NBRC TMC PRACTICE QUESTIONS AND VERIFIED CORRECT ANSWERS

NBRC TMC PRACTICE QUESTIONS AND VERIFIED CORRECT ANSWERS "For a patient receiving volume-controlled mechanical ventilation, the lower inflection point on a pressure-volume loop can best be described as: A. amount of pressure required to keep the alveoli and small airways open B. optimal PEEP C. minimal PEEP D. upper limit of residual volume - CORRECT ANSWER A. The lowest inflection point on a pressure-volume ventilator graphic is an indication of the minimum pressure needed to keep alveoli open." "The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most likely has A. fluid overload B. ARDS C. a pulmonary embolism D. pneumonia - CORRECT ANSWER C. A VQ scan that shows poor perfusion but adequate ventilation is most closely associated with a pulmonary embolism. Supportive data is found in the radiological report of wedge-shaped infiltrates." "The respiratory therapist notes in the medical record of a 65-year-old male that the patient is ordered to receive bronchodilator therapy with Albuterol. The therapist also notes the patient is receiving beta-blocker medication. The therapist should recommend A. Administer Dexamethasone (Decadron) in place of Albuterol B. Add Xopenex to the bronchodilator regimen C. Replace Albuterol with Beclamethasone (Beclovent) D. Switch from Albuterol to ipratropium bromide (Atrovent) - CORRECT ANSWER D. Because albuterol is a beta-agonist medication, patients who are taking beta-blockers should utilize other bronchodilation medication." "A hospital has an extremely low incidence of ventilator-associated pneumonia. To which of the following reasons may this be attributed? A. periodic discontinuation of sedation B. use of respiratory precautions with the population C. diversion of infectious patients to other facilities D. broad use of prophylactic antibiotics - CORRECT ANSWER A. The incidence of ventilator-associated pneumonia, or VAP, is lowered by using a closed system suction catheter, periodically discontinuing sedation, keeping the patient and semi-Fowler's position, and proper handwashing among caregivers. All are correct." "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 - CORRECT ANSWER 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 - CORRECT ANSWER 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." "A patient has idiopathic pneumonia with consolidation in the right lower lobe. The physician suspects a bacterial infection. Which of the following will provide conclusive data to rule out the physician's suspicions? A. WBC B. color of sputum C. sputum acid-fast stain D. oral temperature - CORRECT ANSWER A. A bacterial infection is diagnosed primarily by examining the white blood cell count, also called the leukocyte count. An elevated temperature and yellow sputum indicate the possibility of an infection but are not confirming in nature." "The respiratory therapist should look to which of the following clinical data to determine the effectiveness of incentive spirometry? A. Arterial blood gas analysis pre and post treatment B. Breath sounds before and after every treatment C. Inspiratory capacity predicted volume D. Maximum voluntary ventilation done periodically - CORRECT ANSWER B. The effectiveness of incentive spirometry can best be determined by auscultating breath sounds before and after the treatment and noting changes in air movement. While achieving inspiratory capacity is the goal, the real goal is to increase lung volume, improve alveolar recruitment, and prevent consolidation of sputum in the lungs." "increased labor of breathing. The mandatory rate is 14/min. Which of the following would most likely help the patient? A. Use of pressure support B. Switch to pressure control ventilation C. Increase the machine flow rate D. Increase PEEP - CORRECT ANSWER A. During ventilator weaning, a patient must maintain a moderately low respiratory rate, an adequate sized tidal volume, and low work of breathing. In this case, the patient is experiencing increased labor of breathing and an increase in respiratory rate. This is likely due to a reduced spontaneous tidal volume. Although this data is not shown, this condition can be assumed. The solution for a low spontaneous tidal volume and increased work of breathing during weaning is to provide pressure support." "When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with a blender set at 50%, the respiratory therapist notes an oxygen concentration of 35% near the patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct the problem, the therapist should A. adjust blender setting to 60% B. increase total flow to the oxyhood C. obtain a smaller oxyhood D. change the nebulizer entrainment port to 100% - CORRECT ANSWER D. When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen control on the nebulizer should be set to 100%. This will prevent additional entrainment of room air which will cause a decrease in FIO2." "Following the insertion of a tracheostomy tube, the patient is found to have diffuse crackles upon auscultation secondary to subcutaneous emphysema. Which of the following radiographic findings would be expected with this condition? A. Hyperlucency in the soft tissues B. Diffuse pulmonary hyperlucency C. Tracheal shift from midline D. Scattered patchy infiltrates - CORRECT ANSWER A. Hyperlucency, seen on a chest x-ray is darker in color. Air is radiolucent. Therefore, air located in the soft tissue, as seen with subcutaneous emphysema would result in a hyperlucent X-ray over soft tissue areas. Subcutaneous emphysema by itself will not shift the trachea from midline. Scattered patchy infiltrates are associated with ARDS, not subcutaneous emphysema." "Placement of a pulmonary artery catheter is associated with which of the following most common complications? A. hypotension B. pulmonic valve damage C. cardiac arrhythmias D. internal bleeding - CORRECT ANSWER C. Several complications may arise from the placement of a pulmonary artery catheter, otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the most common complication of the options offered. Another serious complication is perforation of a vessel or cardiac muscle during the insertion." "A galvanic fuel cell oxygen analyzer may read erroneously high under which of the following conditions? A. when the analyzer batteries are depleted B. during a sudden increase in the partial pressure of oxygen C. when a volume-controlled ventilator at high inspiratory pressures D. when liquid gets on the membrane - CORRECT ANSWER C. A galvanic fuel-cell oxygen analyzer may read erroneously when ambient pressures change significantly, such as when a patient is receiving high inspiratory pressure or when a patient changes altitude quickly." "The physician orders mechanical ventilator settings: Mode assist/control VT 600 mLMandatory rate 10/minI:E 1:2FIO2 0.40PEEP 5 cm H2O Which of the following represents the minimum inspiratory flow setting the respiratory therapist should select? A. 24 L/min B. 60 L/min C. 18 L/min D. 40 L/min - CORRECT ANSWER C. There are several methods to determine the minimum flow needed to accomplish specific minimum flow settings on a mechanical ventilator. One shortcut method is to add the I:E ratio numbers together and multiply it by the minute ventilation. In this case, 1+2 = 3. Minute ventilation = (.6L x rate of 10) = 6.0 L. 6.0 L x 3 = 18 L/min. This is the minimum flow. When answering this question if the exact number is not available in the options, the correct choice would be the next highest number. For instance, if 18 L per minute was not an available option, the next best answer in this question would be 24 L per minute." "A 65-kg (143-lb) male patient is in the intensive care unit after being found unconscious and unresponsive with a suspected drug overdose. The following ABG and clinical data are observed. - pH: 7.30 - PaCO2: 50 mmHg - PaO2: 82 mmHg - HCO3-: 24 mEq/L - BE: 0 mEq/L - RR: 24 breaths per min - VT: 260 mL The respiratory therapist should recommend which of the following: A. Intubate, VC, A/C ventilation B. Oral intubation, CPAP 5 cm H2O, PS 6 cm H2O C. Non-invasive ventilation with IPAP 10 cm H2O, EPAP 5 cm H2O D. Manual resuscitation administer Narcan (naloxone) - CORRECT ANSWER B." "Which of the following is an emergency and requires that the patient receive 100% oxygen supplementation? A. Impending ventilatory failure B. Massive loss of blood C. Ventilatory failure D. Vital capacity below 1.0 L - CORRECT ANSWER B." "Which of the following is an indication for the use of FiO2 1.0 on a patient? A. Evidence of pulmonary embolism B. Ventilatory failure C. Impending ventilatory failure D. Myasthenia gravis - CORRECT ANSWER A. Of the options listed, only the suspicion and evidence of pulmonary embolism is suggestive of and emergency and necessitates the use of FiO2 1.0" "For a patient who is unconscious, due to ingestional error of barbiturates, which of the following assessments is the most important? A. Arterial blood gas analysis B. The patient's ability to protect their airway C. Tension test D. A drug toxicology screen - CORRECT ANSWER B." "Which of the following types of patients are most often good candidates for alveolar recruitment maneuvers? 1. Post-surgical 2. Acute lung injury 3. Pulmonary emphysema 4. Acute respiratory distress syndrome 5. Tuberculosis A. 1, 2, 3, and 4 only B. 1, 2, and 3 only C. 1, 3, and 5 only D. 3, 4, and 5 only - CORRECT ANSWER A." "Which of the following is most attributed to effective alveolar recruitment? A. Varying peak pressures applied to the airway B. Using high peak flows to 'pop' open alveoli C. Applying pressure above that which is applied during tidal volume delivery D. Disallowing the patient to exhale tidal volume completely - CORRECT ANSWER C. The central concept behind alveolar recruitment relates to higher-than-normal pressure applied to the alveoli compared to the pressure associated with normal tidal volume delivery" "If the scale of the ventilator graphic is not changed, in which way will the pressure-volume ventilator graphic change in appearance when alveolar recruitment is effective? It will: A. Become skinny and retracted B. Become wider and protracted C. Move upward away from the x-axis D. Become increasingly parallel to the x-axis - CORRECT ANSWER C. As alveoli are recruited, the lungs become more compliant. This will cause a shift of the pressure-volume graphic from "lying down" on its side, parallel to the x-axis; to a higher angle, closer to 45 degrees from the origin" "Which of the following methods is associated with alveolar recruitment A. Airway pressure applied above a patient's plateau pressure B. PEEP greater than 1/4th of peak pressures C. Airway pressure release ventilation D. Peak pressures above 50 cm H2O - CORRECT ANSWER A." "Effective alveolar recruitment will be manifested by which of the following clinical outcomes? 1. Decrease in the A-a 2. Increase in PF ratio 3. Decrease in VT 4. Decrease in Qs/Qt A. 1, 2, and 4 only B. 1 and 4 only C. 2 and 3 only D. 1, 2, 3, and 4 - CORRECT ANSWER A." "Which of the following PEEP levels, set above the patient's plateau pressure, is appropriate as an initial setting during alveolar recruitment maneuvers? A. 10 cm H2O B. 40 cm H2O C. 30 cm H2O D. 20 cm H2O - CORRECT ANSWER A." "Which of the following ventilator modes is most suitable to help recruit alveoli? A. PRVC B. PCV C. APRV D. Inverse positive pressure ventilation - CORRECT ANSWER C." "To qualify for ventilator weaning, a patient's Qs/Qt should be below A. 60% B. 5% C. 10% D. 20% - CORRECT ANSWER D." "A patient receiving VC SIMV ventilation has a spontaneous tidal volume of 500 mL and a respiratory rate of 20/min when removed momentarily from the ventilator. What is the RSBI value? A. 10 B. 25 C. 40 D. 0.025 - CORRECT ANSWER C. RSBI is calculated by RR/VT (L). RSBI = 20 / 0.5 L RSBI = 40" "To be considered for weaning from VC A/C ventilation, a patient's A-aDO2 should be less than: A. 100 mm Hg B. 65 mm Hg C. 300 mm Hg D. 200 mm Hg - CORRECT ANSWER C. An A-aDO2 greater than 300 mm Hg would suggest that the patient requires PEEP to maintain adequate PaO2." "Which of the following generally represents the quickest, most effective method for ventilator liberation? 1. APRV 2. Cold cessation and extubation 3. SBT 4. Gradual decrease in rate and pressure support - CORRECT ANSWER C." "What postural drainage position is most conducive to draining the basal, anterior, and lateral segments? A. Prone B. Supine C. Lateral side, quarter turn D. Trendelenburg - head down 30 degrees - CORRECT ANSWER D." "A patient is in the ICU for treatment of right-sided pneumonia and cor pulmonale. What patient positioning would optimize gas exchange? A. Supine B. Semi-Fowler's C. Lying on the right side with the left lung up D. Lying on the left side with the right lung up - CORRECT ANSWER C. For optimal gas exchange, the unaffected lung should be kept up high" "Which of the following would indicate that the prescribed airway clearance efforts are effective? A. Expectoration of secretions dissipates B. Patient develops rhonchi during clearance procedure C. Patient indicates they can breathe better D. Breath sounds become less diminished - CORRECT ANSWER B" "Which of the following conditions would contraindicate chest percussion for the purpose of airway clearance? A. Bacterial pneumonia B. ARDS C. Cystic fibrosis D. Untreated tuberculosis - CORRECT ANSWER D. May promote destruction and expectoration of lung tissue in patients with untreated tuberculosis" "A 9-year-old asthmatic patient has previously responded well to Xopenex via small-volume nebulizer. The patient is intubated and has been placed on mechanical ventilation for acute respiratory failure. The physician orders Xopenex to be delivered via SVN through the ventilator circuit. Which of the following is an important consideration for effective medication delivery? A. tachycardia is more likely B. particle deposition will be increased C. Placement of the nebulizer can result in variation of medication delivery D. an alpha I response is increased - CORRECT ANSWER C. Administering aerosolized bronchodilators through a mechanical ventilator circuit requires careful judgment by the respiratory therapist. Several factors including all listed in this scenario limit the therapist's ability to properly deliver medication. These factors must be taken into consideration for all mechanically ventilated patients, including pediatric patients." "While assessing a patient receiving positive pressure ventilation with a Servo adult ventilator, the therapist notes a sudden low return volume alarm begins sounding. Which of the following could be the cause? A. pulmonary embolism B. excess condensate in the ventilator circuit C. bronchopleural fistula D. ARDS - CORRECT ANSWER C. The solution to this problem is to determine which answer could lead to a low-pressure alarm. Excess condensate in the ventilator circuit and adult respiratory distress syndrome would more likely lead to high-pressure alarms. A pulmonary embolism is not related to any particular alarm. That leaves a bronchopleral fistula as the only possible cause." "When considering appropriate staffing levels and proper care of patients, a respiratory therapy supervisor would include which of the following A. frequency of declined therapy B. Individual skills of staff members C. previously missed therapy D. staff member preference - CORRECT ANSWER B. When planning appropriate staffing levels for patient care, frequency of therapy, type of therapy ordered, and the individual skills of the staff are all important considerations. Department budgetary goals should not affect staffing." "A respiratory therapist is preparing a patient who will be transferred home and will be ventilator dependent during the night. Which of the following devices would be most helpful to ensure adequate hydration of the patient's airway during the night? A. Large volume nebulizer B. Cascade humidifier C. Heat moisture exchanger (HME) D. Heated wire ventilator circuit with water traps - CORRECT ANSWER C. An HME device is intended for short-term use. Patients who are ventilator-dependent during the night may use this device." "After noting profuse bubbling in the water-seal chamber of a disposable three-chamber chest drainage system, the RT places a clamp on the chest tube proximal to the patient. In doing so, the bubbling dissipates and stops. What can be concluded? A. The leak must be in the tubing leading to the chest drainage system B. Suction pressure at the wall is excessive C. The patient may have perforation in lung tissue D. Leaking is most likely occurring inside the three-chamber system - CORRECT ANSWER C." "A 22-year-old, 6-ft, 3-in Caucasian male is in the ER for sudden, unexplained onset of tachypnea. Chest radiography shows hyper lucency in the left chest, dominated by a large dark area over the entire left lung field. The physican decides to install a chest tube drainage system and asks for your recommendation on chest tube placement. You will suggest which of the following? A. Right side, mid-axillary line, 5th intercostal space B. Right side, left side, 4th intercostal space, mid-clavicular line C. Left side, mid-axillary line, 5th intercostal space D. Left side, 2nd intercostal space, mid-clavicular line - CORRECT ANSWER D." "In a patient with a partial pneumothorax, what percent of collapse is the threshold that indicates the need for chest tube insertion? A. 50% B. 20% C. 10% D. 15% - CORRECT ANSWER B." "By what route is Xolair (omalizumab) administered? A. Subcutaneously B. Aerosolized C. IV D. Intra-muscular - CORRECT ANSWER A." "How many milliliters of aerosolized medication should be prepared to deliver 30 mg of that same drug if the strength is 1.5% A. 2.0 mL B. 4.5 mL C. 20 mL D. 45 mL - CORRECT ANSWER A. Strength of 1.5% x 10 = 15 mg/mL 30 mg / 15 mg/mL = 2.0 mL" "An aerosolized bronchodilator is being administered to a patient. The dose is 5.0 mL and the drug strength is 2.0%. How many milligrams of the drug will be administered? A. 2.5 mg B. 0.4 mg C. 100 mg D. 10 mg - CORRECT ANSWER C. Strength of 2.0% x 10 = 20 mg/mL 5.o mL x 20 mg/mL = 100 mg" "A bronchodilator medication whose strength is 0.5% must be delivered by continuous bronchodilator therapy at 10 mg/hr for 2.5 hours. How many mL will be required to be added to the nebulizer? A. 25 mL B. 5.0 mL C. 1.25 mL D. 10 mL - CORRECT ANSWER B. Strength of 0.5% x 10 = 5 mg/mL 2.5 x 10 = 25 total milligrams # of mL needed = 25 total mg / 5 mg/mL = 5.0 mL" "While performing cardiac compressions on a patient in complete cardiac arrest, the physician suspects a gastric rupture has occurred. The RT should anticipate the order to: A. Prepare for echocardiography B. Continue compressions C. Transfer the patient to CT scan D. Cease compressions for needle puncture of the abdomen - CORRECT ANSWER B." "Which of the following medications may be delivered by instillation down the ETT during ACLS efforts? A. Atropine B. Prostaglandin C. Racemic epinephrine D. Nitroglycerine - CORRECT ANSWER A." "Which of the following antibiotics would be appropriate for a patient with gram-positive organisms and who is resistant to penicillin? A. Cephalexin B. Nafcillin C. Carbenicillin D. Amoxicillin - CORRECT ANSWER B." "Which medications can be used to treat candidiasis? 1. Oxacillin 2. Tobramycin 3. Amphotericin B 4. Nystatin A. 3 and 4 only B. 2 and 3 only C. 1 and 2 only D. 1 and 4 only - CORRECT ANSWER A." "Which of the following would constitute a therapeutic use of a flexible bronchoscope? A. Extracting tracheal tissue for biopsy B. Determining the presence of any mucus plugs C. Locating an aspirated foreign body D. Removal of a large food particle from the airway - CORRECT ANSWER D." "While suctioning blood from the trachea with a bronchoscope following tissue extraction, the scope suddenly demonstrates no suction pressure at the end of the scope. The RT should check the: A. Suction pressure at the wall B. Integrity of the suction line C. Bodai adapter D. Suction channel on the scope - CORRECT ANSWER D. The suction channel is most likely clogged and is the cause of the problem" "Which of the following may be used to facilitate a bronchoscopy while providing mechanical ventilatory support? A. King airway B. Bodai adapter C. Fenestrated tracheostomy tube D. Combitube - CORRECT ANSWER B. Device which attaches to the end of the ETT and has a 90-degree connection for the ventilator and a port that allows insertion of a bronchoscope straight into the airway" "Blood is found in the exudate retrieved during a thoracentesis. This is most likely associated with: A. Infection B. Cancer C. Pleural effusion D. Tuberculosis - CORRECT ANSWER A." "A thoracentesis is performed by inserting a large bore needle into the pleural space between the: A. 5th and 6th ribs B. 7th and 8th ribs C. 3rd and 4th riibs D. 10th and 11th ribs - CORRECT ANSWER B" "When adjusting the mandatory rate on a volume control ventilator of a patient who has COPD, the RT should monitor which of the following to ensure adequate ventilation? A. HCO3 B. PaCO2 C. pH D. PaO2 - CORRECT ANSWER C." "In case of a ventilation emergency, the COPD patient should receive: A. Oxygen not to exceed 35% B. 50% oxygen C. 100% oxygen D. No more than 2 L/min by nasal cannula - CORRECT ANSWER C." "What would be the most likely shape of a flow-volume pulmonary function loop on a patient with COPD? A. Short and narrow B. Tall and narrow C. Short and wide D. Tall and wide - CORRECT ANSWER C. Because a COPD patient has difficulty expiring, the flow volume loop will be wide as they require longer to exhale. Consequently, the volume will be reduced, causing the loop to be short (low in volume indicated on the Y axis)" "While doing an ECG on a patient who is asymptomatic, the RT notes pronounced 'Q' waves on the ECG. The RT should: A. Look for a detached chest lead B. Note the observation, otherwise take no immediate action C. Begin treatment protocols for myocardial infarction D. Call a code - CORRECT ANSWER B" "While performing a routine check of a patient receiving mechanical ventilatory support, the respiratory therapist makes a small adjustment to the ET tube cuff pressure by injecting 2.0 cc of air into the cuff. Immediately after, the high-pressure alarm on the ventilator is activated. The therapist should A. silence the alarm and monitor the patient closely. B. remove the ET tube. C. readjust the cuff using the minimal leak technique. D. attempt to pass a suction catheter through the ET tube. - CORRECT ANSWER D. The activation of the high-pressure alarm is an indication of an occlusion. Since this occurred immediately after adding air to the ET tube cuff, the therapist should suspect the possibility of cuff herniation. To rule this suspicion in or out, a suction catheter should be inserted into the airway to determine if there is an obstruction near the distal end of the tube." "A 6-minute walk test is used to evaluate A. a patient's physical stamina and aerobic endurance. B. pulmonary ventilatory ability. C. PF ratio. D. Oxygen desaturation tendency. - CORRECT ANSWER A. A 6-minute walk test (6MWT) is a way of evaluating a patient's physical performance ability, especially given certain cardiopulmonary limitations. The test evaluates the distance a person can walk in 6 minutes. This is known as a 6-minute walk distance (6MWD)." "Prior to performing pulmonary function testing on a several patients, a respiratory therapist is conducting quality control on the pneumotachometer. After injecting a 3.0 L syringe through the pneumotachometer, the therapist notes a measurement of 2.86 L. Based on this result the therapist should A. commence testing on patients. B. replace the pneumotachometer. C. perform a two-point calibration. D. calibrate the 3.0-L syringe. - CORRECT ANSWER A. Although the pneumotach should achieve a measurement close to 3.0 L, it is permissible to use the equipment for patient testing if the result is within +/- 5% (2.85 L - 3.15 L). In this case, the quality control result is within range, which suggests that the equipment may be used for patient testing." "How many milliliters of a medication whose strength is 5% is needed to deliver 25 mg of that medication? A. 1.25 mL B. 0.50 mL C. 5.0 mL D. 125 mL - CORRECT ANSWER B. The first step is to calculate the number of mg/mL in a drug that is at 5% strength. This is done by multiplying the drug strength by 10. mg/mL = 5% x 10 = 50 mL = 25 mg / 50 mg/mL = 0.50 mL" "ASK: While ventilating a patient with a VC ventilator, the respiratory therapist notices that the ventilator is not delivering the set tidal volume. The therapist should A. cycle the ventilator off, then on. B. obtain an ABG and determine the adequacy of ventilation. C. remove the ventilator from service ,and perform preoperative test. D. adjust the tidal volume to compensate. - CORRECT ANSWER C. Should any critical equipment show suspicious signs of malfunction, that equipment should be immediately removed from service and repaired." "Into which interspace should a chest tube be inserted for the purpose of draining serosanguinous fluid from the pleural space and for the re-expansion of lung tissue? A. 2nd interspace B. 5th interspace C. 4th interspace D. 8th interspace - CORRECT ANSWER B. If fluid is anticipated, chest tubes should be place in the 5th interspace, mid-axillary line." "The following volume-pressure graphic is observed on a patient who is receiving VC A/C ventilation. The respiratory therapist should *Image is a very flat pressure-volume loop* A. switch to PC ventilation B. determine average inspiratory plateau pressures C. change the scale volume axis of the graph D. determine the patient's static compliance - CORRECT ANSWER C. Although this pressure-volume graphic appears to be 'lying down", which is usually associated with decreasing pulmonary compliance, closer observation reveals that the scaling on the volume axis of the graphic is not appropriate. In other words, the graphic appears as it does due to improper scaling. Once corrected, the graphic is likely to show normal compliance." "Which of the following conditions could cause a tracheal shift to the right? 1. atelectasis in the left2. sputum consolidation on the right3. pneumothorax on the right4. lobectomy on the right. A. 1 and 3 only B. 1 and 4 only C. 2 and 4 only D. 1, 2, and 4 only - CORRECT ANSWER C. Sputum consolidation on the right and a lobectomy on that same side would cause a tracheal shift to the right. Other options would shift the trachea to the left." "Corticosteroids help support bronchodilation by: A. Decreasing airway inflammation B. Augmenting the action of rescue medication C. Promoting relaxation of smooth muscle tissue D. Significantly reducing sputum production - CORRECT ANSWER A." "What side effects are associated with the use of dornase alpha? A. Rash and laryngitis B. Candidiasis and thrombocytopenia C. Diplopia and dysphagia D. Pulmonary infection and pneumonia - CORRECT ANSWER A." "Immediately after the administration of succinylcholine (Anectine) in preparation for intubation, the RT should watch for which of the following to determine when the drug has taken effect and when the intubation procedure may commence. A. The acute development of petechia on the skin near the mandible B. Muscle fasciculations (twitching) about the face and neck C. Spontaneous respiratory rate 8/min D. A sudden spike in blood pressure - CORRECT ANSWER B." "A patient has a pulmonary artery catheter in place and is being monitored hemodynamically. Currently, CVP, mPAP, and PCWP are all elevated. Which of the following would help lower these hemodynamic pressures? A. IV normal saline B. Montelukast C. Furosemide D. Mannitol - CORRECT ANSWER C." "A 45-year-old male patient with CHF has peripheral pitting edema rated at a +4. Which of the following medications would be helpful in correcting this tendency toward third-spacing in the periphery? A. D5W fluid B. Nitroprusside (Nipride) C. Osmitrol (Mannitol) D. Acetazolamide (Diamox) - CORRECT ANSWER D. Acetazolamide is especially useful in addressing peripheral pitting edema" "Which of the following agents promotes fluid retention? A. DDAVP B. Furosemide C. Acetazlamide D. Osmitrol - CORRECT ANSWER A." "Desmopressin is an agent that helps prevent: A. Third-spacing B. Fluid retention C. Diuresis D. Elimination of waste products in the urine - CORRECT ANSWER C." "A 45-year-old patient is admitted to the ER with reduced consciousness, RR of 8/min, and a VT of 4 mL/kg. First responders reported that they found the patient with an open bottle of Fentanyl (Sublimaze) and a note nearby. The critical care specialist should recommend the administration of: A. Naloxone B. Diprivan C. Nembutal D. Romazicon - CORRECT ANSWER A. Also called Narcan." "Which of the following drugs is primarily used for analgesia? A. Dopram B. Cephalexin C. Hydrocodone D. Narcan - CORRECT ANSWER C." "Which of the following can provide analgesia transdermally? A. Narcan B. Sublimaze C. Morphine D. Codeine - CORRECT ANSWER B. Also called fentanyl" "Cardiac anti-arrhythmic medications deal with how the heart: A. reacts to excessive CO2 B. Contracts and beats at a consistent rhythm C. Responds to too much oxygen D. Delivers oxygen to its own cardiac tissues - CORRECT ANSWER B." "A cardiac chronotropic medication, such as Verapamil, primarily effects what aspects of the heart's function? A. Response to hypoxemia B. Rate C. Contraction D. Electrical conductivity - CORRECT ANSWER B." "A medication is said to have inotropic properties. What function of the heart is most likely changed when these types of drugs are administered? A. Contraction strength B. Regurgitation C. Contraction rate D. Left-to-right shunting - CORRECT ANSWER A." "What kind of anti-ischemic medications would cause dilation of the coronary vessels? A. Platelet glycoprotein B. Anti-platelet C. Nitrates D. Aminoglycoside - CORRECT ANSWER C." "After attempting to treat a patient's gram-positive bacteria infection with amoxicillin with very little efficacy, the culture and sensitivity report from microbiology shows the patient is penicillin-resistant. Which of the following agents is most likely to be more helpful in eradicating the patient's bacterial infection? A. Vancomycin B. Cephalexin C. Penicillin D. Oxacillin - CORRECT ANSWER D. Nafcillin, oxacillin, and methicillin are special "cillin" class antimicrobials that are more effective when the patient is penicillin-resistant" "Which of the following agents would be most helpful at controlling a gram-positive bacterial infection in a patient who is allergic to penicillin? A. Gentamycin B. Cephalexin (Keflex) C. Methicillin D. Carbenicillin - CORRECT ANSWER B." "Which of the following medications is both a vasoconstrictor and an agent that increases the strength of cardiac contraction (positive inotropic)? A. Phenylephrine (neo-synephrine) B. Atropine C. Nitroprusside (Nipride) D. Dobutamine (Dobutrex) - CORRECT ANSWER D." "The administration of vasoconstrictor medication would most likely result in: A. Hypotension B. Decreased PVR C. Increased SVR D. Cardiac vessel dilation - CORRECT ANSWER C." "A patient with angina and suspected pulmonary hypertension should receive which of the following medications that will also promote a decrease in SVR? A. Rocuronium (Zemuron) B. Sublingual nitroglycerin C. Dobutamine (Dobutrex) D. Fentanyl (Sublimaze) - CORRECT ANSWER B." "BID is a common frequency order for which of the following respiratory medications? A. Albuterol B. Flovent C. Ativan D. Xopenex - CORRECT ANSWER B. Flovent (fluticasone) is a corticosteroid used generally to prevent and relieve inflammation of airway walls. Inflammation is one of the components of asthma so corticosteroids are key in treatment. The frequency is twice per day or b.i.d. Flovent may cause Candidiasis, (oral yeast infection), which may be prevented by judiciously rinsing the mouth after inhaler use." "A high frequency jet ventilator system includes which of the following items? A. Clark electrode B. flow interrupter C. nitrogen analyzer D. pop-off spring valve - CORRECT ANSWER B. Of the options offered, only a flow interrupter is a control associated with high-frequency jet ventilation." "A post-op adult patient achieved an inspiratory capacity of 1800 cc with an incentive spirometer prior to surgery. After the surgery, the patient appears to be confused on how to use the incentive spirometer. The therapist notes the patient is having difficulty getting the balls to rise. The therapist should A. administer oxygen at 5 L/min nasal cannula B. coach the patient more diligently C. switch to a volume-type device D. assess the patient for the cause of the confusion - CORRECT ANSWER C. Incentive spirometry comes in two types: a flow type, which requires keeping balls floating, and the volume type, which simply measures inspiratory capacity. The volume type of incentive spirometer is considered to be the easiest. It is appropriate to switch to a volume spirometer when the patient is having difficulty with a flow type spirometer." "Which of the following is the correct postural position for drainage of the right lateral segment? A. right side, HOB down 12 inches B. left side, HOB down 18 inches C. flat on stomach, HOB down 18 inches D. supine and slightly rotated to the left, HOB down 12 inches - CORRECT ANSWER B. The right lateral segment is drained with the head of bed down 18 inches with the patient lying on the left side." "A respiratory supervisor is calculating appropriate staffing levels for a shift. Which of the following should be included in calculation? A. staff member preferences B. patient medical history C. patient areas and locations D. frequency of refused therapy - CORRECT ANSWER C. To plan for patient care, staffing must be appropriate. Conditions that affect the amount of staff needed include location of patients (how far staff must travel to get to patients), frequency of ordered therapy (how frequently staff must visit the patient), and the type of therapy (how long the therapy will take). The patient's medical history will not likely affect staffing." "A 183-cm (6-ft), 78-kg (171-lb) male patient with ARDS has the following ABGs while receiving PC, A/C ventilatory support: pH 7.28 PaCO2 52 mm HgPaO2 62 mm HgHCO3- 27 mEq/LBE -5 mEq/L Ventilator settings: FIO2 0.6PEEP 18 cm H2OVT(exhaled) 400 mLIP 36 cm H2OIT% 33%(f) 16/min The respiratory therapist should recommend A. increasing the inspiratory pressure. B. increasing FIO2. C. increasing PEEP. D. reducing the rate. - CORRECT ANSWER A" "Which of following calculations will determine inspiratory capacity (IC)? A. TLC - VT - ERV B. TLC - FRC C. ERV + VT + IRV D. IRV - TLC - RV - CORRECT ANSWER B. These types of questions can be difficult. Memorizing pulmonary function volume chart is a good place to start. To find a solution to this problem you generally have to take each answer one by one, do the calculation, and determine if the correct result can be achieved. In this case, inspiratory capacity can be calculated by subtracting the FRC from the TLC." "A patient is transferred to the intensive care unit after abdominal surgery. Vital signs are observed within 20 minutes of arrival. BP 90/58 mm Hg and SpO2 97% on a 40% air-entrainment mask. The patient's color is dusky. The respiratory therapist should A. check Hb level B. administer anticoagulant therapy C. assess INR D. institute volume ventilation - CORRECT ANSWER A. The low BP and dusky color after surgery is suggestive of anemia and possible internal hemorrhaging, likely a problem that developed as a result of the surgery. An Hb check will definitively determine if internal blood loss is occurring." "A physician orders a chest radiograph on an ambulatory patient in the emergency department (ED) in response to a suspicion of pneumonia. Which of the following should be ordered? A. series of oblique-angle radiographs B. PA radiograph C. AP radiograph D. apical lordotic - CORRECT ANSWER B. There are two types of chest x-rays that can be used - a PA x-ray and an AP x-ray. The PA x-ray is more accurate but requires the patient to be mobile. An AP x-ray is used for patients who are bedridden. In this case the patient is clearly ambulatory so A PA radiograph is most appropriate." "For alkaline glutaraldehyde to act as a sterilization agent, non-disposable equipment must be soaked for at least A. 24 hours. B. 20 minutes C. 1 hour. D. 10 hours. - CORRECT ANSWER D." "A patient with myasthenia gravis presents to the clinic with a fever, suspected pneumonia secondary to an infiltrate seen on a chest radiograph, and the following ABG results: pH 7.33 PaCO2 47 torrPaO2 85 torrHCO3- 26 mEq/LFIO2 0.21 Based upon this information, the patient needs A. antibiotic therapy. B. oxygen at 2 L/min nasal cannula. C. pulmonary function testing. D. intubation. - CORRECT ANSWER A. In this example, we see a problem with ventilation as the PaCO2 is 47 torr. However, there is no option that will resolve ventilation, therefore we must look to the scenario for other problems. There is an underlying problem of infection for which antibiotic therapy is indicated." "While preparing to administer a metered-dose inhaler (MDI) to a patient with COPD, the respiratory therapist notices the patient becomes unconscious and markedly cyanotic. Which of the following should the therapist immediately do? A. begin chest compressions B. deliver several puffs of the MDI C. place on a nonrebreathing mask D. page the physician - CORRECT ANSWER C. Although COPD patients should not receive excessive oxygen, when an emergency exists, 100% oxygen is indicated. In this case, the patient is markedly cyanotic and, as a result, has also become unconscious. This is associated with an emergent vital function and should be addressed by administering 100% oxygen." "Which of the following medications may be used as a pulmonary vasodilator and to treat symptoms associated with altitude sickness? A. norepinephrine B. alprazolam C. inhaled NO D. sildenafil - CORRECT ANSWER D. Sildenafil is a medication that can be used as a pulmonary vasodilator AND to treat symptoms related to altitude sickness." "A 150-lb (68-kg), 5-ft 6-in (168 cm) female patient is receiving mechanical ventilation as follows: Mode Assist/control Alveolar minute ventilation 7.5 L/minTotal Rate 15PB 734 mm Hg What is the patient's set tidal volume? A. 700 mL B. 550 mL C. 500 mL D. 350 mL - CORRECT ANSWER C. Tidal volume is calculated by dividing the minute ventilation by the respiratory rate. By knowing any two of these three data, one can calculate the third. For example, to calculate minute ventilation, multiply the tidal volume by the respiratory rate. To calculate respiratory rate, divide minute ventilation by tidal volume." "A pulmonary rehabilitation patient is being monitored for compliance to a smoking cessation program. Which of the following values would be most helpful to evaluate? A. PaO2 B. metHb C. multiple wave-length spectrophotometry D. SPO2 - CORRECT ANSWER C. A patient on a smoking cessation program may be monitored for compliance by periodically assessing the Multiple wave-length spectrophotometry. This allows the measurement of CO in the blood by finger probe. If COHb remains elevated or increases, the patient is likely not compliant with the program." "While observing the PetCO2 value on a patient who is receiving mechanical ventilation, the tracing shows a sharp rise in the CO2 on the capnograph. This rise represents A. massive atelectasis B. pulmonary embolism C. the flushing out of dead space D. a soiled infrared CO2 sensor - CORRECT ANSWER C. Initial end-tidal CO2 readings are often low but demonstrate a sharp rise as carbon dioxide builds up in the dead space is exhaled past the infrared CO2 detector." "While receiving ventilatory support by a non-invasive ventilator, a patient vomits into the full inflatable mask. Although not known, it is believed that the patient may have aspirated. The following arterial blood gases are determined 20 minutes after the event while receiving ventilatory support on IPAP 25 cm H2O, EPAP 5 cm H2O: ABGs pH 7.38PaCO2 42 torrPaO2 81 torrHCO3- 24 mEq/LBE +1 mEq/L The respiratory therapist should A. switch to a nasal mask. B. continue therapy, monitor the patient's temperature. C. perform bronchoalveolar lavage (BAL) D. institute invasive mechanical ventilation. - CORRECT ANSWER D. Because it is believed that the patient may have aspirated, airway protection going forward is of paramount importance. Additionally, since the ABGs appear acceptable with the previous level of ventilatory support, continued ventilatory assistance is likely needed. Thus, invasive ventilation is the most appropriate option." "Microorganisms are found on reusable mouthpieces that were soaked in a cleaning solution for 30 minutes. Which of the following could be a contributing factor for the persistent organisms? A. aeration time B. room temperature C. age of the solution D. barometric pressure - CORRECT ANSWER C. The effectiveness of a cleaning solution, such as alkaline glutaraldehyde, is based on the amount of time the item is soaked in the solution, the type of solution, and the age of the solution. Although not offered, the resistance of the organism is also a factor. Room temperature and barometric pressures are not contributing factors." "What is the maximum negative pressure that should be used to suction a 4-year-old patient who is intubated with a 5.0 mm endotracheal tube? A. -100 mm Hg B. - 80 mm Hg C. -110 mm Hg D. -120 mm Hg - CORRECT ANSWER A. When suctioning, use the following indicated "gauge" pressures: _x000D_ Adult: 100-120 mm Hg (negative), Pediatric: 80-100 mm Hg (negative), Infant: 60-80 mm Hg (negative)" "Which of the following adjustments would significantly affect a patient's partial pressure of carbon dioxide in the blood plasma? 1. increase delivered VT by 100 ml2. changing from a pediatric circuit to an adult circuit3. reducing the mandatory respiratory rate by 4/min4. increasing PEEP by 5 cmH2O A. 2 and 4 only B. 1 and 3 only C. 1 and 4 only D. 2 and 3 only - CORRECT ANSWER B. Of the options offered increasing tidal volume and reducing mandatory rate would have the most significant effect on arterial CO2. Changing the ventilator circuit and increasing PEEP would not affect arterial CO2." "A patient in the intensive care unit (ICU) is receiving mechanical ventilation following a massive heart attack where injury and infarction were sustained. The following data is available: Mode VC, SIMV FIO2 0.50VT 500 mLf 14/minPEEP 5 cm H2O PCWP 12 mm HgCVP 8 mm HgmPAP 20 mm HgC.O. 7.9 L/min ABG pH 7.36PaCO2 49 mm HgPaO2 82 mm HgHCO3- 25 mEq/LBE +1 mEq/L The respiratory therapist should recommend A. inhaled nitric oxide (iNO). B. administration of a loop diuretic. C. fluid administration with D5W. D. administration of Digitalis (Crystodigin). - CORRECT ANSWER B. Hemodynamic values are high. Fluid overload appears to be present. Thus, fluid diuresis is most appropriate." "While performing tracheostomy care on a patient who has an 8.0-mm fenestrated trach tube in place, the respiratory therapist removes the secure ties from the flanges to more freely perform dermal cleaning in the area. The patient then coughs explosively and expels the tracheostomy tube onto the bed covers. The therapist should immediately A. rinse the trach tube with sterile water and re-insert into the stoma. B. perform oral intubation with a 7.5-mm ET tube. C. replace the tracheostomy tube with a new one. D. retrieve the tube and re-insert it into the stoma. - CORRECT ANSWER C" "While undergoing tracheostomy tube hygiene, the patient experiences an explosive cough and partially ejects the tracheostomy tube. After reinsertion of the tube, the patient exhibits a moderate amount of ventilatory distress. The respiratory therapist should immediately A. insert an obturator into the tube. B. remove the tube. C. auscultate breath sounds. D. order a chest radiograph. - CORRECT ANSWER C. Auscultation of the chest will most quickly assess for a potential mal-placed tracheostomy tube. Removing the tube entirely at this point is too drastic. A chest x-ray consumes too much time as the patient is currently in distress." "During the placement of a pulmonary artery catheter, the respiratory therapist observes the waveform on the monitor and notices it is repeatedly rising and falling from 0 mmHg to 25 mmHg, which is an indication that the tip of the catheter is in the right ventricle of the heart. Based on this information, the respiratory therapist will recommend A. inflate the catheter balloon to sail the tip to the proper location B. withdraw the catheter back to the upper vena cava C. rotate the catheter to achieve a dicrotic notch in the waveform D. suture the catheter in place - CORRECT ANSWER A. The pulmonary catheter should be terminated in the pulmonary artery, which is beyond the right ventricle. Therefore, advancing the catheter is appropriate. The catheter may be advanced by sailing it into position, which is done by inflating the catheter balloon and allowing blood flow to carry the catheter into position and then deflating the balloon once it is in the proper position." "A patient receiving VC, A/C mechanical ventilation shows a flow-time graph whose exhalation phase fails to rise to baseline before the inspiratory phase begins. The physician asks the respiratory therapist to assess the affects. The therapist should consider a(n) A. alveolar recruitment. B. valsalva maneuver. C. AutoPEEP determination. D. optimal PEEP study. - CORRECT ANSWER C." "A patient who is receiving mechanical ventilatory support is suspected of pulmonary embolism. Which of the following determinations would be most helpful in screening the patient for this possibility? 1. C(a-v)O22. PetCO23. PaCO24. P/F ratio A. 2 and 3 only B. 2, 3 and 4 only C. 1, 2 and 4 only D. 1 and 4 only - CORRECT ANSWER A." "A patient is in the intensive care unit receiving volume-controlled ventilation and is hemodynamically unstable. A new balloon-tipped, flow-directed, pulmonary artery catheter has been placed. Immediately following insertion, a chest radiograph shows the tip of the catheter is positioned over the right mid lung near the hilum. Which of the following can the respiratory therapist conclude concerning the catheter? A. it should be rotated away from the hilum B. it should be withdrawn several centimeters C. it has punctured the pericardial wall D. the balloon should be inflated and the catheter advanced - CORRECT ANSWER D. The chest radiograph reveals improper placement of the pulmonary artery catheter. To advance the catheter, the balloon should be inflated and the catheter should be sailed into place." "The respiratory therapist should gather which of the following equipment in preparation for the administration of heliox therapy? A. non-rebreathing mask B. air flow meter C. air/oxygen blender D. face tent - CORRECT ANSWER A. Helium-oxygen therapy requires a non-rebreathing mask for delivery." "A 173-cm (5 ft, 8 in), 64-kg (141-lb) female is receiving VC, A/C ventilation on the following settings: FIO2 0.60 PEEP 18 cm H2Of 14/minVT 550 mL Laboratory data shows: pH 7.36 PaCO2 45 torrPaO2 58 torrHCO3- 23 mEq/LBE -2 mEq/LSAO2 88%mPAP 25 mm HgCVP 5 mm HgPCWP 17 mm HgC.I. 1.8 L/min/m2 The respiratory therapist should first A. increase FIO2 to 1.0. B. administer Dopamine, IV. C. flush the PA catheter. D. decrease PEEP. - CORRECT ANSWER D. Although the patient is obviously hypoxic and further increase in PEEP would be normally appropriate, in this case, an increase in PEEP would cause further degradation in the hemodynamic status of the patient. The current hemodynamic values show that cardiac index is less than 2 - 4 L/min/m2, suggesting that the current PEEP level is excessive and should be lowered. Although this will cause a further problem with hypoxemia, reduced cardiac output should be addressed first." "A patient undergoes polysomnography. The results show an AHI of 5. This should be interpreted as A. obstructive sleep apnea B. mild sleep apnea C. central sleep apnea D. normal - CORRECT ANSWER D. An AHI of 5 or less would be considered normal for most adults. This suggests that no sleep apnea is present. AHI refers to Apnea-Hypopnea Index. It represents the number apneas and/or hypopneas that occur in 1 hour. Most adults experience a little of both. AHI values greater than 30 are associated with severe sleep apnea." "A physician suspects an emergency room patient has restrictive lung disease, though there is no record of such an impairment in the patient's medical history. Which of the following would help to evaluate the patient for this suspicion? A. peak flow rate determination B. incentive spirometry C. bedside flow-volume loop D. single-breath nitrogen elimination test - CORRECT ANSWER C. A flow-volume loop can be evaluated by bedside pulmonary function testing. The shape of the loop can indicate the presence of an obstructive and/or a restrictive lung defect." "While observing a PA chest radiogram, the respiratory therapist notices that the apices of the lung are not level with one another. The right is higher than the left while the clavicle structure remains level. What is the most likely reason for this? A. The patient is leaning to the left. B. Over-exposure is projecting a shadow. C. The x-ray camera is tilted to the left. D. The patient is improperly rotated. - CORRECT ANSWER D. Level clavicles rule out any leaning of the patient or tilting of the camera. This is mostly likely caused from the patient being rotated improperly, causing one side the lungs to be closer to the film than the other. This would account for the apparent difference in lung size and/or height." "Which of the following is used to monitor exhaled CO2 continuously? A. transcutaneous device B. standard ABG analyzer C. an infrared device D. point-of-care blood gas analyzer - CORRECT ANSWER C. Also known as a capnometer, an infrared CO2 detector device is used to monitor exhaled CO2 (PetCO2 and PECO2) continuously. ABG analyzers are used only for spot checks and are not suitable for continuous monitoring. The transcutaneous method is used when monitoring arterial CO2 indirectly through the skin but does not monitor exhaled CO2." "A patient complains of claustrophobia while receiving 40% oxygen by air-entrainment mask (Venti mask). The respiratory therapist can assist the patient by making which of the following changes? A. simple mask with a flow of 5 L/min B. partial rebreather with a flow of 12 L/min C. high flow, high humidity nasal cannula at 40 L/min D. nasal cannula at 6 L/min - CORRECT ANSWER D. Of the options listed, only the cannula at 6 L/min is appropriate. The estimated FIO2 for a nasal cannula is about 3-4% per liter of oxygen flow. Thus, 6 L/min would deliver about 39 - 45%, roughly matching the FIO2 delivered by Venti mask." "What is the purpose of aqueous quality control material used in conjunction with a blood gas analyzer? A. evaluates the analyzer for accuracy B. assures the analyzer is precise C. cleans the gas-sensing electrodes in the analyzer D. calibrates the analyzer to a known gas concentration - CORRECT ANSWER A. Aqueous quality control material is manufactured with a known gas concentration. The material is intended to simulate blood and in some cases consists of actual biological material. The results of the blood gas analyzer should be compared with the known, published gas concentrations of the material. In this way, the analyzer can be evaluated for accuracy. The material is not used to change or calibrate the machine, nor is it used for cleaning of electrodes." "How is the build-up of exhaled CO2 prevented in a nasal CPAP mask? A. The CPAP machine contains CO2 scrubbers. B. A purposeful leak is built into the mask unit. C. CO2 is flushed away during the exhalation phase of the CPAP machine. D. The mask is engineered to leak around the patient interface seal. - CORRECT ANSWER B. Every CPAP mask unit has a small port from which gases continuously flow, thus causing a purposeful leak. The CPAP machine compensates delivered pressure to accommodate the small leak. This allows for the continual flushing of exhaled CO2." "A 'flat' sound is heard when performing diagnostic chest percussion. This sound is most closely associated with A. empty, air-filled space. B. fatty tissue. C. bone. D. consolidation. - CORRECT ANSWER C. A 'flat' sound is heard when percussing over bone." "An oxygen flow meter is being used to deliver 60/40% heliox to a patient using a nonrebreather mask. The oxygen flow meter is set to 9 L/min, but a direct measurement of total gas flow to the mask is above 12 L/min. What best explains this disparity? A. The flowmeter is not compensated. B. Helium is less dense than oxygen. C. Nitrogen has greater viscosity than does oxygen. D. The oxygen flowmeter has not been calibrated. - CORRECT ANSWER B. Oxygen flowmeters are not intended for heliox gas administration (although they are commonly used). As such, because helium is a less dense gas than is oxygen, the flowmeter indicator is inaccurate." "A 14-year-old female patient with status asthmaticus has persistent tachycardia while receiving 70%/30% helium-oxygen therapy by nonrebreather mask while the oxygen flow meter indicates a flow of 10 L/min. The respiratory therapist should A. increase the flow rate to 12 L/min. B. utilize a heliox-calibrated flow meter. C. switch to a 60%/40% heliox mixture. D. discontinue heliox. - CORRECT ANSWER C. Persistent tachycardia is evidence of hypoxemia. To increase oxygen delivery, while maintaining decreased airway resistance, 60%/40% heliox is appropriate. This change will increase FIO2." "A newborn delivered at 38 weeks-of-gestation has the following 1-minute APGAR score: Appearance general cyanosis Pulse 80 bmpGrimace noneActivity no movement Respiratory effort weak cry Based on assessment, the respiratory therapist should A. provide routine care, repeat APGAR B. begin cardiopulmonary resuscitation. C. stimulate the infant, reassess at 5 minutes. D. provide supplemental oxygen with high-flow, high-humidity nasal cannula. - CORRECT ANSWER B. The assessment shows an APGAR score of 2 Appearance general cyanosis (0 pts) Pulse 80 bmp (1pt) Grimace none (0 pts) Activity no movement (0 pts) Respiratory effort weak cry (1 pt) APGAR scores of 0 - 3 require CPR Scores of 4 - 6 require stimulation and supplemental oxygen Scores of 7 - 10 require only routine care (warming, drying, etc)." "A patient has an alveolar oxygen tension (PAO2) of 220 mm Hg. The following ABG shows: pH 7.41 PaCO2 38 mm HgPaO2 67 mm HgHCO3- 24 mEq/LBE 0 mEq/L Which of the following is true for the patient's condition? A. VQ mismatching is present. B. A significant pulmonary shunt is present (greater than 20%). C. Cardiac dysfunction is likely present. D. Lung compliance is significantly reduced. - CORRECT ANSWER A. The A-aDO2 is 153 mm Hg (220 - 67). An A-aDO2 of less than 300 mm Hg (but greater than 65 mm Hg) correlates with a VQ mismatch. A-a gradients greater than 300 mm Hg indicate pulmonary shunting greater than 20% but this is not the case with this patient. Lung compliance and cardiac function cannot be evaluated, given the current data." "A patient with Asthma that is unresponsive to bronchodilators and steroid therapy is receiving helium-oxygen gas therapy through a non-rebreather mask at a mixture of 70%/30% through an oxygen flow meter that is set to 10 L/min. What is the total flow of gas to the patient? A. 8 L/min B. 10 L/min C. 16 L/min D. 14 L/min - CORRECT ANSWER C. The correction factor of gas flow with 70%/30% heliox running through an oxygen flow meter is 1.6. Thus, the indicated flow of 10 L/min actually presents a total gas flow of 16 L/min (10 L/min X 1.6)." "Which of the following would be most appropriate in facilitating mobilization and expectoration of secretions for a spontaneously breathing patient who has depressed diaphragmatic muscle strength? A. PEP therapy B. intrapulmonary percussive ventilation C. insufflation/exsufflation therapy D. Flutter-valve therapy - CORRECT ANSWER C. Insufflation/exsufflation can augment a patient's diaphragmatic muscle strength and improve both inhalation size and exhalation strength. These are key requirements in facilitating secretion removal." "A physician is attempting to evaluate the function of the liver. Which of the following imaging techniques would be most helpful? A. CT scan B. PET scan C. Myelogram D. Radiography - CORRECT ANSWER B. Only a PET scan can evaluate the function of an organ. It shows a video-like function while other techniques listed in the question are static in nature and/or not related." "A spontaneously breathing patient is in the emergency room with suspected ingestional error of barbiturates. Current ABGs show pH 7.35 PaCO2 45 torrPaO2 69 torrFIO2 0.50 by air-entrainment mask The respiratory therapist should do which of the following? A. increase FIO2 to 1.0 B. induce vomiting C. administer Narcan (naloxone) D. mask CPAP 5 cm H2O - CORRECT ANSWER D. The patient is hypoxic and requires an improvement in oxygenation. While FIO2 may be raised to 0.60, an increase to 1.0 is not appropriate. Implementation of CPAP is the most appropriate option." "Three days after surgery, an ambulatory patient is able to achieve the full preoperative goal of 2000 mL on his incentive spirometer. To continue daily lung expansion and prevention of pneumonia, what should the respiratory therapist recommend? A. IPPB hyperinflation therapy B. daily ambulation C. prophylactic antibiotics D. increasing the incentive spirometry goal to 4000 mL - CORRECT ANSWER B. Ambulation is a suitable way to promote good alveolar aeration and generally prevent post-operative complications, such as pneumonia." "Which of the following medications may be used as a pulmonary vasodilator and to treat symptoms associated with altitude sickness? A. sildenafil B. inhaled NO C. alprazolam D. norepinephrine - CORRECT ANSWER A. Sildenafil is a medication that can be used as a pulmonary vasodilator AND to treat symptoms related to altitude sickness." "A spontaneously breathing patient is in the emergency room with suspected ingestional error of barbiturates. Current ABGs show pH 7.35 PaCO2 45 torrPaO2 69 torrFIO2 0.50 by air-entrainment mask The respiratory therapist should do which of the following? A. mask CPAP 5 cm H2O B. administer Narcan (naloxone) C. induce vomiting D. increase FIO2 to 1.0 - CORRECT ANSWER A. The patient is hypoxic and requires an improvement in oxygenation. While FIO2 may be raised to 0.60, an increase to 1.0 is not appropriate. Implementation of CPAP is the most appropriate option." "After performing a forced vital capacity maneuver as a part of a complete pulmonary function study, the respiratory therapist inspects the data to determine the consistency of the values. In doing so, the respiratory therapist is assessing for A. calibration B. quality control C. precision D. accuracy - CORRECT ANSWER C Determining the consistency of measured values for pulmonary function machine is related to assessment of precision. Precision relates to how close the values are to one another but does not relate to the accuracy. In other words, a pulmonary function machine may be precise but not accurate." "A 15-year-old patient with muscular dystrophy and pneumonia continue having difficulty expectorating secretions. Which of the following would provide most assistance with bronchial hygiene? A. postural drainage and percussion B. huff coughing C. vibratory PEP therapy D. IPPV - CORRECT ANSWER D. The problem with muscular dystrophy is that the patient may have significant difficulty inspiring enough tidal volume to then generate a forceful exhalation and an effective cough. This can be assisted with IPPV, which will help increase inspired volume and increase the effectiveness of a cough." "What would most likely be indicated by an elevated CVP? A. increased pulmonary vascular resistance B. left heart fai