which of the following is NOT a major extracellular electrolyte?
;
Student Response 1. K+ 100% ***
2. Cl-
3. HCO3-
4. Na+
By what process is water replenished?
;
I. absorption
II. ingestion
III. metabolism
II and III
According to the Starling equilibrium equation, which of the following will NOT facilitate fluid filtration from the capillaries into the interstitial space?
;
1. low capillary osmotic pressure
2. high capillary hydrostatic pressure
3. low interstitial osmotic pressure ***
4. high capillary permeability
Which of the following would NOT cause an abnormal loss of Na+ (hyponatremia)?
;
1. use of certain diuretics
2. excessive sweating or fever
3. ascites
4. steroid therapy ***
What can cause hypochloremia?
;
I. diuretics
II. gastrointestinal loss
III. metabolic acidosis
I and II
Clinical signs of hypokalemia would NOT include which of the following?
;
1. paralysis
2. muscle weakness
3. convulsions ***
4. electrocardiogram abnormalities
Clinical manifestations of hypocalcemia would NOT include which of the following?
;
1. abdominal cramps
2. muscular twitching and spasm
3. depressed tendon reflexes ***
4. electrocardiogram abnormalities
Which of the following is FALSE about phosphate?
;
1. Inorganic phosphate plays a primary role in energy metabolism.
2. Phosphate is the main urinary buffer for titratable acid excretion.
3. Serum phosphate levels range from 1.2 to 2.3 mEq/L.
4. Organic phosphate is the primary extracellular cation. ***
What are the major mechanisms responsible for maintaining a stable pH despite massive CO2 production?
;
I. isohydric buffering
II. gastrointestinal secretion
III. pulmonary ventilation
I and III
Which of the following mechanisms helps to eliminate excess H+ via the kidneys?
;
I. reabsorption of HCO3-
II. phosphate buffering
III. ammonia buffering
I, II, and III
An ABG result shows pH of 7.35, PaCO2 of 30 mm Hg, and HCO3- of 18 mEq/L. Which of the following is the patient's most likely primary disorder?
;
1. respiratory alkalosis
2. metabolic alkalosis
3. respiratory acidosis
metabolic acidosis ***
With partially compensated respiratory alkalosis, which of the following blood gas abnormalities would you expect to encounter?
;
I. decreased pH
II. decreased HCO3-
III. decreased PCO2
IV. increased pH
II, III, and IV
What are some causes of metabolic acidosis with an increased anion gap?
;
I. diarrhea
II. ketoacidosis
III. lactic acidosis
IV. renal failure
II, III, and IV
Which of the following is NOT a cause of hyperchloremic metabolic acidosis?
;
1. NH4Cl administration
2. severe diarrhea
3. methanol intoxication ***
4. hyperalimentation
What would be an example of an iatrogenic (Of or relating to illness caused by medical examination or treatment) cause of metabolic alkalosis?
;
1. vomiting
2. gastric suction ***
3. hypochloremia
4. hypokalemia
Correction of metabolic alkalosis may involve which of the following?
;
I. restoring normal fluid volume
II. administering acidifying agents
III. restoring normal K+ and Cl- levels
I, II, and III
To which anatomic structures do the ventral respiratory centers send motor signals during inspiration?
;
I. diaphragm
II. larnyx
III. pharynx
IV. sternocleidomastoids
I, II, and III
What negative responses can be elicited by suctioning a patient's airway?
;
I. bradycardia
II. coughing
III. laryngospasm
IV. severe bronchospasm
I, II, III, and IV
Which of the following causes hypoxic stimulation of the carotid bodies?
;
I. large decrease in arterial PO2
II. large decrease in oxygen content
III. CO2 poisoning
I only
When given high concentrations of oxygen, a patient with chronic hypercapnia may develop a more serious respiratory acidosis. Which of the following might be contributing to the patient's increased PCO2?
;
I. worsening ventilation—perfusion (mc104-1.jpg/mc104-2.jpg) balance
II. desensitization of the carotid bodies
III. removal of the hypoxic stimulus
I and III
Causes of central neurogenic hyperventilation include which of the following?
;
I. head trauma
II. inadequate brain blood flow
III. severe brain hypoxia
I, II, and III
Which of the following factors has minimal or no impact on the effectiveness of the patient's cough?
;
1. pulmonary vascular resistance ***
2. airways resistance
3. lung recoil
4. lung volume
All of the following are critical elements of a patient's social and environmental history except:
1. occupation and employment history
2. recent travel
Student Response 3. drugs and medications ***
4. living arrangements
What two factors determine cardiac output?
stroke volume and heart rate
Which of the following is NOT a common cause of tachypnea?
;
1. exercise
2. narcotic overdose ***
3. metabolic acidosis
4. hypoxemia
Which of the following is a TRUE statement about the cause of systemic hypertension in adult patients?
;
1. The cause is often related to a lack of exercise.
2. The cause is often related to sleep apnea.
3. The cause is often unknown. 100% ***
4. The cause is often related to poor diet.
You observe a patient's breathing pattern as very irregular and interspersed with long periods of apnea. Which of the following is the most likely cause of this problem?
;
1. central nervous system disorder
2. congestive heart failure
3. metabolic acidosis
4. increased intracranial pressure 100% ***
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 are potential causes of this abnormality?
;
I. central nervous system disorder
II. congestive heart failure
III. metabolic acidosis
I and II
During posterior thoracic palpation of an adult, you notice little or no movement on the right side during a full, deep breath. Which of the following conditions could explain this finding?
;
I. bilateral phrenic nerve paralysis
II. right-sided pleural effusion
III. atelectasis of the right lower lobe
IV. right lobar consolidation
II, III, and IV
While percussing a patient's chest wall, you detect an abnormal increase in resonance. Which of the following are possible causes of this finding?
;
I. asthma
II. pneumothorax
III. emphysema
IV. pneumonia

I, II, and III
Which of the following represent proper chest auscultation technique?
;
I. The practitioner should begin auscultation at the lung bases.
II. The bell or diaphragm should be placed directly on the chest wall.
III. The patient should be instructed to breathe through an open mouth.
IV. The patient should be placed in a comfortable upright position.
V. The patient should be told to breathe more deeply than normal.

. I, II, III, IV, and V
Which of the following causes decreased breath sounds?
;
I. air or fluid in the pleural space
II. hyperinflation of lung tissue
III. mucus plugging of the airways
IV. shallow or slow breathing
I, II, III, and IV
Which of the following pulmonary disorders is most likely to result in hepatomegaly?
;
1. acute asthma
2. cor pulmonale 100% ***
3. acute viral infections
4. pulmonary atelectasis
Which of the following is NOT one of the formed elements in the blood?
;
1. leukocytes
2. thrombocytes
3. erythrocytes
4. electrolytes 100% ***
Which of the following conditions is most likely to cause a dry, nonproductive cough?
;
1. chronic obstructive pulmonary disease
2. chronic bronchitis
3. cystic fibrosis
4. pulmonary fibrosis 100% ***