Kacmarek: Egan's Fundamentals of Respiratory Care, 10th

Edition Chapter41: Respiratory Failure and the Need for Ventilatory

Support

Test Bank

MULTIPLE CHOICE

1. A diagnosis of respiratory failure can be made if which of the following are present?
1. PaO2 55 mm Hg, FIO2 0.21, PB 760 mm Hg
2. PaCO2 57 mm Hg, FIO2 0.21, PB 760 mm Hg
3. P(A−a)O2 45 mm Hg, FIO2 1.0, PB 760 mm Hg
4. PaO2/FIO2 400, PB 750 mm Hg
a. 1 and 2
b. 1, 3, and 4
c. 3 and 4
d. 1, 2, 3, and 4

ANS: A
Criteria for respiratory failure based on arterial blood gases have been established by
Campbell and generally define failure as a PaO2 (arterial partial pressure of oxygen) less than
60 mm Hg and/or a PaCO2 (alveolar partial pressure of carbon dioxide) greater than 50 mm
Hg in otherwise healthy individuals breathing room air at sea level.

DIF: Application REF: p. 990 OBJ: 1

2. What is respiratory failure due to inadequate ventilation?

a. hypoxemic
b. hypercapnic
c. compensated
d. chronic

ANS: B
Hypercapnic (type II) respiratory failure describes “bellows failure” of the lungs resulting in
elevated carbon dioxide levels.

DIF: Recall REF: p. 990 OBJ: 2

3. Hypercapnic (type II) respiratory failure is a synonym for which one of the following
a.
terms? mismatching
b. shunt
c. diffusion impairment
d. ventilatory failure

ANS: D
Hypercapnic respiratory failure is also known as ventilatory failure.
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Test bank 41-2

DIF: Recall REF: p. 990 OBJ: 2

4. Hypoxemia can be caused by which of the following?

1. diffusion impairment
2. alveolar hypoventilation
3. mismatch
4. intrapulmonary shunting
a. 1, 2, and 3
b. 1, 3, and 4
c. 1, 2, 3, and 4
d. 2, 3, and 4

ANS: C
Hypoxemia can be caused by mismatch, shunt, alveolar hypoventilation,
diffusion impairment, perfusion impairment, decreased inspired oxygen, and
venous admixture.

DIF: Recall REF: p. 1003 OBJ: 2

5. Which of the following best describes the difference between mismatch and shunt
when supplemental oxygen is administered?
a. Both will respond equally well.
b.
mismatch will respond well but shunt will not.
c.
mismatch will not respond but shunt will respond well.
d. Neither will respond to the administration of supplemental oxygen.

ANS: B
mismatch will respond to supplemental oxygen.
DIF: Recall REF: p. 991 OBJ: 2

6. Which of the following clinical signs suggest more severe hypoxemia?

a. tachycardia
b. cyanosis with polycythemia
c. central nervous system dysfunction
d. use of accessory muscles

ANS: C
More severe hypoxemia can lead to significant central nervous system dysfunction, ranging
from irritability to confusion to coma.

DIF: Recall REF: p. 990 OBJ: 2

7. Which of the following clinical signs is most often associated with hypoxemia due to shunt?
a. diffuse wheezing
b. “white” chest radiograph
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Test bank 41-3

c. stridor
d. loud P2

ANS: B
Shunt usually presents with a “white” chest radiograph.

DIF: Recall REF: p. 992 OBJ: 2

8. A patient with interstitial lung disease who presents with hypoxemia due to diffusion defect
would have which of the following clinical signs?
1. fine bibasilar crackles
2. clubbing of the finger nail beds
3. jugular venous distention
4. increased P2
a. 1 and 2
b. 1, 3, and 4
c. 3 and 4
d. 1, 2, 3, and 4

ANS: D
Patients may have clubbing of the nail beds. Rheumatologic manifestations may be present if
the underlying cause is a connective tissue disorder. Joint abnormalities, Reynaud disease, and
telangiectasia (a vascular lesion formed by dilatation of a group of small blood vessels) may
be observed. The pallor of anemia can be a clue to poor gas exchange, although chronic
hypoxemia may lead to polycythemia and possibly cyanosis. Pulmonary hypertension may
present with signs of right heart failure such as edema, jugular vein distension, and a louder
pulmonary component of the second heart sound.

DIF: Recall REF: p. 992 OBJ: 2

9. What type of disease is associated with perfusion/diffusion impairment?

a. liver disease
b. renal disease
c. neuromuscular disease
d. vascular disease

ANS: D
Perfusion/diffusion impairment is a rare cause of hypoxemia found in individuals with liver
disease complicated by the hepatopulmonary syndrome.

DIF: Recall REF: p. 992 OBJ: 3

10. What is the most common cause of low mixed venous oxygen?
a. liver disease
b. cardiac disease
c. neuromuscular disease
d. vascular disease
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Test bank 41-4

ANS: B
Congestive heart failure with low cardiac output is the most common cause of low mixed
venous oxygen, due to increased peripheral extraction of oxygen.

DIF: Recall REF: p. 993 OBJ: 3

11. What is the normal P(A−a)O2 range while breathing room air?
a. 25 mm Hg to 50 mm Hg
b. 10 mm Hg to 25 mm Hg
c. greater than 25 mm Hg
d. less than 10 mm Hg

ANS: B
The P(A-a)O2 ranges from 10 mm Hg in young patients to approximately 25 mm Hg in the
elderly while breathing room air.

DIF: Recall REF: p. 993 OBJ: 3

12. What happens to the P(A−a)O2 with mismatch and shunt?

a.
It increases with mismatch and decreases with shunt.
b.
It decreases with both mismatch and shunt.
c.
It increases with both mismatch and shunt.
d. It does not change.

ANS: C
A mismatch and shunt both result in elevated P(A−a)O2 levels.

DIF: Recall REF: p. 993 OBJ: 3

13. What is the optimal treatment of intrapulmonary shunt?

a. increase the FIO2
b. decrease the FIO2
c. surgery
d. alveolar recruitment

ANS: D
Treatment of intrapulmonary shunt must be directed toward opening collapsed alveoli or
clearing fluid or exudative material before oxygen can be beneficial at below toxic
levels.

DIF: Recall REF: p. 993 OBJ: 3

14. A patient with an opiate drug overdose is unconscious and exhibits the following blood gas
 −
results breathing room air: pH = 7.19; PCO2 = 89; HCO3 = 27; PO2 = 48. Which of the
following best describes this patient's condition?
a. chronic hypoxemic respiratory failure

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Test bank 41-5

b. chronic hypercapnic respiratory failure

c. acute hypoxemic respiratory failure
d. acute hypercapnic respiratory failure

ANS: D
Hypercapnic respiratory failure (“pump failure,” “ventilatory failure”) is characterized by an
elevated PaCO2, creating an uncompensated respiratory acidosis (whether acute or acute-on
chronic).

DIF: Application REF: p. 993 OBJ: 3

15. All of the following would tend to cause hypercapnic respiratory failure except:
a. smoke inhalation
b. opiate drug overdose
c. chronic obstructive pulmonary disease
d. hypothyroidism

ANS: A
This ventilatory drive can be diminished by various factors such as drugs (overdose/sedation),
brainstem lesions, diseases of the central nervous system such as multiple sclerosis or
Parkinson’s disease, hypothyroidism, morbid obesity (e.g., obesity-hypoventilation), and sleep
apnea.

DIF: Recall REF: p. 995 OBJ: 3

16. Which of the following are associated with hypercapnic respiratory failure due to decreased
ventilatory drive?
1. brainstem lesions
2. encephalitis
3. hypothyroidism
4. asthma
a. 1, 2, and 3
b. 2 and 4
c. 3 and 4
d. 1, 2, 3, and 4

ANS: A
This ventilatory drive can be diminished by various factors such as drugs (overdose/sedation),
brainstem lesions, diseases of the central nervous system such as multiple sclerosis or
Parkinson’s disease, hypothyroidism, morbid obesity (e.g., obesity-hypoventilation), and sleep
apnea.

DIF: Recall REF: p. 995 OBJ: 3

17. All of the following are associated with hypercapnic respiratory failure due to respiratory
muscle weakness or fatigue except:
a. hyperthyroidism

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Test bank 41-6

b. myasthenia gravis
c. amyotrophic lateral sclerosis
d. Guillain-Barré syndrome

ANS: A
Examples include spinal trauma, motor neuron disease where lesions of the anterior horn cells
may gradually lead to progressive ventilatory failure (such as in amyotrophic lateral sclerosis,
or poliomyelitis), motor nerve disorders (including Guillain-Barré syndrome and Charcot
Marie-Tooth disease), disorders of the neuromuscular junction (such myasthenia gravis and
botulism), and muscular diseases (including muscular dystrophy, myositis, critical care
myopathy, and metabolic disorders).

DIF: Recall REF: p. 995 OBJ: 3

18. Which of the following is a feature of Guillain-Barré?

a. ascending muscle weakness
b. descending muscle weakness
c. limited to lower extremities
d. limited to trunk

ANS: A
Guillain-Barré syndrome can commonly show up with lower extremity weakness progressing
to the respiratory muscles in one third of patients.

DIF: Recall REF: p. 995 OBJ: 3

19. All of the following are associated with hypercapnic respiratory failure due to increased work
of breathing except:
a. asthma
b. myasthenia gravis
c. obesity
d. kyphoscoliosis

ANS: B
Most commonly, this situation occurs when increased dead space accompanies COPD or
elevated airway resistance accompanies asthma. Both of these obstructive airway diseases
may raise respiratory work requirements excessively due to the presence of intrinsic positive
end-expiratory pressure. Increased workload can also result from thoracic abnormalities such
as pneumothorax, rib fractures, pleural effusions, and other conditions creating a restrictive
burden on the lungs. Finally, requirements for increased minute ventilation can arise when
increased CO2 production accompanies hypermetabolic states, such as in extensive burns.

DIF: Recall REF: p. 996 OBJ: 3

20. Which of the following information best helps to distinguish chronic hypercapnic respiratory
failure from acute hypercapnic respiratory failure?
a. long-standing dyspnea that worsens on exertion

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Test bank 41-7

b. forced expiratory volume in 1 second-to-forced vital capacity ratio (FEV1/FVC) of

less than 75% predicted
c. kidneys retaining bicarbonate to elevate the blood pH
d. physical signs of hypoxemia, such as cyanosis and clubbing

ANS: C
Most commonly, chronic hypercapnic respiratory failure accompanying COPD or obesity
hypoventilation syndrome would elicit a renal response by which the kidneys retain
bicarbonate to elevate the blood pH.

DIF: Application REF: p. 997 OBJ: 4

21. Which of the following is false about the “acute-on-chronic” form of respiratory failure?
a. It usually involves patients with hypoxemic respiratory failure.
b. It is most common in patients with chronic airway obstruction.
c. Bacterial or viral infections are common precipitating factors.
d. Mortality is associated with severity of acidosis.

ANS: A
Patients with chronic hypercapnic respiratory failure (chronic ventilatory failure) are at
significant risk for this, as indicated by the fact that COPD is now the fourth leading cause of
death in the United States. Acute-on-chronic respiratory failure can also be the presenting
manifestation of neuromuscular disease in the setting of a concurrent pulmonary infection.
Most common precipitating factors include bacterial or viral infections, congestive heart
failure, pulmonary embolus, chest wall dysfunction, and medical noncompliance.

DIF: Recall REF: p. 997 OBJ: 4

22. Which of the following is the cardinal sign of increased work of breathing?
a. hyperventilation
b. retractions
c. bradycardia
d. tachypnea

ANS: D
Tachypnea is the cardinal sign of increased work of breathing.

DIF: Recall REF: p. 997 OBJ: 5

23. In patients suffering from acute respiratory acidosis, below what pH level are intubation and
ventilatory support generally considered?
a. 7.2
b. 7.3
c. 7.1
 d. 7.0

ANS: A

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Test bank 41-8

See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

24. Which of the following patients has the most serious problem with the adequacy of
oxygenation?
Patient FIO2 PaO2

a.

b.

c.
d.

ANS: C
See Table 41-3.

DIF: Analysis REF: p. 998 OBJ: 6

25. A need for some form of ventilatory support is usually indicated when an adult’s rate of
breathing rises above what level?
a. 35/min
b. 30/min
c. 25/min
d. 20/min

ANS: A
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

26. Which of the following measures is/are useful indicators in assessing the adequacy of a
patient’s oxygenation?
1. PaO2–PaO2
2. PaO2-to-FIO2 ratio
3. VD/VT
4. pulmonary shunt ( s/ t)
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3
 ANS: A
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

27. Which of the following measures taken on adult patients indicate unacceptably high
ventilatory demands or work of breathing?

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Test bank 41-9

a. VE of 17 L/min
b. breathing rate of 22/min
c. VD/VT of 0.45
d. MIP of –40 cm H2O

ANS: A
See Table 41-3.

DIF: Application REF: p. 998 OBJ: 6

28. Ventilatory support may be indicated when the VC falls below what level?
a. 45 ml/kg
b. 65 ml/kg
c. 10 ml/kg
d. 30 ml/kg

ANS: C
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

29. What is the normal range of maximum inspiratory pressure, or MIP (also called negative
inspiratory force, or NIF), generated by adults?
a. –80 to –100 cm H2O
b. –50 to –80 cm H2O
c. –30 to –50 cm H2O
d. –20 to –30 cm H2O

ANS: A
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

30. Which of the following MIP measures taken on an adult patient indicates inadequate
respiratory muscle strength?
a. –90 cm H2O
b. –70 cm H2O
c. –40 cm H2O
d. –15 cm H2O
 ANS: D
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

31. Common bedside measures used to assess the adequacy of lung expansion include all of the
following except:

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Test bank 41-10

a. VC
b. respiratory rate
c. VT
d. VD/VT

ANS: D
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

32. Inadequate respiratory muscle strength is likely when a patient’s MVV is which of the
following?
a. <2 times the resting VE
b. >3 times the resting VE
c. <200 L/min
d. >120 L/min

ANS: A
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 6

33. You determine that an acutely ill patient can generate an MIP of –18 cm H2O. Based on this
information, what might you conclude?
a. The patient has inadequate respiratory muscle strength.
b. The patient has inadequate alveolar ventilation.
c. The patient has an excessive work of breathing.
d. The patient has an unstable or irregular ventilatory drive.

ANS: A
See Table 41-3.

DIF: Application REF: p. 998 OBJ: 6

34. Which of the following indicate severely impaired oxygenation requiring high FIO2s and
positive end-expiratory pressure?
1. PaO2–PaO2 greater than 350 mm Hg on 100% O2
2. VC less than 10 ml/kg
3. PaO2/FIO2 less than 200
a. 1 and 2
 b. 1 and 3
c. 2 and 3
d. 1, 3, and 3

ANS: B
See Table 41-3.

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Test bank 41-11

DIF: Recall REF: p. 998 OBJ: 7

35. Breathing 100% O2, a patient has a PaO2–PaO2 of 60 mm Hg. Based on this information, what
might you conclude?
a. The patient has severe hypoxemia.
b. The patient has an excessive work of breathing.
c. The patient has acceptable oxygenation.
d. The patient has inadequate ventilation.

ANS: C
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 7

36. What is the normal range for PaO2/FIO2?

a. 350 to 450
b. 250 to 350
c. 150 to 250
d. 75 to 150

ANS: A
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 7

37. Which of the following measures should be used in assessing the adequacy of a patient’s
alveolar ventilation?

1. PaO2
2. arterial pH
3. PaCO2
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: C
See Table 41-3.

DIF: Recall REF: p. 998 OBJ: 7

38. A patient with a 10-year history of chronic bronchitis and an acute viral pneumonia exhibits
−
the following blood gas results breathing room air: pH = 7.22; PCO2 = 67; HCO3 = 26; PO2 =
60. Which of the following best describes this patient’s condition?
a. chronic hypoxemic respiratory failure
b. acute hypercapnic respiratory failure
c. chronic hypercapnic respiratory failure

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc.
Test bank 41-12

d. acute hypoxemic respiratory failure

ANS: B
Assessment of the pH allows a determination of whether the problem is acute or

chronic. DIF: Application REF: p. 998 OBJ: 7

39. Because an elevated PaCO2 increases ventilatory drive in normal subjects, the clinical
presence of hypercapnia indicates which of the following?
1. inability of the stimulus to get to the muscles
2. weak or missing central nervous system response to the elevated PCO2
3. pulmonary muscle fatigue
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: D
Because an elevated PaCO2 increases ventilatory drive in healthy subjects, the very existence
of hypoventilation suggests other problems with the respiratory apparatus. Specifically, the
presence of acute respiratory acidosis indicates one of three major problems: (1) the
respiratory center is not responding normally to the elevated PaCO2, (2) the respiratory center
is responding normally, but the signal is not getting through to the respiratory muscles, or (3)
despite normal neurologic response mechanisms, the lungs and chest bellows are simply
incapable of providing adequate ventilation due to parenchymal lung disease or muscular
weakness.

DIF: Application REF: p. 999 OBJ: 7

40. Which of the following indicators are useful in assessing respiratory muscle strength?
1. maximum voluntary ventilation (MVV)
2. forced vital capacity (FVC)
3. dead space−to−tidal volume ratio (VD/VT)
3. maximum inspiratory pressure (MIP)
a. 1 and3
b. 2 and 4
c. 3 and 4
d. 1, 2, and4

ANS: D
 The most commonly used tests to assess respiratory muscle strength at the bedside are MIP
and maximum expiratory pressure (MEP), FVC, and MVV.

DIF: Recall REF: p. 999 OBJ: 6

41. A reversible impairment in the response of an overloaded muscle to neural stimulation best
describes which of the following?

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Test bank 41-13

a. central respiratory muscle fatigue

b. transmission respiratory muscle fatigue
c. contractile respiratory muscle fatigue
d. chronic respiratory muscle fatigue

ANS: C
Contractile respiratory muscle fatigue is a reversible impairment in the contractile response to
a neural impulse in an overloaded muscle.

DIF: Recall REF: p. 999 OBJ: 6

42. When is respiratory muscle fatigue likely to occur?

a. when VE exceeds 20% of the maximum voluntary ventilation (MVV)
b. when VE exceeds 40% of the MVV
c. when VE exceeds 60% of the MVV
d. when VE exceeds 80% of the MVV

ANS: C
Comparing the spontaneous minute ventilation with MVV is a helpful index as fatigue and
failure are both likely to occur if the minute ventilation exceeds 60% of MVV.

DIF: Recall REF: p. 1000 OBJ: 6

43. In intubated patients, what do sources of increased imposed work of breathing include?
1. endotracheal tube
2. ventilator circuit
3. auto-PEEP
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: D
In intubated patients, sources of imposed work of breathing include the endotracheal tube,
ventilator circuit, and auto-PEEP due to dynamic hyperinflation with airflow obstruction, as is
commonly seen in the patient with COPD.

DIF: Recall REF: p. 1000 OBJ: 7

44. A patient develops acute hypercapnic respiratory failure due to muscle fatigue. Which of the
 following modes of ventilatory support would you consider for this patient? 1. assist-control
ventilation with adequate backup
2. continuous positive airway pressure
3. synchronized intermittent mandatory ventilation with adequate backup
rate 4. bilevel pressure support by mask
a. 2 and 4
b. 3 and 4

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Test bank 41-14

c. 1, 2, and 3
d. 1, 3, and 4

ANS: D
Noninvasive positive-pressure ventilation can improve hypoxemia and hypercarbia by several
mechanisms including but not limited to (1) compensating for the inspiratory threshold load
imposed by intrinsic positive end-expiration pressure, (2) supplementing a reduced tidal
volume, (3) partial or complete unloading of the respiratory muscles, (4) reducing venous
return and left ventricular afterload, and (5) alveolar recruitment.

DIF: Application REF: p. 1000 OBJ: 7

45. Which of the following modes of ventilatory support would you recommend for a hypoxemic
patient with congestive heart failure?
a. continuous positive airway pressure (CPAP)
b. intermittent mandatory ventilation (IMV)
c. inverse-ratio pressure control ventilation (PCV)
d. high-level pressure support ventilation (PSV)

ANS: A
In a systematic review of randomized trials, noninvasive positive-pressure ventilation was
found to reduce intubation rates and mortality in patients with acute cardiogenic pulmonary
edema. Overall, the level of evidence was noted to be similar for CPAP without significant
advantages of bilevel positive-pressure ventilation over CPAP.

DIF: Analysis REF: p. 1000 OBJ: 7

46. Which of the following modes of ventilatory support would you recommend for a severely
hypoxemic patient with acute lung injury or acute respiratory distress syndrome (ARDS)?
a. continuous positive airway pressure
b. high VT volume-cycled ventilation
c. pressure-controlled ventilation
d. bilevel pressure support by mask

ANS: C
Volume-cycled ventilation in patients with ARDS frequently leads to high peak airway and
plateau pressures.

DIF: Analysis REF: p. 1002 OBJ: 7

47. A patient who just suffered severe closed-head injury and has a high intracranial pressure
(ICP) is about to be placed on ventilatory support. Which of the following strategies could
help to lower the ICP?
a. Maintain a PaCO2 from 25 to 30 mm Hg (deliberate hyperventilation).
b. Allow as much spontaneous breathing as possible (SIMV).
c. Maintain a high mean pressure using PEEP levels of 10 to 15 cm H2O.
d. Maintain a PaCO2 of 50 to 60 mm Hg (deliberate hypoventilation).

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Test bank 41-15

ANS: A
Hyperventilation applied acutely and for short periods of time may be used to reduce ICP. The
goal is to lower the PaCO2 to between 25 to 30 mm Hg, which causes alkalosis, which in
combination with hypocapnia helps reduce cerebral blood flow until the ICP can be controlled
by other measures.

DIF: Application REF: p. 1002 OBJ: 7

48. Which of the following patients are at greatest risk for developing auto-PEEP during
mechanical ventilation?
a. those with acute lung injury
b. those with COPD
c. those with congestive heart failure
d. those with bilateral pneumonia

ANS: B
These patients frequently have problems with elevated airway pressure or dynamic
hyperinflation (auto-PEEP), which can cause barotrauma and increased dyssynchrony
between the patient and the ventilator.

DIF: Application REF: p. 1003 OBJ: 7

49. What are some causes of dynamic hyperinflation?

1. increased expiratory time
2. increased airway resistance
3. decreased expiratory flow rate
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3

ANS: C
In such patients, lower tidal volumes (6 to 8 ml/kg), moderate respiratory rates, and high
inspiratory flow rates (70 to 100 L/min) are recommended to avoid dynamic
hyperinflation.

DIF: Recall REF: p. 1003 OBJ: 7

50. Strategies to reduce auto-PEEP in mechanically ventilated patients with obstructive lung
 disease include all of the following except which one?
a. Use high inspiratory flows (60 to 100 L/min).
b. Apply extrinsic PEEP.
c. Use low VT values (8 to 10 ml/kg).
d. Use high respiratory rates (greater than 25/min).

ANS: D

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Test bank 41-16

In such patients, lower tidal volumes (6 to 8 ml/kg), moderate respiratory rates, and high
inspiratory flow rates (70 to 100 L/min) are recommended to avoid dynamic
hyperinflation.

DIF: Recall REF: p. 1003 OBJ: 7

51. Which of the following is the normal alveolar-to-arterial difference for a 56 year old female in
the emergency department?
a. 12 mm Hg
b. 14 mm Hg
c. 16 mm Hg
d. 18 mm Hg

ANS: D
[P(A-a)O2] = (age/4) + 4
[P(A-a)O2] = (56/4) + 4
[P(A-a)O2] = 18 mm Hg

DIF: Application REF: p. 1002 OBJ: 7

52. Which of the following are causes of hypoxemia?

1. ventilation/perfusion (V/Q) mismatch
2. alveolar hypoventilation
3. diffusion impairment
4. increased inspired O2
a. 1 and 2
b. 2 and 3
c. 1, 2, and 3
d. 1, 2, 3, and 4

ANS: C
The following are causes of hypoxemia: V/Q mismatch (most common cause), shunt, alveolar
hypoventilation, diffusion impairment, perfusion/diffusion impairment (rare), decreased
inspired oxygen, and venous admixture.

DIF: Recall REF: p. 990 OBJ: 2

53. The respiratory therapist in the ICU is called to assess a patient with ARDS. The patient is
SOB. The x-ray shows “white” chest radiograph and the PAO2 is 60 torr on an FIO2 of 100%.
 Which of the following is indicated?
a. shunting
b. alveolar hyperventilation
c. decreased CO2
d. perfusion impairment

ANS: A

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Test bank 41-17

Shunt is indicated by the following: shunt usually presents with a white radiograph. ARDS is
a classic example of shunting. Shunt also does not respond to high level of supplemental
oxygen.

DIF: Analysis REF: p. 993 OBJ: 3

54. Mr. Adam is in the ICU on an F IO2 of 100%. An arterial blood gas reveals the following
information: pH of 7.18, PaCO2 of 59, PaO2 of 65 , HCO3 of 24. What action would you
recommend?
a. Provide ventilatory support.
b. Put patient on steroids.
c. Give patient Chest PT.
d. Put patient on CPAP.

ANS: A
The patient is in hypoxic (Type I) and hypercapnic (Type2) acute respiratory failure.
Providing full mechanical ventilatory support will provide the ventilator support needed to
normalize pH and improve oxygenation.

DIF: Analysis REF: p. 997 OBJ: 7

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