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A pressure-volume loop ventilator graphic shows no rise in pressure for the
first 200 mL of delivered volume. The therapist should
A. increase inspiratory flow rate
B. increase PEEP
C. decrease tidal volume
D. decrease inspiratory flow rate
B.
In this question the description of the pressure volume loop would
indicate a flat bottom as manifested by no rise in pressure with the
first 200 mL of delivered volume. We call this a "flat football". The
solution is to increase PEEP to a level that the pressure begins to rise
immediately as volume is introduced.
,Which of the following would be the most effective, appropriate method for
resolving atelectasis in a spontaneously breathing, post operative patient who
is under the influence of sedation and will not respond to verbal stimuli?
A. IPPB
B. sustained maximal inhalation (incentive spirometer)
C. deep breathing coaching
D. intubation and mechanical ventilation
A.
A postoperative patient under sedation, and possibly in pain, may be tempted
to breathe less, causing respiratory acidosis and atelectasis. To correct this
problem, IPPB therapy is most appropriate. Incentive spirometry would also
help but the patient is unable to respond to verbal stimuli. This alone is an
indication for IPPB therapy.
,After performing minimum occluding volume technique with a 65-kg (143-lb)
patient who is orally intubated with a 7.0-mm ET tube, the respiratory therapist
should NEXT
A. check ET tube cuff pressure
B. perform tracheal palpation
C. order a chest radiograph
D. document ET tube markings at the lips
A.
The ET tube cuff pressure may be adjusted correctly by several techniques
including minimum leak technique (also called minimum occluding volume,
minimal seal technique, and the use of a pressure manometer called a
cuffalator. If minimum seal or minimal leak technique is used, the respiratory
therapist is still required to monitor the pressure after the technique is
performed. Although this is often not done in real life, it is technically part of
the procedure.
The respiratory therapist observes an ECG wave form on a patient that is
consistent with atrial tachycardia. The patient is complaining of chest pain,
dizziness, and nausea. The respiratory therapist should recommend
A. unsynchronized defibrillation
B. Atropine sulfate
C. epinephrine
D. cardioversion
D.
Non-deadly arrhythmias, such as this one, may be addressed through
cardioversion. Cardioversion is a form of defibrillation with low wattage and
with the synchronization set to "active". This allows the shock to be
synchronized to the R wave.
, A 38-year-old male presents in the emergency department (ED)
complaining of frequent vomiting. The following laboratory data is
available: Arterial blood gases pH 7.55 PaCO2 42 torrPaO2 85 torrHCO3- 31
mEq/LBE +7 mEq/LFIO2 0.21K+ 3.0
mEq/LCl- 95 mEq/LNa+ 135 mEq/L
Which of the following should the respiratory therapist recommend?
A. administer NaCL
B. administer NaHCO3-
C. administer KCL
D. administer volume-expanding fluids
C.
This patient has a CO2 of 42 mmHg, which suggests adequate ventilation.
However, the high pH is associated with alkalosis. Because the CO2 is normal,
the cause of the alkalosis must be metabolic in nature. One treatment for
metabolic alkalosis is to administer potassium chloride or KCl.
A patient is receiving volume-controlled ventilation following bariatric
surgery for obesity. Which of the following medications should the respiratory
therapist recommend to ensure the patient's comfort and assist in ventilator
management?
A. Pronestyl
B. morphine sulfate
C. vecuronium bromide (Norcuron)
D. Mestinon
B.
Morphine sulfate is one of the best medications to administer to patients
receiving mechanical ventilatory support to help the patient rest pain-free and to
generally sedate and relax the patient.