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CCRN Respiratory questions and answers 2024
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CCRN Respiratory questions and answers 2024
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CCRN Respiratory questionsand answers 2024
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
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