A patient with acute cardiogenic pulmonary edema (ACPE), as evidenced by pink, frothy secre-tions, arrives in the emergency department (ED) by ambulance with a nonrebreather mask (NRM) at 15 L/min.
An arterial blood gas sample is drawn in the ED while the patient is on the NRM; the values are: pH = 7.50, PaCO2 = 28 mm Hg; PaO2 = 43 mm Hg; SaO2 = 84; HCO3 = 24 mEq/L. After evaluating the situation, the respiratory therapist should suggest which of the following thera-pies?
a. IPPB with supplemental oxygen
b. Mask CPAP with supplemental oxygen
c. Postural drainage to clear the secretions
d. NIV via nasal mask with postural drainage
Q. 2 During ventilation with VC-CMV, pleural drainage leaks sometimes can be compensated for by increasing which of the following?
a. The number of chest tubes
b. The set tidal volume
c. The set pressure limit
d. The set peak inspiratory flow
Q. 3 A mechanically ventilated patient with COPD is receiving partial ventilatory support with PSV. The respiratory therapist notes a sudden rise at the end of each breath on the pressure-time graphic.
What action should the respiratory therapist take at this time?
a. Change the mode to PRVC.
b. Change the mode to VC-CMV.
c. Lower the flow cycle setting.
d. Adjust the pressure support level.
Q. 4 The high-pressure alarm activates on a patient receiving mechanical ventilatory support. The pa-tient is tachycardic and tachypnic with absent breath sounds on the right side. Which of the fol-lowing condition(s) could be the cause?
1. Pneumothorax
2. Pulmonary edema
3. Disconnection from the ventilator
4. Increased airway resistance
a. 1 only
b. 4 only
c. 1, 2, and 3 only
d. 1 and 4 only
Q. 5 The respiratory therapist is performing a patient-ventilator system check on a patient who was in a motor vehicle accident 2 days earlier. The therapist gathers the following information from the flow sheet:
Day/Time 1/25:1720 1/26:0830 1/26:1840 1/27:0650
Mode VC-CMV VC-CMV VC-CMV VC-CMV
PIP (cm H2O) 21 28 32 41
Pplateau (cm H2O) 18 25 29 38
Which condition most likely has produced the changes reflected in these data?
a. Bronchospasm
b. Abdominal distention
c. Secretion retention
d. Mucosal edema
Q. 6 The following two graphic loops show which of the following conditions?
a. Leak in the patient-ventilator circuit
b. Increased airway resistance
c. Decreased lung compliance
d. Active exhalation
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