A 28-year-old man with botulism poisoning is beginning to develop progressive paralysis. The respiratory therapist has been monitoring the patient's MIP and VC every 2 hours.
The most recent results show that the patient continues to deteriorate: MIP = 27 cm H2O, VC = 32 mL/kg. Which of the following could be appropriately recommended?
a. Gastric lavage
b. Oxygen therapy
c. Medication to reverse the paralysis
d. Mechanical ventilatory support
Q. 2 Which of the following are goals of mechanical ventilation?
1. To provide support to the pulmonary system to maintain an adequate level of alveolar ventila-tion
2. To reduce the WOB until the cause of respiratory failure can be eliminated
3. To restore ABG levels to normal
4. To prevent or treat atelectasis with adequate end-inspiratory lung inflation
a. 1 and 2 only
b. 1 and 3 only
c. 1, 2, and 3 only
d. 1, 2, and 4 only
Q. 3 After oxygen is administered, a patient's heart rate changes from 110 to 85 beats/min. The initial tachycardia was most likely caused by which of the following?
a. Anxiety
b. Hypoxemia
c. Hypercapnia
d. Pain
Q. 4 A 14-year-old boy who had previously been diagnosed with mild persistent asthma has a PEFR of 100 L/min. This indicates which of the following?
a. Increased airway resistance
b. Heart failure
c. Increased lung compliance
d. Inability to take in a deep breath and cough
Q. 5 A 59-year-old patient is in severe respiratory distress in the emergency department. The patient is being treated for congestive heart failure and pulmonary edema.
Vital signs are pulse 98 beats/min, respiratory rate 23 breaths/min, and BP 138/98 mm Hg. The patient's ABG results on a nonrebreather mask are as follows: pH 7.35; partial PaCO2 45 mm Hg; PaO2 49 mm Hg; SaO2 79; and HCO3 24 mEq/L. The respiratory therapy that is most appropri-ate at this time is which of the following?
a. 6 L/min nasal cannula
b. 50 air entrainment mask
c. Mask continuous positive airway pressure (CPAP) with 100 oxygen
d. Intubate and mechanically ventilate
Q. 6 The disorders that cause respiratory failure due to increased work of breathing include which of the following? 1. Myasthenia gravis 2. Cardiogenic pulmonary edema 3. Interstitial pulmonary fibrosis 4. Amyotrophic lateral sclerosis
a. 1 and 2 only
b. 2 and 3 only
c. 3 and 4 only
d. 1 and 4 only
Q. 7 A 45-year-old woman arrives in the emergency department after ingesting an unknown quantity of pain medication and alcohol. Her friend found her unconscious in her apartment. She is cur-rently unresponsive to verbal stimuli.
Vital signs reveal: pulse 56 beats/min; respiratory rate 10 breaths/min and shallow; and BP 90/50 mm Hg. Her ABG on room air reveals: pH 7.21; PaCO2 64 mm Hg; PaO2 52 mm Hg, HCO3 24 mEq/L. The appropriate treatment for this patient includes which of the following?
1. Naloxone hydrochloride (Narcan)
2. Nasal cannula 4 L/min
3. Nonrebreather mask
4. Intubation and ventilatory support
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