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A 72-year-old male patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation in the ICU. Over the past three days, the respiratory therapist and nursing staff have observed a decline in the patient’s respiratory and hemodynamic status. The patient has been requiring higher ventilator settings and the peak inspiratory pressures have been increasing.  The following data has been collected: Parameter Day 1 Day 2 Day 3 Urine Output (mL): 1000 800 600 Fluid Intake (mL): 2500 3000 3500 Net Fluid Balance (Intake – Output): 1500 2200 2900 Lung Compliance (mL/cm H₂O): 40 35 30 Peak Inspiratory Pressure (cm H₂O): 25 30 35 Mean Arterial Pressure (mm Hg): 85 80 78 CBC Parameter Day 1 Day 2 Day 3 White Blood Cell Count (K/µL): 11.2 13.8 13.5 Hemoglobin (g/dL): 12.5 12.2 11.8 Hematocrit (%): 36.8 35.5 34.2 Platelet Count (K/µL): 220 205 198 Renal Markers Day 1 Day 2 Day 3 Serum Creatinine (mg/dL): 1.2 1.5 1.8 Blood Urea Nitrogen (BUN) (mg/dL): 20 28 36 Estimated Glomerular Filtration Rate (eGFR) (mL/min): 70 58 50 Electrolytes Day 1 Day 2 Day 3 Sodium (mEq/L): 138 136 129 Potassium (mEq/L): 4.2 4.8 5.4 Chloride (mEq/L): 102 105 108 Bicarbonate (mEq/L): 22 21 20 Based on the data provided in the chart and the patient’s clinical presentation, what is the most likely cause of the patient’s declining condition?

A 55-year-old male patient with acute respiratory failure is undergoing nasotracheal suctioning in the ICU. The respiratory therapist is concerned about airway trauma during the procedure. Which of the following practices should be implemented to minimize airway trauma during suctioning?

A 68-year-old male with a 20-year history of severe chronic obstructive pulmonary disease (COPD) is managed at home with a medication regimen that includes tiotropium bromide (Spiriva) and albuterol. Despite adherence to this regimen, he continues to report frequent dyspnea on exertion. Last Spirometry Results: Parameter Result (Percent of Predicted) FVC 72% FEV₁ 42% FEV₁/FVC 58%    Which of the following medications should the respiratory therapist recommend adding to the treatment plan to improve symptom control?

A 67-year-old female patient is receiving mechanical ventilation following an abdominal surgery. During a routine ventilator assessment, the respiratory therapist notes that the peak inspiratory pressures have decreased, and a persistent cuff leak is detected despite multiple attempts to reinflate the cuff. The patient is also exhibiting signs of decreased tidal volume delivery and a change in the quality of airflow sounds. The ventilator alarm for low exhaled tidal volume is activated. A chest X-ray is performed, revealing that the tip of the endotracheal tube (ETT) is positioned above the level of the vocal cords. Which of the following is the most appropriate action to address this issue?

In invasive hemodynamic monitoring, which of the following devices is used to convert a pressure signal from the catheter into an electronic signal displayed on the monitor?

Which is best described as a unit of volume divided by a unit of time. 

A 58-year-old male patient has been on mechanical ventilation for 14 days due to acute respiratory failure. The respiratory therapist notes progressive difficulty maintaining a proper airway seal, with increased air leaks observed during ventilation. A bronchoscopy confirms a diagnosis of tracheomalacia. Which of the following factors is most likely responsible for the development of this condition?

A 67-year-old female patient is receiving mechanical ventilation following an abdominal surgery. During a routine ventilator assessment, the respiratory therapist notes that the peak inspiratory pressures have decreased, and a persistent cuff leak is detected despite multiple attempts to reinflate the cuff. The patient is also exhibiting signs of decreased tidal volume delivery and a change in the quality of airflow sounds. The ventilator alarm for low exhaled tidal volume is activated. A chest X-ray is performed, revealing that the tip of the endotracheal tube (ETT) is positioned above the level of the vocal cords. Which of the following is the most appropriate action to address this issue?

A 72-year-old male patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation in the ICU. Over the past three days, the respiratory therapist and nursing staff have observed a decline in the patient’s respiratory and hemodynamic status. The patient has been requiring higher ventilator settings and the peak inspiratory pressures have been increasing.  The following data has been collected: Parameter Day 1 Day 2 Day 3 Urine Output (mL): 1000 800 600 Fluid Intake (mL): 2500 3000 3500 Net Fluid Balance (Intake – Output): 1500 2200 2900 Lung Compliance (mL/cm H₂O): 40 35 30 Peak Inspiratory Pressure (cm H₂O): 25 30 35 Mean Arterial Pressure (mm Hg): 85 80 78 CBC Parameter Day 1 Day 2 Day 3 White Blood Cell Count (K/µL): 11.2 13.8 13.5 Hemoglobin (g/dL): 12.5 12.2 11.8 Hematocrit (%): 36.8 35.5 34.2 Platelet Count (K/µL): 220 205 198 Renal Markers Day 1 Day 2 Day 3 Serum Creatinine (mg/dL): 1.2 1.5 1.8 Blood Urea Nitrogen (BUN) (mg/dL): 20 28 36 Estimated Glomerular Filtration Rate (eGFR) (mL/min): 70 58 50 Electrolytes Day 1 Day 2 Day 3 Sodium (mEq/L): 138 136 129 Potassium (mEq/L): 4.2 4.8 5.4 Chloride (mEq/L): 102 105 108 Bicarbonate (mEq/L): 22 21 20 Based on the data provided in the chart and the patient’s clinical presentation, what is the most likely cause of the patient’s declining condition?

A 61-year-old male with a 30-pack-year smoking history and a 10-year diagnosis of chronic obstructive pulmonary disease (COPD) presents to the pulmonary clinic for a routine evaluation. The patient reports mild dyspnea on exertion but denies any recent exacerbations or infections. He lives independently and uses oxygen at night.   Vitals (on room air): Vital Signs   Heart Rate (HR)  92 bpm Respiratory Rate (RR)  20 breaths/min Blood Pressure (BP)  135/85 mmHg SpO₂ on Room Air  88% BMI  27 kg/m²   Laboratory Results: Lab Test Result Hemoglobin (Hgb) 17.5 g/dL Hematocrit (Hct) 52% White Blood Cell Count (WBC) 8.5 × 10⁹/L Sodium (Na⁺) 138 mEq/L Potassium (K⁺) 4.0 mEq/L Chloride (Cl⁻) 96 mEq/L Creatinine 0.9 mg/dL   Arterial Blood Gas (ABG) Analysis (on room air): Parameter Result pH 7.40 PaCO₂ 57 mm Hg PaO₂ 42 mm Hg HCO₃⁻ 35 mEq/L Base Excess +8 mEq/L SaO₂ 77%   Based upon the clinical presentation, which of the following is the most appropriate next step in the management of this patient?