TMC test bank wrong questions and
answers
Disadvantages of noninvasive ventilation include which one of the following?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP - ANSWER>>Disadvantages of noninvasive
ventilation (NPPV) include the following: it can only be
used in cooperative patients; it does not provide direct airway access (thus
increasing
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
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 - ANSWER>>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
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 - ANSWER>>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
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 - ANSWER>>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.
Which of the following indicates a deficit in fluid balance
A. Pedal edema
B. Poor skin turgor
C. cap refill
D. JVD - ANSWER>>Poor skin turgor
ARDS patient, what should RT use to evaluate oxygen delivery for optimal PEEP
A. ABG
,B. mixed venous
C. serum lactate
D. CO - ANSWER>>mixed venous
RT performing a high calibration on a nitric oxide, expected value is
A. 45
B. 10
C. 25
D. 80 - ANSWER>>45
To help prevent infection after an aerosol drug treatment provided via small
volume nebulizer (SVN) you would:
A. shake out any residual solution then bag the SVN
B. rinse the SVN with tap water then dry and bag it
C. run the SVN at high flows until completely dry
D. rinse the SVN with sterile water then dry and bag it - ANSWER>>To minimize
the likelihood of infection in patients receiving aerosol drug therapy via a
small volume nebulizer (SVN), you should 1) use a different SVN for each patient,
2)
change the SVN and tubing every 24 hours, and 3) perform thorough hand
hygiene
prior to each therapy session. It is also recommended that the nebulizer NOT be
rinsed
with tap water, but rather rinsed with sterile water and blown dry between uses.
If
rinsing with sterile water not feasible, rinse the device with filtered or tap water,
then
rinse with isopropyl alcohol and dry.
The correct ANSWER is: rinse the SVN with sterile water then dry and bag it
A doctor orders aerosol drug therapy via small volume nebulizer for a patient
receiving mechanical ventilation via a dual-limb breathing circuit. To prevent drug
residue from affecting ventilator performance you must make sure that:
A. both inspiratory and expiratory HEPA filters are in place
B. a HEPA filter is in place on the inspiratory limb of the circuit
C. a heat and moisture exchanger is in place at the patient connector
, D. a HEPA filter is in place on the expiratory limb of the circuit - ANSWER>>HEPA
filters are needed to prevent drug residue from entering the ventilator and
affecting its performance. For dual-limb circuits, be sure that inspiratory and
expiratory
HEPA filters are in place. For single-limb circuits, you normally only need an
inspiratory
HEPA filter; expiratory filtration may be required on patients with disorders
requiring
droplet or respiratory precautions.
The correct ANSWER is: both inspiratory and expiratory HEPA filters are in place
Your patient is receiving aerosolized bronchodilators to treat her asthma. What is
the best way to determine whether this treatment is achieving the desired goal?
A. measure the patient's MIP before-and-after treatment
279
B. measure the patient's inspiratory capacity before-and-after treatment
C. measure the patient's FEV1% before-and-after treatment
D. calculate the patient's alveolar minute volume - ANSWER>>The best way to
determine the effectiveness of bronchodilator therapy at the bedside
is to measure the patient's forced expiratory flows before and after treatment.
Either
the FEV1% or the peak expiratory flow rate (PEFR) can be used, although the
FEV1% is a
more reliable and valid measure. In general, an improvement of at least 12-15%
between the pre- and post-test values is needed to indicate reversibility of the
obstruction with the bronchodilator.
The correct ANSWER is: measure the patient's FEV1% before-and-after treatment
A cooperative patient receiving aerosol therapy with 0.9% NaCl is unable to
produce an acceptable volume of sputum for laboratory studies. The most
appropriate action would be to
A. administer the aerosol continuously
B. change to hypertonic saline
C. initiate chest physiotherapy
D. perform nasotracheal suctioning - ANSWER>>Hypertonic saline solution can
help draw fluid out of the airway mucosa. For this
answers
Disadvantages of noninvasive ventilation include which one of the following?
A. costs more than invasive ventilation
B. requires heavy patient sedation
C. limits direct access to lower airway
D. increases the likelihood of VAP - ANSWER>>Disadvantages of noninvasive
ventilation (NPPV) include the following: it can only be
used in cooperative patients; it does not provide direct airway access (thus
increasing
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
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 - ANSWER>>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
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 - ANSWER>>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
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 - ANSWER>>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.
Which of the following indicates a deficit in fluid balance
A. Pedal edema
B. Poor skin turgor
C. cap refill
D. JVD - ANSWER>>Poor skin turgor
ARDS patient, what should RT use to evaluate oxygen delivery for optimal PEEP
A. ABG
,B. mixed venous
C. serum lactate
D. CO - ANSWER>>mixed venous
RT performing a high calibration on a nitric oxide, expected value is
A. 45
B. 10
C. 25
D. 80 - ANSWER>>45
To help prevent infection after an aerosol drug treatment provided via small
volume nebulizer (SVN) you would:
A. shake out any residual solution then bag the SVN
B. rinse the SVN with tap water then dry and bag it
C. run the SVN at high flows until completely dry
D. rinse the SVN with sterile water then dry and bag it - ANSWER>>To minimize
the likelihood of infection in patients receiving aerosol drug therapy via a
small volume nebulizer (SVN), you should 1) use a different SVN for each patient,
2)
change the SVN and tubing every 24 hours, and 3) perform thorough hand
hygiene
prior to each therapy session. It is also recommended that the nebulizer NOT be
rinsed
with tap water, but rather rinsed with sterile water and blown dry between uses.
If
rinsing with sterile water not feasible, rinse the device with filtered or tap water,
then
rinse with isopropyl alcohol and dry.
The correct ANSWER is: rinse the SVN with sterile water then dry and bag it
A doctor orders aerosol drug therapy via small volume nebulizer for a patient
receiving mechanical ventilation via a dual-limb breathing circuit. To prevent drug
residue from affecting ventilator performance you must make sure that:
A. both inspiratory and expiratory HEPA filters are in place
B. a HEPA filter is in place on the inspiratory limb of the circuit
C. a heat and moisture exchanger is in place at the patient connector
, D. a HEPA filter is in place on the expiratory limb of the circuit - ANSWER>>HEPA
filters are needed to prevent drug residue from entering the ventilator and
affecting its performance. For dual-limb circuits, be sure that inspiratory and
expiratory
HEPA filters are in place. For single-limb circuits, you normally only need an
inspiratory
HEPA filter; expiratory filtration may be required on patients with disorders
requiring
droplet or respiratory precautions.
The correct ANSWER is: both inspiratory and expiratory HEPA filters are in place
Your patient is receiving aerosolized bronchodilators to treat her asthma. What is
the best way to determine whether this treatment is achieving the desired goal?
A. measure the patient's MIP before-and-after treatment
279
B. measure the patient's inspiratory capacity before-and-after treatment
C. measure the patient's FEV1% before-and-after treatment
D. calculate the patient's alveolar minute volume - ANSWER>>The best way to
determine the effectiveness of bronchodilator therapy at the bedside
is to measure the patient's forced expiratory flows before and after treatment.
Either
the FEV1% or the peak expiratory flow rate (PEFR) can be used, although the
FEV1% is a
more reliable and valid measure. In general, an improvement of at least 12-15%
between the pre- and post-test values is needed to indicate reversibility of the
obstruction with the bronchodilator.
The correct ANSWER is: measure the patient's FEV1% before-and-after treatment
A cooperative patient receiving aerosol therapy with 0.9% NaCl is unable to
produce an acceptable volume of sputum for laboratory studies. The most
appropriate action would be to
A. administer the aerosol continuously
B. change to hypertonic saline
C. initiate chest physiotherapy
D. perform nasotracheal suctioning - ANSWER>>Hypertonic saline solution can
help draw fluid out of the airway mucosa. For this
