TMC Test Bank NBRC
1. Disadvantages of noninvasive ventilation include which one of the follow- ing?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP: Disadvantages of noninvasive
ventilation (NPPV) include the following: it can only be
used in cooperative patients; it does not provide direct airway access (thus increas-
ing
the risk of secretion retention), and more therapist time is needed during the
initial period of use. On the other hand NPPV may help decrease the incidence
of VAP and
typically costs less than invasive ventilation.
The correct answer is: limits direct access to lower airway
2. On a patient receiving volume control AC ventilation, you observe
a flow-volume
with a sawtooth pattern on exhalation.Which of the following actions would you
consider most appropriate?
,A. recommend administering a bronchodilator
B. assess the patient's need for suctioning
C. measure the endotracheal tube cuff pressure
D. switch to pressure control ventilation: The flow-volume loop reveals irregular
sawtooth- like oscillations, primarily in the
expiratory portion of the loop. This indicates either 1) accumulation of airway
secretions in the trachea/large airways (requiring suctioning), or 2) condensate
partially
blocking the expiratory limb of the ventilator circuit proximal to the expiratory flow
sensor. Auscultation of rhonchi or tactile fremitus over the trachea would confirm
excess secretions as the problem.
The correct answer is: assess the patient's need for suctioning
3. A 30 year-old male was found supine and unresponsive. In the ER it was
confirmed he had aspirated while on his back. After the patient is transferred to
ICU his physician orders postural drainage and percussion every 4 hours.
What is
the best position to place him in to drain the affected area?
A. prone with a pillow under his hips
,B. prone with feet elevated 30 degrees
C. supine with a pillow under his hips
D. supine with feet elevated 30 degrees: This patient aspirated while lying flat
on his back. Most commonly, this affects the
superior segments of both lower lobes.The position which facilitates drainage from
this lung region is a prone position with a pillow under the patient's hips.
The correct answer is: prone with a pillow under his hips
4. You need to perform nasotracheal suctioning on a patient with retained
secretions. As compared to suctioning via a tracheal airway, which of the
following complications are unique to this procedure?
A. hypotension
B. gagging/aspiration
C. hypoxemia
D. increased ICP: Complication/hazards common to both tracheobronchial and
nasotracheal suctioning
include hypoxemia, cardiac dysrhythmias, bradycardia, hyper-/hypotension,
bronchospasm, atelectasis, increased intracranial pressure and the
potential for contamination/infection. Unique complications of nasotracheal
suctioning include nasal trauma/epistaxis, pharyngeal trauma, gagging (with
potential
241
vomiting/aspiration), and laryngospasm. Also misdirection of the catheter is
, more common with nasotracheal suctioning.
5. Which of the following indicates a deficit in fluid balance
A. Pedal edema
B. Poor skin turgor
C. cap refill
D. JVD: Poor skin turgor
6. ARDS patient, what should RT use to evaluate oxygen delivery for optimal
PEEP
A. ABG
B. mixed venous
C. serum lactate
D. CO: mixed venous
7. RT performing a high calibration on a nitric oxide, expected value is
A. 45
B. 10
C. 25
D. 80: 45
1. Disadvantages of noninvasive ventilation include which one of the follow- ing?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP: Disadvantages of noninvasive
ventilation (NPPV) include the following: it can only be
used in cooperative patients; it does not provide direct airway access (thus increas-
ing
the risk of secretion retention), and more therapist time is needed during the
initial period of use. On the other hand NPPV may help decrease the incidence
of VAP and
typically costs less than invasive ventilation.
The correct answer is: limits direct access to lower airway
2. On a patient receiving volume control AC ventilation, you observe
a flow-volume
with a sawtooth pattern on exhalation.Which of the following actions would you
consider most appropriate?
,A. recommend administering a bronchodilator
B. assess the patient's need for suctioning
C. measure the endotracheal tube cuff pressure
D. switch to pressure control ventilation: The flow-volume loop reveals irregular
sawtooth- like oscillations, primarily in the
expiratory portion of the loop. This indicates either 1) accumulation of airway
secretions in the trachea/large airways (requiring suctioning), or 2) condensate
partially
blocking the expiratory limb of the ventilator circuit proximal to the expiratory flow
sensor. Auscultation of rhonchi or tactile fremitus over the trachea would confirm
excess secretions as the problem.
The correct answer is: assess the patient's need for suctioning
3. A 30 year-old male was found supine and unresponsive. In the ER it was
confirmed he had aspirated while on his back. After the patient is transferred to
ICU his physician orders postural drainage and percussion every 4 hours.
What is
the best position to place him in to drain the affected area?
A. prone with a pillow under his hips
,B. prone with feet elevated 30 degrees
C. supine with a pillow under his hips
D. supine with feet elevated 30 degrees: This patient aspirated while lying flat
on his back. Most commonly, this affects the
superior segments of both lower lobes.The position which facilitates drainage from
this lung region is a prone position with a pillow under the patient's hips.
The correct answer is: prone with a pillow under his hips
4. You need to perform nasotracheal suctioning on a patient with retained
secretions. As compared to suctioning via a tracheal airway, which of the
following complications are unique to this procedure?
A. hypotension
B. gagging/aspiration
C. hypoxemia
D. increased ICP: Complication/hazards common to both tracheobronchial and
nasotracheal suctioning
include hypoxemia, cardiac dysrhythmias, bradycardia, hyper-/hypotension,
bronchospasm, atelectasis, increased intracranial pressure and the
potential for contamination/infection. Unique complications of nasotracheal
suctioning include nasal trauma/epistaxis, pharyngeal trauma, gagging (with
potential
241
vomiting/aspiration), and laryngospasm. Also misdirection of the catheter is
, more common with nasotracheal suctioning.
5. Which of the following indicates a deficit in fluid balance
A. Pedal edema
B. Poor skin turgor
C. cap refill
D. JVD: Poor skin turgor
6. ARDS patient, what should RT use to evaluate oxygen delivery for optimal
PEEP
A. ABG
B. mixed venous
C. serum lactate
D. CO: mixed venous
7. RT performing a high calibration on a nitric oxide, expected value is
A. 45
B. 10
C. 25
D. 80: 45
