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Chapter 2: Ventilation
TRUE/FALSE
1. The transairway pressure causes airflow in and out of the conducting airways.
ANS: T
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The transairway pressure is the difference between the mouth pressure and the
alveolar pressure. When the pressure in the alveoli is more negative than the
pressure at the mouth, air flows into the conducting airways and vice versa.
The transairway pressure is the difference between the mouth pressure and the
alveolar pressure. When the pressure in the alveoli is more negative than the
pressure at the mouth, air flows into the conducting airways and vice versa.
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2. The vagus nerve causes the diaphragm to contract.
ANS: F
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The phrenic nerve innervates the diaphragm and causes it to contract.
The phrenic nerve innervates the diaphragm and causes it to contract.
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3. During normal breathing, diaphragmatic excursion is approximately 6 cm.
ANS: F
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During normal breathing, diaphragmatic excursion is approximately 1.5 cm.
During normal breathing, diaphragmatic excursion is approximately 1.5 cm.
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4. During positive pressure ventilation, the intra-alveolar pressure will rise above atmospheric pressure.
ANS: T
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During positive pressure ventilation, the intra-alveolar pressure will rise above
atmospheric pressure. For example, if the pressure on the ventilator is 30 cm
H2O, then the intra-alveolar pressure is about 30 cm H2O.
During positive-pressure ventilation, the intra-alveolar pressure will rise above
atmospheric pressure. For example, if the pressure on the ventilator is 30 cm
H2O, then the intra-alveolar pressure is about 30 cm H2O.
5. Compliance is the amount of pressure that the lungs will accommodate for each liter of air.
ANS: F
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Compliance is the amount of air that the lungs will accommodate for each
centimeter of pressure.
CL = V/P
Compliance is the amount of air that the lungs will accommodate for each
centimeter of pressure.
CL = V/P
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6. At rest, the average compliance is 100 mL/cm H2O.
ANS: T
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The average compliance is 0.1 L/cm H2O or 100 mL/cm H2O.
The average compliance is 0.1 L/cm H2O or 100 mL/cm H2O.
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7. Hooke’s law is another way to express elastance.
ANS: F
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Hooke’s law is another way to express compliance. Elastance is the reciprocal of
compliance.
Hooke’s law is another way to express compliance. Elastance is the reciprocal of
compliance.
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8. Lungs that have high compliance have low elastance.
ANS: T
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Lungs that are easily expanded have less recoil (elastance). Emphysema would
be an example of this.
Lungs that are easily expanded have less recoil (elastance). Emphysema would
be an example of this.
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9. Surface area can be defined as the attraction of like molecules.
ANS: F
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Surface tension can be defined as the attraction of like molecules. When the
liquid lining of the lung is in contact with the air in the lung, the liquid lining is
attracted to the liquid lining, which causes the lungs to naturally deflate or
collapse.
Surface tension can be defined as the attraction of like molecules. When the
liquid lining of the lung is in contact with the air in the lung, the liquid lining is
attracted to the liquid lining, which causes the lungs to naturally deflate or
collapse.
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10. DPPC gives surfactant its surface-tension-reducing capabilities.
ANS: T
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DPPC gives surfactant its surfacing-tension-reducing capabilities. Surfactant
without DPPC, as with premature neonates, lacks the ability to decrease surface
tension.
DPPC gives surfactant its surface-tension-reducing capabilities. Surfactant
without DPPC, as with premature neonates, lacks the ability to decrease surface
tension.
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11. The lungs naturally want to expand.
ANS: F
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The lungs naturally want to collapse. The thorax naturally wants to expand.
The lungs naturally want to collapse. The thorax naturally wants to expand.
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12. The thorax naturally wants to collapse.
ANS: F
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The thorax naturally wants to expand. The lungs naturally want to collapse.
The thorax naturally wants to expand. The lungs naturally want to collapse.
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13. The term static refers to the study of the forces in action.
ANS: F
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The term dynamic refers to the study of the forces in action.
The term dynamic refers to the study of the forces in action.
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14. Laminar flow can be described as chaotic.
ANS: F
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Laminar flow can be described as smooth.
Laminar flow can be described as smooth.
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15. Turbulent flow can be described as chaotic.
ANS: T
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Turbulent flow can be described as chaotic.
Turbulent flow can be described as chaotic.
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16. Time constants are a product of airway resistance and lung compliance.
ANS: T
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Time constants are a product of airway resistance and lung compliance.
Time constants are a product of airway resistance and lung compliance.
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17. Compliance is a change in volume over a change in pressure.
ANS: T
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Compliance is a change in volume over a change in pressure.
Compliance is a change in volume over a change in pressure.
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MULTIPLE CHOICE
1. The abbreviation PAO2 means:
a. the partial pressure of oxygen in the arterial blood
b. the partial pressure of oxygen in the venous blood
c. the partial pressure of oxygen in the alveoli
d. the partial pressure of oxygen in the atmosphere
ANS: C
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A
B
C
D
The correct abbreviation for the partial pressure of oxygen in the arterial blood is PaO2.
The correct abbreviation for the partial pressure of oxygen in the venous blood is PvO2.
The capitalized A indicates alveolar; therefore, the PAO2 is the partial pressure of
oxygen in the alveoli.
The correct abbreviation for the partial pressure of oxygen in the atmosphere is PatmO2.
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2. If the Vt is 560 mL, RR is 15/min, and patient weight 165 lbs., what is the alveolar ventilation (VA)?
a. 8.235 LPM
b. 1.915 LPM
c. 2.955 LPM
d. 5.925 LPM
ANS: D
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A
B
C
D
When performing the algebra, you must first perform the math within the parentheses,
then the math outside the parentheses.
VA = (560 - 165) × 15
When performing the algebra, you must perform the math within the parentheses, then
the math outside the parentheses.
VA = (560 - 165) × 15
When performing the algebra, you must perform the math that is within the parentheses,
then the math outside the parentheses.
VA = (560 - 165) × 15
Alveolar ventilation is calculated by subtracting the dead space, which is 1 mL per
pound of weight, from the tidal volume and then multiplying that number by the
respiratory rate. VA = (560 - 165) × 15
VA = 395 × 15
VA = 5925
mL/min or 5.925 LPM
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3. Dead space can be defined as:
a. the volume of gas that does participate in gas exchange
b. the volume of gas that does not participate in gas exchange
c. the volume of gas in the upper airway only
d. the volume of gas in the trachea only
ANS: B
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A
B
C
D
For a volume of gas to participate in gas exchange, it must reach the alveoli; dead space
does not reach the alveoli.
Dead space is the volume of gas that does reach the alveoli.
Gas in the upper airway is known as anatomic dead space.
Gas in the trachea is known as anatomic dead space.
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4. Lung regions that have a decreased airway resistance require:
a. less time to inflate
b. more time to inflate
c. no difference in the time needed to inflate
d. none of the above
ANS: A
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A
B
C
D
Lung regions that have a decreased airway resistance require less time to inflate.
When airway resistance increases, then the time needed to inflate that area of the lung
will increase.
There are regional differences in airway resistance even in a healthy lung, so the time to
inflate the regions varies.
There are regional differences in airway resistance even in a healthy lung, so the time to
inflate the regions varies.
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5. What two properties represent the natural tendencies of the lungs and thorax?
a. The lungs want to collapse, and the thorax wants to collapse.
b. The lungs want to expand, and the thorax wants to collapse.
c. The lungs want to expand, and the thorax wants to expand.
d. The lungs want to collapse, and the thorax wants to expand.
ANS: D
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A
B
C
D
The alveoli naturally recoil, and the thorax naturally wants to expand, not collapse.
The alveoli naturally recoil, not expand, and the thorax naturally wants to expand, not
collapse.
The alveoli naturally recoil, not expand, and the thorax naturally wants to expand.
The alveoli naturally recoil, and the thorax naturally wants to expand.
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6. According to Poiseuille’s law, flow is a function of the fourth power of the radius of the tube. Which
of the following statements best represents this?
a. When the radius of the tube is decreased by 1/16, gas flow is reduced to 1/2 of its original
flow.
b. When the radius of the tube is decreased by 1/2, gas flow is reduced to 1/16 of its original
flow.
c. When the radius of the tube is decreased by 1/2, gas flow is reduced to 1/2 of its original
flow.
d. When the radius of the tube is decreased by 1/16, gas flow is reduced to 1/16 of its original
flow.
ANS: B
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A
B
C
D
When the radius of the tube is decreased by 1/2, not 1/16, gas flow is reduced to 1/16,
not 1/2 of its original flow.
When the radius of the tube is decreased by 1/2, gas flow is reduced to 1/16 of its
original flow.
When the radius of the tube is decreased by 1/2, gas flow is reduced to 1/16, not 1/2 of
its original flow.
When the radius of the tube is decreased by 1/2, not 1/16, gas flow is reduced to 1/16 of
its original flow.
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7. Arranging Poiseuille’s law for pressure, it can be said that if flow remains constant and the radius of
the tube decreases by 1/2, pressure will:
a. decrease by 16% of its original value
b. decrease by 4 times its original value
c. increase 4 times its original value
d. increase 16 times its original value
ANS: D
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A
B
C
D
Pressure will not decrease when the radius of a tube decreases. It will only increase.
Incorrect. Pressure will not decrease when the radius of a tube decreases. It will only
increase.
Pressure will increase 16 times its original value because pressure is a function of the
radius of the tube to the fourth power.
Pressure will increase 16 times its original value. This is true because pressure is a
function of the radius of the tube to the fourth power.
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8. Applying Poiseuille’s law to the tracheobronchial tree, it can be said that since gas flow varies directly
with the radius 4 of the tracheobronchial tree, during exhalation gas flow will:
a. increase
b. decrease
c. remain constant
d. vary only if it is a forced exhalation
ANS: B
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A
B
C
D
Incorrect. Since the airways naturally get smaller during exhalation, meaning the radius
decreases, gas flow must also decrease.
Correct. Since the airways naturally get smaller during exhalation, meaning the radius
decreases, gas flow must also decrease.
Incorrect. Since the airways naturally get smaller during exhalation, meaning the radius
decreases, gas flow must also decrease.
Incorrect. Since the airways naturally get smaller during exhalation, meaning the radius
decreases, gas flow must also decrease.
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9. Which of the following is the correct definition for driving pressure?
a. the sum of the pressures of two points in a tube or vessel
b. the pressure difference between the alveoli and the pleural space
c. the pressure difference that occurs across the airway wall
d. the pressure difference between two points in a tube or vessel
ANS: D
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A
B
C
D
The correct definition for driving pressure is the pressure difference between two points
in a tube or vessel.
This is the definition for transpulmonary pressure.
This is called the transmural pressure.
The correct definition for driving pressure is the pressure difference between two points
in a tube or vessel.
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10. When does air stop flowing into the lungs?
a. when pressure in the alveoli equals the pressure in the pleural space
b. when pressure in the pleural space equals the barometric pressure
c. when the pressure in the alveoli equals the barometric pressure
d. none of the above
ANS: C
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A
B
C
D
Air stops flowing into the lungs when the pressure in the alveoli equals the barometric
pressure.
Air stops flowing into the lungs when the pressure in the alveoli equals the barometric
pressure.
Air stops flowing into the lungs when the pressure in the alveoli equals the barometric
pressure.
Air stops flowing into the lungs when the pressure in the alveoli equals the barometric
pressure.
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MULTIPLE RESPONSE
1. The ventilatory pattern consists of what components?
a. respiratory rate
b. inspiratory flow
c. tidal volume
d. inspiratory to expiratory ratio
ANS: A, C, D
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The ventilatory pattern consists of the RR, Vt, and I:E ratio. The RR is how fast
or slow the person is breathing in 1 minute. The Vt is the amount of air that
moves in and out of the lungs in one breath. The I:E ratio is a comparison of the
amount of time for inspiration to the amount of time for expiration.
Inspiratory flow is not part of the ventilatory pattern, but is how fast the breath
flows into the conducting airways.
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2. What are the two forces that cause the lung to recoil?
a. compliance of the lung itself
b. surface area
c. surface tension
d. elastic properties of the lung itself
ANS: C, D
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Surface tension is the attraction of like molecules. The liquid lining of the lungs
are naturally attracted to each other and not to the gas molecules in the lung; this
creates higher surface tension. Elastance is the ability of an object to respond to
force and return to its original shape; the lungs do this naturally.
Compliance is the reciprocal of elastance. Surface area is a product of surface
tension and elastance. It does not cause recoil.
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3. During a normal inspiration, what do the bronchial airways naturally do?
a. constrict
b. dilate
c. increase in length
d. decrease in length
ANS: B, C
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During a normal inspiration, the bronchial airways naturally dilate and increase
in length.
During a normal expiration, the bronchial airways naturally go back to their
original diameter and length.
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4. When Poiseuille’s law is arranged for flow, it can be said that flow will decrease in response to:
a. a decreased pressure
b. a decreased tube length
c. an increased pressure
d. a decreased tube radius
ANS: A, D
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When Poiseuille’s law is arranged for flow, it can be said that flow will decrease
in response to a decreased pressure and a decreased radius.
According to Poiseuille’s law, flow will increase when the tube length is
decreased and the pressure is increased.
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5. The DPPC molecule has two unique ends that allow it to decrease surface tension. What are those two
ends?
a. positive
b. hydrophobic
c. hydrophilic
d. negative
ANS: B, C
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The DPPC molecule has two unique ends, one is hydrophobic and the other is
hydrophilic.
The DPPC molecule has two unique ends, one is hydrophobic and the other is
hydrophilic.
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6. Poiseuille’s law can be arranged for what two purposes?
a. volume
b. rate
c. flow
d. pressure
ANS: C, D
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Poiseuille’s law can be arranged for flow and pressure.
Poiseuille’s law can be arranged for flow and pressure.
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7. The dynamic features of the lung are best explained by which of the following?
a. Poiseuille’s law
b. plateau pressure
c. static pressures
d. airway resistance
ANS: A, D
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The dynamic features of the lung are best explained by Poiseuille’s law and
airway resistance.
The static features of the lung are explained by the plateau pressure and static
pressures.
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COMPLETION
1. Time constants are a product of ___________________________________ and lung compliance.
ANS: airway resistance
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2. ____________________ compliance is how easily a lung region fills with gas during a specific time
period.
ANS: Dynamic
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3. High flow rates cause a more ____________________ flow.
ANS: turbulent
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4. An increase in the ____________________ of breathing is more effective in increasing a person’s
alveolar ventilation than an equivalent ____________________ in breathing rate.
ANS: depth, increase
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5. ____________________ dead space and ____________________ dead space are combined and
referred to as physiologic dead space.
ANS:
Anatomic, alveolar
Alveolar, anatomic
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6. When lung compliance ____________________, the patient’s respiratory rate generally increases,
while at the same time the tidal volume ____________________.
ANS: decreases, decreases
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7. When airway resistance ____________________, the patient’s respiratory rate usually decreases,
while at the same time the tidal volume ____________________.
ANS: increases, increases
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8. When a patient is in severe respiratory distress, the ventilatory pattern that the patient adopts will more
likely be based on minimizing ___________________________________ rather than on ventilatory
efficiency.
ANS:
work of breathing
WOB
work requirements
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9. ____________________ is a breathing pattern where an individual breathes most comfortably in the
upright position.
ANS: Orthopnea
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10. As lung compliance decreases, it will require ____________________ pressure to inflate the lung.
ANS:
more
higher
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11. As lung compliance improves or increases, it will require ____________________ pressure to inflate
the lung.
ANS:
less
lower
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12. Surfactant ____________________ surface tension.
ANS: decreases
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13. ____________________ flow occurs at high flow rates and at high pressure gradients.
ANS: Turbulent
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14. According to Poiseuille’s law when arranged for flow, if the pressure remains constant and the radius
of a tube decreases by ____________________, then the flow will decrease to
______________________________ of its original flow.
ANS:
one-half, one-sixteenth
one half, one sixteenth
1/2, 1/16
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15. According to Poiseuille’s law when arranged for pressure, if the flow remains constant and the tube
diameter decreases by ____________________, then the pressure will increase by
______________________________ its original level.
ANS:
one-half, sixteen times
one half, sixteen times
1/2, 16 times
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16. Air moves in and out of the lungs because of a ____________________ gradient.
ANS: pressure
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17. If the radius of a tube is decreased by 16%, flow will decrease to ____________________ its original
rate.
ANS:
one-half
one half
1/2
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18. Mucus accumulation will cause the radius of the tube to ____________________.
ANS: decrease
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19. Bronchospasm will cause airway resistance to ____________________.
ANS: increase
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20. The radius of the airway ____________________ during exhalation.
ANS: decreases
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21. The radius of the airway ____________________ during inspiration.
ANS: increases
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22. Air flow through the airway can be described as laminar or ____________________.
ANS: turbulent
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SHORT ANSWER
1. If a patient’s Vt is 610 mL, RR is 17 breaths/min, and weight 73.4 kg, what is the alveolar minute
ventilation?
ANS:
VA = (Vt - VD) × RR
First change the weight from kilograms to pounds by multiplying the weight by 2.2. The patient
weighs 161.48 lbs.
VA = (610 - 161.48) × 17
VA = 7.62 LPM
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2. Explain what physiologic dead space is.
ANS:
Physiologic dead space is the sum of the anatomic dead space and alveolar dead space.
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3. What happens to the respiratory rate when lung compliance decreases?
ANS:
In general, the RR will increase as lung compliance decreases. At the same time, Vt decreases.
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4. What does the statement “the lung compliance has decreased” mean?
ANS:
A decreased lung compliance means that the lungs are stiffer than normal or stiffer than they were
previously. So it will take more pressure to deliver the same tidal volume.
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5. Explain the term Biot’s respiration.
ANS:
Biot’s respiration is short episodes of rapid, uniformly deep inspirations, followed by 10 to 30 seconds
of apnea. This pattern may be seen in patients with meningitis.
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6. Explain or describe Cheyne-Stokes respiration.
ANS:
Cheyne-Stokes respiration is 10 to 30 seconds of apnea, followed by a gradual increase in volume and
frequency of breathing, followed by a gradual decrease in volume until another period of apnea occurs.
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