Lindsey Jones TMC Form E
1. A 32 year-old female patient reports to the emergency room complaining of a
sudden onset of coughing. She indicates the coughing started when she was eating.
Which of the following would most definitively rule out a cancerous mass in the lungs
A. spiral CT scan
B. BUN
C. lateral neck radiograph
D. V/Q scan < Ans > A. spiral CT scan
Explanation ; A sudden onset of coughing while the patient was eating is most likely
associated with foreign body aspiration (food in the main stem bronchus). However,
nonproductive coughing could also be caused by a cancerous mass in the upper airway.To
rule this out a procedure that shows the upper airway with three dimensionality is most
appropriate. A ventilation perfusion scan and a BUN blood test would not do this. It may
be tempting to get a lateral neck x-ray, but the results are not three dimensional and
therefore would not be as confirming in nature. The most confirming examination would
be a spiral CT scan.
2. In which of the following would the respiratory therapist expect to see a
decrease if inspiratory flow is reduced but the rate does not change?
A. gas distribution
B. expiratory time
C. inspiratory time
D. I:E ratio < Ans > B. expiratory time
Explanation ; If rate is unchanged, and inspiratory flow is reduced, this would result in an
increase in inspiratory time and a consequent decrease in expiratory time.
3. When evaluating a patient's pulmonary condition, the therapist should in- clude
,which of the following in the assessment?
A. marital status and disease history
B. insurance and disease history
C. occupation and smoking history
D. language skills and social status < Ans > C. occupation and smoking history
Explanation ; When evaluating a patient's pulmonary condition, occupation may reveal
long-term exposure to pulmonary irritants. Smoking history would also be helpful.
Marital status and language skills do not directly relate to a patient's pul- monary
condition.
4. A patient with ARDS weighs 75 kg (165 lbs) and is receiving volume-con- trolled
ventilation with the following ventilatory parameters and arterial blood gas results <
Ans >
Mode Assist/control
Mandatory rate 20
,VT 400 mL
FIO2 1.0
PEEP 22 cm H2O
Peak pressure 52 cm H2O
Plateau pressure 35 cm H2O pH
7.35
PaCO2 45 mm Hg
PaO2 80 mm Hg
HCO3- 26 mEq/L
BE +1 mEq/L
The respiratory therapist should recommend
A. Increase PEEP to 25 cm H2O
B. Increase mandatory rate to 22
C. Switch to pressure-control ventilation
D. Increase VT 500 mL < Ans > C. Switch to pressure-control ventilation
Explanation ; For this patient, peak pressures are greater than 50 cmH2O. When high peak
pressures are the result of decreasing pulmonary compliance, such as seen with ARDS,
the patient would benefit from a change in ventilatory mode to pressure-control
ventilation. If, however, the increased peak pressures are a result of temporary conditions,
such as bronchoconstriction, or secretions in the airways, pressure-control ventilation is
not necessarily indicated. Those types of problems may be corrected quickly and peak
pressures may be lowered.
5. A respiratory therapist is instructing the family of a patient who will be com- pletely
ventilator-dependent at home. Which of the following are appropriate to include in
that instruction?
, A. setting ventilator alarms
B. basic ventilator setting changes
C. titration of FIO2
D. recognizing signs of infection < Ans > D. recognizing signs of infection
Explanation ; For the family of the patient who is ventilator-dependent at home,
providing instruction on recognizing signs of infection, providing CPR, and perform- ing
bronchial hygiene are all appropriate. The patient will not be expected to make ventilator
changes because this should be done by a qualified professional and only at the order of a
physician.
6. A patient receiving mechanical ventilation is experiencing an increase in
autoPEEP. Which of the following should the respiratory therapist increase to lower
autoPEEP?
A. pressure support
B. flow rate
1. A 32 year-old female patient reports to the emergency room complaining of a
sudden onset of coughing. She indicates the coughing started when she was eating.
Which of the following would most definitively rule out a cancerous mass in the lungs
A. spiral CT scan
B. BUN
C. lateral neck radiograph
D. V/Q scan < Ans > A. spiral CT scan
Explanation ; A sudden onset of coughing while the patient was eating is most likely
associated with foreign body aspiration (food in the main stem bronchus). However,
nonproductive coughing could also be caused by a cancerous mass in the upper airway.To
rule this out a procedure that shows the upper airway with three dimensionality is most
appropriate. A ventilation perfusion scan and a BUN blood test would not do this. It may
be tempting to get a lateral neck x-ray, but the results are not three dimensional and
therefore would not be as confirming in nature. The most confirming examination would
be a spiral CT scan.
2. In which of the following would the respiratory therapist expect to see a
decrease if inspiratory flow is reduced but the rate does not change?
A. gas distribution
B. expiratory time
C. inspiratory time
D. I:E ratio < Ans > B. expiratory time
Explanation ; If rate is unchanged, and inspiratory flow is reduced, this would result in an
increase in inspiratory time and a consequent decrease in expiratory time.
3. When evaluating a patient's pulmonary condition, the therapist should in- clude
,which of the following in the assessment?
A. marital status and disease history
B. insurance and disease history
C. occupation and smoking history
D. language skills and social status < Ans > C. occupation and smoking history
Explanation ; When evaluating a patient's pulmonary condition, occupation may reveal
long-term exposure to pulmonary irritants. Smoking history would also be helpful.
Marital status and language skills do not directly relate to a patient's pul- monary
condition.
4. A patient with ARDS weighs 75 kg (165 lbs) and is receiving volume-con- trolled
ventilation with the following ventilatory parameters and arterial blood gas results <
Ans >
Mode Assist/control
Mandatory rate 20
,VT 400 mL
FIO2 1.0
PEEP 22 cm H2O
Peak pressure 52 cm H2O
Plateau pressure 35 cm H2O pH
7.35
PaCO2 45 mm Hg
PaO2 80 mm Hg
HCO3- 26 mEq/L
BE +1 mEq/L
The respiratory therapist should recommend
A. Increase PEEP to 25 cm H2O
B. Increase mandatory rate to 22
C. Switch to pressure-control ventilation
D. Increase VT 500 mL < Ans > C. Switch to pressure-control ventilation
Explanation ; For this patient, peak pressures are greater than 50 cmH2O. When high peak
pressures are the result of decreasing pulmonary compliance, such as seen with ARDS,
the patient would benefit from a change in ventilatory mode to pressure-control
ventilation. If, however, the increased peak pressures are a result of temporary conditions,
such as bronchoconstriction, or secretions in the airways, pressure-control ventilation is
not necessarily indicated. Those types of problems may be corrected quickly and peak
pressures may be lowered.
5. A respiratory therapist is instructing the family of a patient who will be com- pletely
ventilator-dependent at home. Which of the following are appropriate to include in
that instruction?
, A. setting ventilator alarms
B. basic ventilator setting changes
C. titration of FIO2
D. recognizing signs of infection < Ans > D. recognizing signs of infection
Explanation ; For the family of the patient who is ventilator-dependent at home,
providing instruction on recognizing signs of infection, providing CPR, and perform- ing
bronchial hygiene are all appropriate. The patient will not be expected to make ventilator
changes because this should be done by a qualified professional and only at the order of a
physician.
6. A patient receiving mechanical ventilation is experiencing an increase in
autoPEEP. Which of the following should the respiratory therapist increase to lower
autoPEEP?
A. pressure support
B. flow rate
