CCRN Acute Respiratory Failure 2

Question 1

A patient has a PaO2 of 55 mmHg on room air with a normal PaCO2. This finding is most consistent with which type of respiratory failure?

Accepted Answer

Type I (hypoxemic) respiratory failure

Answer

Type II (hypercapnic) respiratory failure

Answer

Chronic compensated respiratory acidosis

Answer

Metabolic alkalosis

Question 2

Which arterial blood gas finding defines Type II respiratory failure?

Accepted Answer

PaCO2 > 45 mmHg with hypoxemia

Answer

PaO2 > 80 mmHg with normal pH

Answer

PaCO2 < 35 mmHg

Answer

Normal A-a gradient

Question 3

A widened alveolar-arterial (A-a) oxygen gradient with hypoxemia suggests which mechanism?

Accepted Answer

Ventilation-perfusion mismatch or shunt

Answer

Pure hypoventilation

Answer

High altitude exposure

Answer

Low inspired oxygen concentration

Question 4

Which condition causes hypoxemia that does NOT correct with 100% supplemental oxygen?

Accepted Answer

Intrapulmonary shunt

Answer

V/Q mismatch

Answer

Hypoventilation

Answer

Low FiO2

Question 5

A patient with a COPD exacerbation has pH 7.28, PaCO2 68, HCO3 30. This represents:

Accepted Answer

Acute-on-chronic respiratory acidosis

Answer

Acute respiratory alkalosis

Answer

Pure metabolic acidosis

Answer

Fully compensated respiratory acidosis

Question 6

Which early clinical sign most reliably indicates impending respiratory failure in an alert patient?

Accepted Answer

Increasing accessory muscle use with rising respiratory rate

Answer

Warm dry skin

Answer

Bradycardia at rest

Answer

Decreased urine output

Question 7

A patient's PaCO2 is rising and they are becoming somnolent despite supplemental oxygen. The priority intervention is:

Accepted Answer

Provide ventilatory support (NIV or intubation)

Answer

Increase FiO2 to 100%

Answer

Administer a diuretic

Answer

Encourage incentive spirometry