NBRC TMC PRACTICE QUESTIONS & ANSWERS WITH RATIONALES

NBRC TMC PRACTICE QUESTIONS & ANSWERS WITH RATIONALES "An arterial puncture has been performed to obtain blood for analysis of 02, C02, and pH. What is the best way to manage the blood sample? a. Warm the sample to keep it at body temperature b. Place it into a mix of ice and water c. Let the blood naturally cool to room temperature d. Shake the sample to hemolyze the blood - CORRECT ANSWER Place it into a mix of ice and water Explain: Placing the blood sample into ice water will prevent the blood from consuming the O2 within the sample." "A 26-year-old patient who weighs 80 kg (171 lb) received injuries in a motor vehicle crash. The patient was intubated with a 6.0-mm ID endotracheal tube and is receiving volume-controlled ventilation. Twenty-four hours later, the patient has clear breath sounds but cannot tolerate weaning the mandatory rate below 8 in the SIMV mode with 15 cm H20 pressure support. The respiratory therapist should recommend. a. Increasing the peak inspiratory flow b. Raising the VT c. Setting the mandatory rate to 10 d. Reintubating with a larger endotracheal tube - CORRECT ANSWER Reintubating with a larger endotracheal tube Explain: The small endotracheal tube compromises spontaneous breathing because of increased airways resistance. This can be resolved only by a larger tube or extubation." "During nasotracheal suctioning, a patient exhibits a gag reflex but doesn't cough. Watery secretions are aspirated through the catheter. Which of the following should the respiratory therapist do next? a. Insert an oropharyngeal airway and repeat the procedure b. Hyperextend the patient's next when passing the catheter c. Ask the patient to swallow while passing the catheter d. Increase the suction pressure and repeat the procedure - CORRECT ANSWER Hyperextend the patient's next when passing the catheter Explain: Aspiration of watery secretions would indicate catheter position in either the oropharynx or the esophagus. Hyperextending the neck will better direct the catheter to the trachea." "A 24-year-old female presents with a history of nasal stuffiness, episodes of daytime dyspnea, and a cough that occurs every summer. Which of the following drug classifications should a respiratory therapist recommend to control the patient's symptoms? a. Leukotriene inhibitor b. IgE immunoglobulin antagonist c. Beta-adrenergic agonist d. Anticholinergic - CORRECT ANSWER Leukotriene inhibitor Explain: The patient has allergic rhinitis and, at most, mild persistent asthma. A leukotriene inhibitor, such as montelukast (Singulair), are indicated to control mild asthma and allergic rhinitis." "According to CLIA standards, quality control must be performed for blood gas analyzers every a. 8 hours b. 48 hours c. 72 hours d. 24 hours - CORRECT ANSWER 8 hours Explain: Eight hours is the CLIA-approved time frame for quality control of blood gas analyzers." "A patient has received an aerosolized bronchodilator through a handheld nebulizer over the past day. Which of the following would a respiratory therapist recommend to minimize the risk of her getting a nosocomial infection? 1. Add a broad-spectrum antibiotic to the nebulizer with each treatment 2. Change the handheld nebulizer and mouthpiece every 24 hours 3. Discard medications and saline solution 24 hours after opening 4. Respiratory therapists should wash their hands before giving a treatment a. 1 and 2 only b. 3 and 4 only c. 2, 3, and 4 only d. 1, 2, 3, 4 - CORRECT ANSWER 2, 3, and 4 only Explain: Hand washing and replacement of equipment and unused medications every 24 hours are two of the best ways to prevent the spread of infection." "A 58-year-old male presents to the ED with a chief complaint of acute chest pain. Which of the following diagnostic tests should be done FIRST? a. Electrocardiography b. Chest radiograph c. CT scan of the chest d. Cardiac ultrasound - CORRECT ANSWER Electrocardiography Explain: An ECG is required to rule out an acute myocardial infarction or arrhythmia before considering other diagnoses." "Which imaging techniques are preferred when identifying metastatic disease associated with non-small cell lung cancer? a. PET scan b. Chest radiograph c. Ultrasound d. Ventilation scan - CORRECT ANSWER PET scan Explain: The metabolically active tissue of a malignant mass will be shown in a PET scan." "For a patient receiving mechanical ventilation, which of the following assessments can be made from a pressure-volume loop? (Spon. VT ) (Presence of insp. work) (Air trappin) (Pulm. compliance) 1. no yes yes yes 2. yes yes yes no 3. yes yes no yes 4. yes no yes yes a. 1 b. 3 c. 2 d. 4 - CORRECT ANSWER 3 Explain: Although a pressure-volume loop can identify the presence of air trapping by looking at the shape of the curve, the amount of air trapping cannot be determined." "A patient sustained a right phrenic nerve injury. During the assessment, a respiratory therapist would most likely find a. bradypnea b. bronchospasm c. inspiratory stridor d. asymmetrical chest movement - CORRECT ANSWER asymmetrical chest movement Explain: Since the phrenic nerves provide innervation to the hemidiaphragms, injury to one of these would result in one hemidiaphragm descending during inhalation and the other moving upward in response to the decreased pressure in the thorax." "Data for a patient receiving mechanical ventilation are as follows: Mode: Assist/control FiO2: 0.35 Mandatory rate: 15 Total rate: 20 VT: 800 mL pH: 7.57 PaCO2: 25 torr PaO2: 125 torr HCO3: 22 mEq/L BE: +1 Which of the following should the respiratory therapist recommend? 1. Set 5 cm H2O PEEP 2. Change FiO2 to 0.25 3. Change the mode to SIMV 4. Set mandatory rate to 10 a. 1 and 2 only b. 1 and 3 only c. 2 and 4 only d. 3 and 4 only - CORRECT ANSWER 3 and 4 only Explain: 1. False. The PaO2/FiO2 is greater than 300. Oxygenation is acceptable. 2. False. The hyperoxemia is caused by a combination of an FiO2 that is too high and the hyperventilation. Lowering the FiO2 this much may excessively reduce the PaO2 once the ventilation is decreased, resulting in hypoxemia. 3. True. Changing to the SIMV mode should reduce the hyperventilation resulting in improved acid-base balance. 4. True. Setting the mandatory rate to 10 may reduce minute ventilation resulting in improved acid-base balance." "While counseling a patient during a smoking cessation session, the patient expresses concern about weight gain. A respiratory therapist should address the patient's concern by explaining that this is partially the result of a. Decreased metabolism b. Increased loss of self-control c. Reliance on nicotine replacement therapy d. Lack of available aversive conditioning - CORRECT ANSWER Decreased metabolism Explain: Metabolism decreases when nicotine is withdrawn. If dietary intake remains unaltered and exercise is not included, there may be a resulting weight gain." "The preferred suction device to remove large amounts of secretions from the oral cavity of an adult patient is a a. Yankauer device b. DeLee suction trap c. Whistle-tip catheter d. Coude catheter - CORRECT ANSWER Yankauer device Explain: Yankauer suction devices are designed specifically to suction secretions from the mouth in an efficient way." "A 27-year-old patient has a carboxyhemoglobin (COHb) level of 10.3% on admission to the burn unit. Oxygen by non-rebreathing mask should be a. Utilized until the patient's COHB level returns to the normal range b. Utilized until the patient's oxygen saturation (Sp02) is 91% c. Weaned to obtain an oxygen saturation (Sp02) 94% d. Discontinued if the patient has concomitant COPD - CORRECT ANSWER Utilized until the patient's COHB level returns to the normal range Explain: CO has 200 times more affinity to hemoglobin than oxygen. 100 % oxygen must be provided until the CO has been displaced." "A respiratory therapist is reviewing a chest radiograph of a patient with a hemothorax and sees the end of a chest tube. On returning to the patient's bedside, where should the therapist expect to see the tube as it enters the chest wall? a. Third intercostal space at the mid-clavicular line b. Fifth intercoastal space at the mid-axillary line c. Second intercoastal space at the mid-clavicular line d. Fourth intercoastal space at the mid-axillary line - CORRECT ANSWER Fifth intercoastal space at the mid-axillary line Explain: The fifth intercostal space in the mid-axillary line is appropriate for draining fluid from the chest. A tube placed any higher than the thorax may not adequately drain the fluid." "A patient received volume-controlled ventilation for 24 hours with an FIO2 of 0.80. The following arterial blood gas results are obtained: pH: 7.38 PaCO2: 41 torr PaO2: 61 torr HCO3: 23 mEq/L BE: +1 mEq/L During a routine patient assessment, a respiratory therapist also notices patient-ventilator dyssynchrony. Which of the following should the therapist recommend? 1. PEEP 2. pressure support 3. SIMV 4. inspiratory hold a. 1, 2, and 3 only b. 1, 2, and 4 only c. 1, 3, and 4 only d. 2, 3, and 4 only - CORRECT ANSWER 1, 2, and 3 only Explain: 1. True. PEEP might reduce the P(A-a)O2 gradient. 2. True. Pressure support would reduce the effort associated with spontaneous breaths and help to synchronize the patient's breathing pattern with the ventilator. 3. True. SIMV would help to synchronize the patient's breathing pattern with the ventilator. 4. False. The inspiratory hold would do little to reduce patient/ventilator dyssynchrony and/or improve oxygenation." "The following capnography tracing is observed following intubation This waveform is consistent with a. Cardiac arrest b. Normal exhalation c. Air leak d. Airflow obstruction - CORRECT ANSWER Airflow obstruction Explain: Obstructive lung disease shows impaired expiratory air flow with a more rounded ascending phase that never reaches the plateau." "A 62-kg (136-lb) patient is receiving pressure-controlled ventilation. The following data are available: FiO2: 0.40 Mandatory rate: 15 PEEP: 10 cm H2O Peak Pressure: 30 cm H2O I:E ratio: 1:4 Exhaled tidal volume: 700 mL pH: 7.52 PaCO2: 26 torr PaO2: 110 torr HCO3: 21 mEq/L BE: -2 mEq/L A respiratory therapist should recommend decreasing the a. Fi02 b. Peak pressure c. Mandatory rate d. Inspiratory time - CORRECT ANSWER Peak pressure Explain: Decreasing the peak pressure should result in a decreased tidal volume and minute ventilation, resulting in an improvement of respiratory alkalosis." "To determine the need for ventilatory support in a patient with Guillain-Barré syndrome, which of the following clinical information should be obtained? a. Chest radiograph and V02max b. V02max and MIP c. MIP and vital capacity d. Vital capacity and chest radiograph - CORRECT ANSWER MIP and vital capacity Explain: MIP is an indication of respiratory muscle strength. Vital capacity provides information regarding respiratory reserve. Both provide data about the need for ventilatory support in a patient with neuromuscular disease." "A 70-kg (154-lb) patient who is apneic and chronically hypercapnic is receiving volume-controlled ventilation with a mandatory rate of 12 and a tidal volume of 800 mL. An arterial blood gas analysis reveals a PaCO2 of 39 torr. The respiratory therapist is asked to adjust the minute volume to maintain a PaCO2 of 50 torr. Which of the following settings should the therapist use to achieve the desired PaCO2? a. Mandatory Rate 8; VT 800 b. Mandatory Rate 10; VT 750 c. Mandatory Rate 11; VT 600 d. Mandatory Rate 14; VT 550 - CORRECT ANSWER Mandatory Rate 10; VT 750 Explain: VE = (actual PaCO2 x VE) / desired PaCO2 = VE = (39 x 9600) / 50 = 7488 mL" "The following pulmonary function testing results were obtained from a patient: (Predicted) (Observed) (% of Predicted) FVC (L) 4.5 3.1 69 FEV1/FVC (%) 70 20 29 FEF25%-75% (L/sec) 4.3 1.8 42 RV (L) 1.1 1.6 145 TLC (L) 6.8 8.9 131 Based on these results, what is the patient's most likely condition? a. Severe obstructive lung disease b. Within normal limits c. Mild restrictive lung disease d. Mild obstructive lung disease - CORRECT ANSWER Severe obstructive lung disease Explain: The combination of low flows and increased RV and TLC are seen only with obstructive lung disease. These results indicate severe disease." "Which of the following allows rapid determination of the lowest FIO2 needed to achieve satisfactory oxygenation? a. Capillary refill inspection b. Pulse oximetry c. Nail bed inspection d. Absence of cyanosis - CORRECT ANSWER Pulse oximetry Explain: A. Capillary refill usually checks perfusion and cardiac status, not oxygenation. B. Pulse oximetry gives a rapid response to changes in FIO2 . C. A nail bed inspection is an unreliable estimation of oxygenation. D. The absence of cyanosis does not necessarily indicate adequate oxygenation." "An elderly patient has been given a diuretic to help treat her congestive heart failure. It is noticed on her ECG monitor that she is having occasional premature ventricular contractions. It is most important to monitor which of the following electrolyte values? Choose only ONE best answer. a. Sodium b. Bicarbonate c. Potassium d. Calcium - CORRECT ANSWER Potassium Explain: Many diuretics have a side effect of potassium excretion. A decreased potassium level can lead to severe cardiac rhythm disturbances, like PVCs, and even cardiac arrest." "A patient receiving mechanical ventilation had a total fluid intake of 4100 mL and a total fluid output of 1100 mL over a 24-hour period. Which of the following might increase in this situation? Choose only ONE best answer. a. P(A-a)O2 b. serum HCO3- c. Lung compliance d. Hematocrit - CORRECT ANSWER P(A-a)O2" "A pressure-cycled ventilator with a heated humidifier and modified IPPB circuit is used to deliver an aerosolized medication and ventilate a patient in the Recovery Room. When the respiratory therapist checks the patient and ventilator, it is noticed that the inspiratory time is longer than when first charted, and the machine does not cycle off until the patient blows out. What should be done to correct the problem? 1. Tighten the humidifier jar and lid 2. Increase the peak pressure 3. Tighten the medication nebulizer jar and manifold 4. Give the patient 100% oxygen a. 1 and 2 only b. 1 and 3 only c. 2 and 4 only d. 1, 2, and 3 only - CORRECT ANSWER 1 and 3 only" "A 6-year-old child who weighs 25 kg (60 lb) is intubated and receiving volume-controlled ventilation. Pertinent data are below: Mode: Assist/control FiO2: 0.90 Mandatory rate: 20 Tidal volume: 200 mL pH: 7.46 PaCO2: 32 torr PaO2: 58 torr HCO3: 22 mEq/L BE: -1 Which of the following should a respiratory therapist recommend? a. Initiate 5 cm H2O PEEP b. Increase the mandatory rate to 25/min c. Increase the FiO2 to 1.0 d. Increase the inspiratory time to 1.2 seconds - CORRECT ANSWER Initiate 5 cm H2O PEEP Explain: Inadequate oxygenation with an FiO2 of 0.90 is an indication for use of PEEP." "Which of the following should be used to most accurately assess oxygen saturation in a patient with suspected smoke inhalation? a. Point-of-care blood gas analyzer b. Capnometer c. Hemoximeter (CO-oximeter) d. Pulse oximeter - CORRECT ANSWER Hemoximeter (CO-oximeter) Explain: A hemoximeter (CO-oximeter) can directly measure various forms of hemoglobin saturation, including oxyhemoglobin, carboxyhemoglobin, and methemoglobin. In a patient with suspected smoke inhalation, elevation in the carboxyhemoglobin level can be expected.:" "A patient is receiving volume-controlled mechanical ventilation. The patient will be weaned from a mandatory rate of 12. The following measurements were obtained while the patient was placed on a T-piece device during the initial weaning assessment: Respiratory rate: 26 Minute ventilation: 9 L/min Vital capacity: 625 mL Rapid shallow breathing index: 75 Which of the following should the respiratory therapist recommend? a. Return to the volume-controlled mode b. Decrease the mandatory rate c. Initiate pressure support ventilation (PSV) d. Continue the T-piece trial - CORRECT ANSWER Continue the T-piece trial Explain: A. The patient's spontaneous parameters do not demonstrate signs of distress or weakness; therefore, there is no need to return to the volume-controlled mode of ventilation. B. The patient is breathing spontaneously. A decrease in the mandatory rate while in the volume-controlled mode would not reduce the degree of mechanical support as long as the patient's respiratory drive and CO2 production remain unchanged. C. The patient's spontaneous parameters indicate that he is ready for discontinuation of mechanical ventilation. Of the measurements listed, the RSBI is the most accurate and demonstrates that the patient is ready to breathe without mechanical support. D. The T-piece trial needs to be continued and the patient re-evaluated for extubation." "An unpackaged HME is found lying on top of a ventilator. No condensate is observed inside the HME. The patient has no other humidification device in place. Which of the following should a respiratory therapist do? a. Visually inspect the HME for mucus obstruction b. Open a new HME and attach it to the endotracheal tube c. Discard the HME and monitor airway pressures over time d. Insert the HME between the patient Y and the endotracheal tube - CORRECT ANSWER Open a new HME and attach it to the endotracheal tube Explain: A clean HME is required." "Which of the following is the most appropriate chart notation for a respiratory therapist to make after completing an aerosol bronchodilator treatment? a. Treatment given as ordered over 15 minutes; no aftertaste noted; chest clear on auscultation b. Aerosol therapy given; pulse stable; RR same as pre-treatment; no changes during therapy; well tolerated c. Aerosol therapy given with 2.5 mg albuterol and 2 mL normal saline; vital signs stable; well tolerated d. Treatment given with 2.5 mg albuterol plus normal saline, well-tolerated; pre- and post-pulse 72; RR 10; breath sounds clear - CORRECT ANSWER Treatment given with 2.5 mg albuterol plus normal saline, well-tolerated; pre- and post-pulse 72; RR 10; breath sounds clear Explain: A. Specific data regarding dosage or patient response is missing. B. See explanation A. C. See explanation A. D. Pertinent data is presented in appropriate format." "A 22-year-old patient with a history of intermittent wheezing has the following pulmonary function test results: Prebronch. Postbronch. FEV1 (% predicted) 84 88 FVC (% predicted) 85 86 FEV1/FVC (%) 84 86 Peak flow (% predicted) 98 96 Which of the following should a respiratory therapist recommend? a. Lung volume measurements b. Inhalation challenge c. DLCO testing d. Polysomnography - CORRECT ANSWER Inhalation challenge Explain: A. An inhalation challenge is indicated when there is a slight improvement in postbronchodilator lung function in a patient with a history of wheezing. Lung volume measurements will add no diagnostic value. B. An inhalation challenge uses broncho provocative stimulus (e.g., methacholine) to test the hyper activeness of the airway. Patients with asthma demonstrate an excessive response to various doses of this substance. C. DLCO measures the lungs' ability to transfer gases across the alveolar-capillary membrane. There is no indication that the patient has a diffusion impairment. D. Polysomnography is a test to diagnose sleep apnea. There is no indication that this study is needed." "To treat obstructive sleep apnea, a respiratory therapist is asked to evaluate a home care patient with a nasal CPAP mask. The patient's wife states that he has been snoring more loudly lately and has periods of apnea while sleeping. You confirm this after observing the patient during a nap. What should be done FIRST? a. Schedule an appointment with his physician b. Adjust the nasal mask for a better fit c. Increase the CPAP pressure d. Insert an oropharyngeal airway - CORRECT ANSWER Adjust the nasal mask for a better fit Explain: Adjusting the nasal mask, so it fits better will stop the leak. The CPAP will be restored, and the airway obstruction will be opened." "A patient has been receiving mechanical ventilation through a tracheostomy tube for 16 days. The patient begins to thrash about in the bed following withdrawal of a drug-induced coma. The patient's tracheostomy tube has become dislodged. Following appropriate sedation, the respiratory therapist should first a. Occlude the stoma and bag-mask ventilate b. Perform nasal intubation c. Reinsert the tracheostomy tube d. Initiate oxygen therapy and observe the patient - CORRECT ANSWER Reinsert the tracheostomy tube Explain: A. Reinsertion of the tracheostomy tube should be the first response of the therapist. B. Nasal intubation is not indicated for a patient with a well established tracheostomy tract. C. After 16 days, the tracheostomy tract should be well established and the tube can easily be reinserted. D. This would not address the need to provide airway patency for the patient." "An adult patient who requires mechanical ventilation will be transported to another hospital in a helicopter. Prior to transport, a respiratory therapist should a. Estimate the duration of the oxygen supply b. Ensure the endotracheal tube cuff is deflated c. Set the FIO2 to 1.0 d. Attach a heated humidifier to the ventilator circuit - CORRECT ANSWER Estimate the duration of the oxygen supply Explain: A. An adequate oxygen supply is necessary to complete the trip. B. The endotracheal cuff should be inflated rather than deflated. C. There is no clinical indication to increase the FIO2. Increasing the FIO2 will affect the O2 supply available for the transport. D. Heated humidification is not necessary for this situation and adds cumbersome equipment to the transport." "A 22-year-old woman with asthma was transported to the hospital after being found unconscious from a heroin overdose. She was nasally intubated and is receiving mechanical ventilation. Naloxone (Narcan) was administered. Twenty-four hours later, the patient is awake, alert, and agitated. She is motioning that she wants the endotracheal tube removed. Which of the following should a respiratory therapist recommend? a. Gradually reduce the level of ventilatory support b. Extubate the patient c. Sedate the patient d. Change to noninvasive mechanical ventilation - CORRECT ANSWER Extubate the patient Explain: A. A patient who is intubated for acute ventilatory failure due to drug overdose does not need gradual withdrawal from mechanical ventilation. B. Once the need for mechanical ventilation is resolved, ventilator use can be discontinued in a patient with a narcotic drug overdose. C. Sedation is contraindicated. D. While noninvasive mechanical ventilation may not harm the patient, it is not indicated in this case." "A 3 year old is receiving VC ventilation. A respiratory therapist is preparing to administer aerosolized dornase alfa (Pulmozyme) in-line with the ventilator. Which of the following devices should the therapist select to administer the therapy? a. DPI b. MDI c. Ultrasonic nebulizer d. Vibrating mesh nebulizer - CORRECT ANSWER Vibrating mesh nebulizer Explain: A. Dornase alfa (Pulmozyme) is not available in DPI form. B. Dornase alfa (Pulmozyme) is not available in MDI form. C. An ultrasonic nebulizer may alter the configuration of the medication. D. A vibrating mesh nebulizer will not alter the configuration of the medication and will not increase volume delivery to the patient." "While administering an IPV treatment at 20 cm H2O to a patient with cystic fibrosis, a respiratory therapist notes the patient has suddenly become very short of breath and cyanotic. The therapist's most appropriate action is to a. Suction the patient b. Terminate the treatment c. Decrease the peak pressure to 10 cm H2O d. Stop the treatment for 10 to 20 minutes - CORRECT ANSWER Terminate the treatment Explain: A. There is neither evidence of increased secretions, nor the patient's inability to cough effectively. Therefore, suctioning this patient is not indicated. B. The treatment should be discontinued because the patient is demonstrating severe respiratory distress of unknown etiology. Determining the cause of the distress is of the utmost importance. C. Decreasing the peak pressure will not identify the cause of the distress. Continuing the treatment, even at a lower pressure, may worsen the patient's condition. D. Temporarily stopping the treatment will not determine the cause of the respiratory distress." "After recovering from an accidental drug overdose, the physician believes an alert 28-year-old patient can be weaned from mechanical ventilation. Which method should the respiratory therapist recommend be tried FIRST? a. T-piece adapter with reservoir b. Pressure support c. CPAP on a free-standing system d. SIMV - CORRECT ANSWER T-piece adapter with reservoir Explain: A. The T-piece (Briggs) adapter with reservoir is often used in a spontaneous breathing trial (SBT) to wean patients requiring mechanical ventilation for only a short time. If the patient fails the SBT, another weaning method, such as pressure support, CPAP, SIMV, or automatic tube compensation, should be considered. B. Most short-term, recovered ventilator patients can be successfully weaned on a T-piece in a spontaneous breathing trial (SBT). Pressure support may be needed if the patient fails the SBT and has significantly increased airway resistance from the endotracheal tube. C. Most short-term, recovered ventilator patients can be successfully weaned on a T-piece in a spontaneous breathing trial (SBT). CPAP may be needed if the patient fails the SBT and has a decreased functional residual capacity. D. Most short-term, recovered ventilator patients can be successfully weaned on a T-piece in a spontaneous breathing trial (SBT). SIMV provides partial ventilatory support and may be needed to wean a patient who has required mechanical ventilation for a prolonged time." "A respiratory therapist examines a patient and notes coarse crackles over both lung fields. Which of the following does this most likely indicate? a. Subcutaneous emphysema b. Pleurisy c. Bronchospasm d. Secretions - CORRECT ANSWER Secretions Explain: A. Subcutaneous emphysema is demonstrated by the presence of crepitus during chest wall palpation. B. Pleurisy is a symptom of pain while breathing, typically associated with inspiration. There are often no physical findings for pleurisy. C. Bronchospasm is noted as a wheezing sound from narrowed airways. D. Secretions in the airway produce low-pitched, discontinuous lung sounds described as coarse crackles upon auscultation." "A 31-year-old male is intubated after a motor vehicle crash. A respiratory therapist palpates asymmetrical chest movement during each inspiration when the manual resuscitator is squeezed, but no crepitus. Breath sounds are diminished on the left. Which of the following should the therapist do FIRST? a. Perform colorimetric capnometry b. Administer a bronchodilator c. Obtain an arterial blood gas sample d. Assess depth of endotracheal tube insertion - CORRECT ANSWER Assess depth of endotracheal tube insertion Explain: A. Colorimetric capnometry will differentiate between esophageal and endotracheal intubation, but will not assess for possible right mainstem intubation implied by the presentation. B. This presentation is more consistent with right mainstem intubation that would not be addressed by a bronchodilator. C. Arterial blood gas analysis does not address the described problem of asymmetrical chest expansion. D. Intubation of the right mainstem bronchus most likely explains the asymmetrical chest movement and decreased breath sounds. The best corrective action is to assess the depth of the endotracheal tube insertion." "Which of the following should a respiratory therapist recommend for a patient who is receiving mechanical ventilator support and has moderate musculoskeletal pain? a. propofol b. midazolam HCl (Versed) c. lorazepam (Ativan) d. fentanyl citrate (Sublimaze) - CORRECT ANSWER fentanyl citrate (Sublimaze) Explain: A. Propofol is a sedative and will not be useful for analgesia. B. Midazolam HCl (Versed) is an anxiolytic agent and will not be useful for analgesia. C. Lorazepam (Ativan) is an anxiolytic agent and will not be useful for analgesia. D. Fentanyl citrate (Sublimaze) is an analgesic agent and will be helpful to reduce musculoskeletal pain." "A respiratory therapist is administering an 80/20 heliox mixture to an adult female. When using a flowmeter calibrated for oxygen, the actual flow is how many times greater than the indicated flow? a. 1.4 b. 1.6 c. 1.8 d. 2.0 - CORRECT ANSWER 1.8 Explain: A. The conversion factor for a 60/40 heliox mixture is 1.4. B. The conversion factor for a 70/30 heliox mixture is 1.6. C. The conversion factor for an 80/20 heliox mixture is 1.8. D. This conversion factor does not exist for a heliox mixture." "When calibrating a fuel cell oxygen analyzer, the analyzer should be set to a. 40% while exposed to nitrous oxide b. 21% while exposed to room air c. 70% while exposed to oxygen d. 0% while exposed to carbon dioxide - CORRECT ANSWER 21% while exposed to room air Explain: A. Nitrous oxide is not used to calibrate a fuel cell oxygen analyzer. B. Room air is used for the low calibration of an oxygen analyzer and should be set at 21%. C. When exposed to oxygen, the fuel cell should be set to 100%, not 70%. D. A fuel cell oxygen analyzer does not use CO2 for calibration." "A 44-year-old patient presents to the ED with diabetic ketoacidosis. Which of the following respiratory patterns is most consistent with this diagnosis? a. Irregular breathing with periods of apnea b. Regular, slow, deep breathing c. Rapid, deep breathing d. Slow, shallow breathing - CORRECT ANSWER Rapid, deep breathing Explain A. Irregular breathing with periods of apnea is called ataxic breathing. Ataxic breathing occurs when there is an injury to the medulla. B. Regular, slow, deep breathing does not describe breathing that is associated with diabetic ketoacidosis. C. To attempt to compensate by blowing off CO2, there is an increase in rate and depth of breathing. This is called Kussmaul's breathing and is the result of diabetic ketoacidosis. D. Slow, shallow breathing is bradypnea and is associated with respiratory depression.:" "The following spirometry values are obtained on a 35-year-old woman: VT 450 mL Dead space 160 mL VC 3900 mL Respiratory rate 14 breaths/min Inspiratory capacity 3100 mL Based on this information, the patient's minute alveolar ventilation is a. 4060 mL b. 6300 mL c. 11,200 mL d. 43,400 mL - CORRECT ANSWER 4060 mL Explain: (VT-VD)RR Minute alveolar ventilation is found with the use of this formula: respiratory rate × (VT - dead space). 14 breaths/min × (450 mL - 160 mL) = 4060 mL." "A 168-cm (5-ft 6-in), 62-kg (136-lb) 39-year-old female is receiving PC, A/C ventilation. The following data are available: FIO20.40Mandatory rate15Total rate15Set inspiratory pressure20 cm H2OExhaled VT620 mLI:E1:4PEEP10 cm H2O pH7.52PaCO226 mm HgPaO2110 mm HgHCO3-21 mEq/LBE0 mEq/LSaO2 (calc) 98% A respiratory therapist should recommend decreasing the a. FIO2 b. Set inspiratory pressure c. Mandatory rate d. Inspiratory time - CORRECT ANSWER Set inspiratory pressure Explain: A. Although the patient's PaO2 is slightly high, the patient's respiratory alkalosis should be addressed first. B. Decreasing the set inspiratory pressure should result in a decreased tidal volume and minute ventilation, resulting in an improvement of the respiratory alkalosis. Additionally, the current exhaled tidal volume is greater than 8 mL/kg of ideal body weight and may be potentially harmful. C. While decreasing the mandatory rate will potentially correct the respiratory alkalosis, the high tidal volume needs to be addressed first. D. Reducing inspiratory time will not improve the respiratory alkalosis and may worsen oxygenation." "After a patient inhaled hypertonic saline for a sputum induction procedure, he begins to wheeze. What should be done at this time? a. Give the patient epinephrine (Adrenaline) through the intravenous line b. Discontinue the treatment and notify the physician c. Add arformoterol (Brovana) to the nebulizer d. Power the nebulizer with 100% O2 - CORRECT ANSWER Discontinue the treatment and notify the physician Explain: A. This ultra-short acting sympathomimetic medication cannot be given without a physician's order. It is not indicated in this situation. B. Wheezing indicates an adverse reaction. Stop the treatment, monitor the patient, and notify the physician. It may be necessary to administer a short acting sympathomimetic bronchodilator. C. This long acting sympathomimetic medication cannot be given without a physician's order. It is not indicated in this situation. D. O2 will not stop the wheezing. There is no indication that the patient is hypoxic." "A patient is producing large amounts of purulent, fetid sputum. When left to rest, the sputum separates into three distinct layers. Which of the following is the most likely diagnosis for this patient? a. Asthma attack b. Pulmonary edema c. Chronic bronchitis d. Bronchiectasis - CORRECT ANSWER Bronchiectasis Explain: A. Asthmatic sputum is usually clear or white in color without any odor. B. Pulmonary edema sputum is pink and frothy secretions without any odor. C. Chronic bronchitis sputum is usually bright yellow and not fetid. D. Layering and foul-smelling sputum is the classic description of bronchiectasis." "A 59-year-old man who weighs 77 kg (169 lb) is receiving volume-controlled ventilation after abdominal surgery. Ventilator settings and arterial blood gas analysis results are below: FiO2: 0.40 Mandatory rate: 14 Total rate: 14 Tidal volume: 700 mL pH: 7.47 PaCO2: 31 torr PaO2: 117 torr HCO3: 22 mEq/L BE: -1 The respiratory therapist should a. Decrease the minute ventilation b. Discontinue mechanical ventilation c. Increase the peak flow setting d. Administer bicarbonate IV - CORRECT ANSWER Decrease the minute ventilation Explain: A. Decreasing minute ventilation would increase thePaCO2 to within the normal range, which would decrease the pH to a normal range. B. No information is available that the patient is able to breathe spontaneously on his own. C. Increasing peak flow would have no effect on the arterial blood gas results. D. Administering bicarbonate intravenously would increase the pH further from the normal range." "A respiratory therapist is preparing to perform an arterial puncture on a nonresponsive patient whose medical history includes a diagnosis of HIV. For the protection of the patient and therapist, the therapist should a. Have another medical professional in the room when performing the puncture b. Confirm the diagnosis with the patient's family before performing the puncture c. Use universal precautions when obtaining the sample d. Wear gloves, a gown, and a mask when obtaining the sample - CORRECT ANSWER Use universal precautions when obtaining the sample Explain: A. There is no need for another medical professional to be present when performing the puncture. B. Universal precautions are appropriate for all patients, therefore confirmation of the HIV diagnosis with the family is unnecessary. Further, to do so without authorization from the patient would be a violation of HIPAA regulations. C. Universal precautions should be used when obtaining an ABG sample. D. There is no indication for the gown or mask to be used." "A patient is being weaned from ventilatory support using a T-piece for 30 minutes every hour. The patient's pulse was 90/min, and respirations were 20/min before the weaning procedure. After 20 minutes with a T-piece, the following data are obtained at an FiO2 of 0.40: Pulse: 100 Respirations: 26 Vital capacity: 11 mL/kg MIP: -20 cm H2O pH: 7.42 PaCO2: 34 torr PaO2: 80 torr HCO3: 22 mEq/L BE: -2 mEq/L Which of the following should the respiratory therapist do? a. Add 50 mL mechanical dead space b. Increase the FiO2 c. Reinstitute mechanical ventilation d. Continue the weaning process - CORRECT ANSWER Continue the weaning process Explain: A. Mechanical dead space will increase the PaCO2. The PaCO2 and pH are acceptable for continued weaning. B. Increasing the FiO2 will increase PaO2. The PaO2 is acceptable for continued weaning. C. All data indicate the patient is tolerating the weaning attempt. D. The data indicate that the weaning process is being well tolerated." "When instructing a patient on the administration of umeclidinium/vilanterol (Anoro Ellipta), which of the following is most important to emphasize? a. Gargle immediately after use b. Inhale slowly with a breath hold c. Breathe in fast and deep d. Shake medication vigorously before use - CORRECT ANSWER Breathe in fast and deep Explain: A. Umeclidinium/vilanterol (Anoro Ellipta) is not an inhaled steroid and, thus, does not require gargling after use. B. Umeclidinium/vilanterol (Anoro Ellipta) is a DPI that requires rapid inhalation. C. Breathing in fast and deep is the proper method of administration for umeclidinium/vilanterol (Anoro Ellipta). D. Umeclidinium/vilanterol (Anoro Ellipta) is a DPI and does not require shaking before use." "A respiratory therapist on a medical emergency team is directed to maximize FIO2 for a patient who is not intubated. Which of the following should the therapist select? a. 10 cm H2O CPAP, FIO2 of 0.50 b. NPPV of 15/5 cm H2O, FIO2 of 0.50 c. Nonrebreathing mask, flowmeter on flush d. Simple oxygen mask, flowmeter on 6 L/min - CORRECT ANSWER Nonrebreathing mask, flowmeter on flush Explain: A. The goal of CPAP is to expand atelectatic alveoli. It is unlikely to improve the oxygenation in this patient. B. NPPV will ventilate the patient and expand alveoli. However, an FIO2 of 0.50 is unlikely to improve this patient's oxygenation. C. A nonrebreathing mask with high-flow oxygen will ensure that each breath contains an FIO2 approximating 1.00, and is most likely to increase this patient's oxygenation. D. A simple oxygen mask with a flow of 6 L/min, with air entrainment, provides 35% oxygen that is unlikely to improve this patient's oxygenation." "When a respiratory therapist evaluates a patient with COPD in a pulmonary rehabilitation program, what would indicate that the patient's physical condition is improving? a. Six-minute walking distance has increased by 10% b. Pulse oximeter value is unchanged c. The patient has gained 5 lbs in the past week d. The patient has a positive outlook on life - CORRECT ANSWER Six-minute walking distance has increased by 10% Explain: A. An increased exercise level is the best indicator of improved physical conditioning. B. A stable pulse oximeter value would indicate that the patient's cardiopulmonary condition has not deteriorated. C. It is unclear if the weight gain comprises muscle mass or water. However, it is probably water because most COPD patients cannot gain that much muscle mass quickly. Gaining that much water weight is a cause of concern for heart failure. D. A positive outlook on life is a good indicator of the patient's emotional state. It may not be related to the patient's physical conditioning." "A respiratory therapist is assessing a 168-cm (5-ft 6-in), 73-kg (161-lb), 41-year-old female who was admitted 12 hours ago for an aspirin overdose. The following information is obtained as the patient breathes air: HR 89/min RR 15/min BP 110/70 mm Hg SpO2 86% A respiratory therapist should FIRST a. Initiate oxygen at 4 L/min by cannula b. Record the results in the medical record c. Obtain an arterial blood gas sample d. Validate the SpO2 reading at a different site - CORRECT ANSWER Validate the SpO2 reading at a different site Explain: A. In the presence of normal vital signs, the SpO2 value may be inaccurate. Therapy should not be initiated before confirming this value. B. The SpO2 value may not be accurate. Recording the value in the medical record may result in unnecessary interventions. C. Obtaining an arterial blood gas sample based on an inaccurate SpO2 value may cause unnecessary harm to the patient. D. The saturation may not be accurate and should be measured at a different site." "A patient with COPD and pneumonia is receiving volume-controlled ventilation. The following ventilator settings are available: Mode: SIMV FiO2: 0.28 Mandatory rate: 8 Total rate: 16 VT: 700 mL PEEP: 4 cm H2O Pressure support: 5 cm H2O Vital signs and oxygenation have been stable for 48 hours. Which of the following should the respiratory therapist recommend? a. Change to pressure-controlled ventilation b. Titrate pressure support to achieve VT of 700 mL c. Extubate to an FIO2 of 0.40 with an aerosol mask d. Initiate a spontaneous breathing trial - CORRECT ANSWER Initiate a spontaneous breathing trial Explain: With the information provided, this patient qualifies for spontaneous breathing trials, but there is insufficient data to indicate readiness for extubation." "A 36-year-old female patient who weighs is 159 cm (5 ft 2 in) tall and weighs 136 kg (300 lb) has just undergone gastric bypass surgery. She is brought to the PACU still intubated. The patient has no history of pulmonary disease. A respiratory therapist should recommend which of the following ventilator settings? Tidal volume Mandatory rate 1. 300 mL 8 2. 400 mL 10 3. 600 mL 10 4. 500 mL 8 a. 1 b. 2 c. 3 d. 4 - CORRECT ANSWER 2 Explain: A. The resulting minute ventilation of 2.4 L/min is inadequate for this patient. B. Using the predicted or PBW formula for women (45.5 kg + 2.3 kg for each inch over 5 ft), the patient's PBW is 50 kg (110 lb). Tidal volume is 8 mL/kg of PBW, which is appropriate. C. This tidal volume is 12 mL/kg of PBW, which is too large. D. This tidal volume is 10 mL/kg of PBW, which is too large." "The polysomnography sleep laboratory is fully scheduled for several weeks. The physician wants to know if there is another option to determine if a patient has sleep apnea. What should be recommended? a. Overnight pulse oximetry b. Nasal air flow monitoring c. Holter monitoring for 48 hours d. Chest-wall and abdominal-wall impedance comparison - CORRECT ANSWER Overnight pulse oximetry Explain: A. Overnight pulse oximetry can be used to screen patients with suspected obstructive sleep apnea. The patient's oxygen saturation is found to decrease during apnea episodes. B. Nasal airflow monitoring is done only during a full polysomnography test. C. Holter monitoring is done to evaluate a patient with cardiac problems. A continuous electrocardiogram recording is made, and the patient keeps an activity journal. D. Chest-wall and abdominal-wall movement is done only during a full polysomnography test." "A 27-year-old male patient has mild asthma. The patient's pulse is 80/min before administration of an aerosolized bronchodilator. The patient's pulse rises and stabilizes at 92/min during the treatment. Which of the following should a respiratory therapist do? a. Terminate the treatment, and document the response in the progress notes b. Terminate the treatment, and notify the head nurse c. Continue the treatment as ordered d. Continue the treatment with normal saline - CORRECT ANSWER Continue the treatment as ordered Explain: A. There is no indication that the treatment needs to be terminated. B. See explanation A. C. The heart rate response is within normal limits, so continuing the treatment as ordered is appropriate. D. Normal saline has no pharmacological value in this situation." "For which of the following are PEF measurements indicated? a. Establish readiness for weaning b. Evaluate lung compliance c. Determine ventilatory reserve d. Monitor airways obstruction - CORRECT ANSWER Monitor airways obstruction Explain: A. MIP and RSBI are useful in establishing readiness for weaning. B. Lung compliance is measured by tidal volume, peak pressure, plateau pressure, and PEEP. C. FVC and MVV can be used to establish a ventilatory reserve. D. PEF measurements are routinely used to monitor airway obstruction in patients with asthma." "Which of the following is the most effective aerosolized bronchodilator for a patient with an acute asthma exacerbation? a. albuterol b. ipratropium (Atrovent) c. salmeterol (Serevent) d. tiotropium (Spiriva) - CORRECT ANSWER albuterol Explain: A. Albuterol is a fast-acting beta2-agonist and is the appropriate treatment for acute bronchospasm. B. Ipratropium (Atrovent) is useful only as an adjunct to albuterol and only in the early phases of treatment. C. Salmeterol (Serevent) is a long-acting beta2-agonist that has a long onset of action and will not be useful for an acute exacerbation. D. Tiotropium (Spiriva) is a long-acting bronchodilator and is not useful for an acute asthma exacerbation." "A 26-year-old female is brought to the ED with a flail chest injury following a motor vehicle crash. Mechanical ventilation is initiated. The patient exhibits hypotension, worsening tachycardia, and increased work of breathing. Breath sounds on the right side are virtually absent. A respiratory therapist should FIRST recommend a. A needle decompression b. An echocardiogram c. An increase in analgesia d. A chest CT scan - CORRECT ANSWER A needle decompression Explain: A. In the presence of a flail chest, the findings most likely indicate a pneumothorax requiring needle decompression. B. An echocardiogram does not address the issue of decreased breath sounds. C. Though analgesia is important for patient comfort, needle decompression needs to be performed emergently. D. While a chest CT scan may be helpful, due to the patient's significant compromise, needle decompression is first indicated." "After a transcutaneous electrode is attached to a patient's skin, a respiratory therapist should wait a few minutes for the values to stabilize. This wait is associated with a. Capillary dilatation b. Electrode calibration c. Barometric pressure equilibration d. Cerebral blood perfusion - CORRECT ANSWER Capillary dilatation Explain: A. The site must be heated for 2-5 minutes to facilitate capillary dilatation. Once dilatation occurs, transcutaneous values will stabilize. B. Electrode calibration is performed prior to application of the electrode. C. Barometric pressure equilibration is part of the calibration procedure performed prior to application to the skin. D. Cerebral blood perfusion is not assessed during transcutaneous monitoring and has no effect on the values." "Which of the following is the most significant factor leading to the development of tracheomalacia? a. Cuff pressure b. Trauma during intubation c. Intracuff volume d. Tube length - CORRECT ANSWER Cuff pressure Explain: A. Excessive cuff pressure will obstruct mucosal blood flow to the tracheal wall. The resulting ischemia weakens the tracheal wall, and tracheomalacia develops. B. Tracheal trauma can result in scar formation and stenosis, but not tracheomalacia. C. Intracuff volume is significant only if it results in excessive pressure exerted against the tracheal wall. D. Endotracheal tube length has no relationship to tracheomalacia." "Furosemide (Lasix) and oxygen therapy are initiated for a patient with pulmonary edema. Which of the following should a respiratory therapist recommend? a. Monitoring of electrolyte levels and a PA catheter b. A CBC and pulse oximetry c. Pulse oximetry and monitoring of electrolyte levels d. A PA catheter and a CBC - CORRECT ANSWER Pulse oximetry and monitoring of electrolyte levels Explain: A. A PA catheter is not necessary for treating or managing pulmonary edema. B. A CBC is not impacted by treating pulmonary edema with furosemide or oxygen therapy. C. Pulse oximetry to monitor the SpO2 in a patient with pulmonary edema is essential to track the patient's status. As furosemide will impact fluid levels, monitoring the patient's electrolyte levels is essential to ensuring a correct sodium level. D. A PA catheter is not necessary for treating or managing pulmonary edema. A CBC is not impacted by treating pulmonary edema with furosemide or oxygen therapy." "A home care respiratory therapist is setting up an oxygen concentrator and pulse-dose nasal cannula on a patient with COPD. During the INITIAL assembly, what must be done? a. Properly adjust the pressure sensor b. Check the patient's SpO2 c. Check the patient's vital signs d. Demonstrate the alarm systems - CORRECT ANSWER Properly adjust the pressure sensor Explain: A. The pressure sensor must be properly calibrated so that a bolus of oxygen will be delivered to the patient with each inspiration. After knowing that the equipment is working properly, the other listed options can be done. B. First, the equipment must be set up properly. After it is known that the patient is getting supplemental oxygen the pulse oximeter value can be checked. C. First, the equipment must be set up properly. After it is known that the patient is getting supplemental oxygen the vital signs can be checked. D. First, the equipment must be set up properly. Then the respiratory therapist can educate the patient about the equipment, including the alarm systems." "After a respiratory therapist set up a nasal cannula on a patient who complained of shortness of breath, the following ECG tracing is seen on the monitor. The patient has fainted, and a carotid pulse cannot be detected. What should be recommended as the most important thing to do? a. Switch to a nonrebreathing mask b. Defibrillate the patient c. Administer a carotid massage d. Deliver a precordial thump - CORRECT ANSWER Defibrillate the patient Explain: A. Since the patient is already receiving supplemental oxygen by the nasal cannula, it is not a priority to change to a nonrebreathing mask. The patient has ventricular tachycardia and no pulse, probably leading to apnea. Defibrillation and other CPR procedures are needed as soon as possible. B. The cardiac rhythm shows ventricular tachycardia. The lack of a palpable carotid pulse indicates that cardiac output is very low. Defibrillation is indicated as quickly as possible to restore a normal sinus rhythm. If defibrillation is unsuccessful, CPR measures should be started. C. A physician sometimes performs a carotid massage to correct atrial tachycardia. The rhythm shown is ventricular tachycardia. D. A physician may deliver a precordial thump if ventricular fibrillation is directly witnessed and a defibrillator is unavailable. The patient's ECG tracing shows ventricular tachycardia." "While performing a blood gas analysis on a patient who is breathing room air, a respiratory therapist notes the following directly measured values: pH 7.52 PaCO2 47 torr PaO2 108 torr What should be done? a. Draw and analyze a new blood sample b. Add the data into the patient's electronic medical record c. Calibrate the blood gas analyzer d. Phone the results to the patient's respiratory therapist - CORRECT ANSWER Calibrate the blood gas analyzer Explain: A person who is breathing room air cannot have a PaO2 this high without hyperventilating. The high PaCO2 with high pH value are not possible. Check the pH, O2, and CO2 electrodes for an error. After calibration, reanalyze the blood sample. A new blood sample would only be needed if it was drawn or managed incorrectly leading to unreliable analysis results. Report the patient data only after being sure of its accuracy." "A patient with sepsis is now developing ARDS. What suggestions could be made to help protect the patient's lungs from ventilator-associated injury? 1. Deliver a tidal volume of about 4 to 6 mL/kg of ideal body weight 2. Deliver a tidal volume of about 8 mL/kg of ideal body weight 3. PEEP should be set at 10 cm of water 4. The plateau pressure (Pplat) should be 28 cm of water 5. The peak pressure (Ppeak) should be 28 cm of water A. 1 and 4 only B. 2 and 4 only C. 2, 3, and 5 only D. 1, 3, and 4 only - CORRECT ANSWER 1 and 4 only Explain: A. Current research indicates that small lung volumes are less likely to result in lung injury in patients with ARDS or other low compliance conditions. In addition, the plateau pressure (Pplat) should be less than 28 cm of water to help minimize the risk of lung injury. PEEP is often added, as needed, to maintain the functional residual capacity (FRC). B. The plateau pressure (Pplat) should be less than 28 cm of water to help minimize the risk of lung injury. However, small lung volumes of about 4-6 mL/kg are less likely to result in lung injury in patients with ARDS or other low compliance conditions. C. Small lung volumes of about 4-6 mL/kg are less likely to result in lung injury in patients with ARDS or other low compliance conditions. While PEEP is likely needed, it should not be set at an arbitrary 10 cm of water. The plateau pressure, not peak pressure, should be less than 28 cm of water to help minimize the risk of lung injury. D. While PEEP will likely be needed, it should not be set at an arbitrary 10 cm of water. The other two statements are correct." "Which of the following information may be obtained from a forced expiratory spirogram? FVC FEV1 FRC RV A. 1 and 2 only B. 1 and 3 only C. 2 and 4 only D. 3 and 4 only - CORRECT ANSWER 1 and 2 only Explain: 1. True. FVC can be obtained from a forced expiratory spirogram. 2. True. FEV1 can be obtained from a forced expiratory spirogram. 3. False. FRC is obtained only from lung volume measurement. 4. False. RV is obtained only from lung volume measurement." "Five minutes after extubating a patient, a respiratory therapist observes marked stridor, labored breathing, intercostal retractions, and a decreasing SpO2. Aerosolized racemic epinephrine has been delivered without benefit. Which of the following should the therapist recommend at this time? A. Treatment with dexamethasone (Decadron) B. Manual ventilation with bag and mask C. A cool aerosol treatment D. Reintubation - CORRECT ANSWER Reintubation Explain: A. Administration of steroids to reduce airway edema is a slow process and not applicable in this situation. B. Due to the airway edema, manual ventilation with bag and mask will be ineffective and not correct the serious airway problem. C. Administration of a cool aerosol treatment will delay care. D. Reintubation will re-establish a patent airway." "A decision is made to switch a stable mechanically ventilated patient from a wick-type humidifier to a heat and moisture exchanger. Two sections of corrugated tubing (12 inches) are used to connect the HME between the circuit Y and the endotracheal tube. After an hour, the following arterial blood gas values are obtained: pH 7.32 PaCO 254 mm Hg PaO2 68 mm Hg HCO3- 24 mEq/L BE 0 mEq/L SaO2 92% What should the respiratory therapist recommend in this situation? A. Recheck the blood gas results B. Increase the inspired oxygen percentage C. Take off the corrugated tubing D. Change back to the wick-type humidifier - CORRECT ANSWER Take off the corrugated tubing Explain: A. There is no indication that anything has changed in the patient's condition to raise doubts about the accuracy of the blood gas results. The added corrugated tubing acts as mechanical dead space. This will increase the patient's PaCO2 and decrease the PaO2. B. The patient's PaO2 of 68 torr is lower than ideal but not dangerous. Mild hypoxemia is not the patient's problem; it is retained carbon dioxide from the added mechanical dead space. C. Take off the corrugated tubing to remove the mechanical dead space that is causing the patient to retain carbon dioxide and have a decreased PaO2. D. The patient's problem is not which humidification system to use. The problem of retained carbon dioxide is caused by the mechanical dead space in the added corrugated tubing. It must be removed." "Which of the following values is the best indicator of an individual's response to inhaled bronchodilators? A. FVC B. FEV1 C. FEF200-1200 D. Diffusing capacity - CORRECT ANSWER FEV1 Explain: A. FVC assesses the patient's ability to cough and breathe deeply. B. FEV1 is the best indicator of reversible airway obstruction in response to inhaled bronchodilators. C. FEF200-1200 is a good indicator of large airway function but does not help evaluate small airway response to bronchodilators. D. Diffusing capacity measures the ability of gases to diffuse across the alveolar-capillary membrane." "A nurse finds an adult female patient unresponsive with shallow respirations. When the medical emergency team arrives, the patient's vital signs are: HR 100/min RR 6/min BP 100/58 mm Hg SpO2 78% A respiratory therapist should FIRST A. Obtain an ABG sample B. Check for a patent IV line C. Initiate NPPV D. Begin bag-valve mask resuscitation - CORRECT ANSWER Begin bag-valve mask resuscitation Explain: A. ABG analysis may be necessary, but the therapist should first begin bag-valve-mask resuscitation. B. The therapist is not responsible for checking the patient for an IV line. C. NPPV is not adequate to support this patient's profound hypoxemia. D. Bag-valve-mask resuscitation is required for a patient in severe respiratory distress." "An air-entrainment mask will deliver an FIO2 higher than intended when A. The flow is set too high B. Nebulized water is being added through the air-entrainment ports C. Corrugated tubing was added between the air-entrainment adapter and mask D. The air-entrainment ports have been blocked - CORRECT ANSWER The air-entrainment ports have been blocked Explain: A. Increasing the flow will entrain more room air while maintaining the same FIO2. B. Adding nebulized water will not affect the FIO2. C. Additional tubing between the mask and air-entrainment adapter will not affect the FIO2. D. Blocked air-entrainment ports prevent air from being added to the inspired gas flow and result in a higher FIO2." "A 4-day-old, 35 weeks gestational age infant with symptoms of respiratory distress syndrome is receiving an FIO2 of 0.28 and nasal CPAP at 8 cm H2O. His vital signs, appearance, and fluid output have been stable for 12 hours. The results of a blood gas analysis obtained from an umbilical artery catheter are below: pH: 7.43 PaCO2: 42 torr PaO2:1 29 torr HCO3: 27 mEq/L BE: +3 mEq/L Based on this information, a respiratory therapist should recommend which of the following? A. Maintain the present therapy and monitor the infant B. Discontinue CPAP and increase the FIO2 to 0.40 C. Decrease CPAP to 5 cm H2O D. Decrease the FIO2 to 0.21 - CORRECT ANSWER Decrease CPAP to 5 cm H2O Explain: A. PaO2 exposes this infant to an increased risk of developing retinopathy of prematurity. B. Discontinuation of CPAP puts the infant at risk of developing atelectasis and increased shunt. The FiO2 of 0.40 may not result in an appropriate PaO2. C. Decreasing the CPAP level to 5 cm H2O should allow the PaO2 to be reduced to a more appropriate level. D. The hazards associated with 8 cm H2O CPAP are more significant than that of an FIO2 of 0.28; therefore, a better choice is to reduce the CPAP level first. A sudden decrease in FIO2 to 0.21 may result in hypoxemia." "Which of the following are true regarding bilevel positive pressure ventilators? 1. They function correctly in the presence of a leak. 2. They function as demand flow devices. 3. Exhaled gases pass through a fixed leak-type valve. 4. They provide adjustable pressure levels. A. 1, 2, and 3 only B. 1, 2, and 4 only C. 1, 3, and 4 only D. 2, 3, and 4 only - CORRECT ANSWER 1, 3, and 4 only Explain: 1. True. Bilevel positive pressure ventilators are continuous flow devices that compensate for leaks. 2. False. Bilevel Positive pressure ventilators are continuous flow devices, not demand flow devices. 3. True. Bilevel positive pressure ventilators are designed to function with a fixed leak-type valve. 4. True. Bilevel positive pressure ventilators provide two separate adjustable pressure levels." "A 27-year-old patient has a carboxyhemoglobin (COHb) level of 10.3% on admission to the burn unit. Oxygen by non-rebreathing mask should be A. Utilized until the patient's COHb level returns to the normal range B. Utilized until the patient's oxygen saturation (SpO2 ) is 91% C. Weaned to obtain an oxygen saturation (SpO2 ) 94% D. Discontinued if the patient has concomitant COPD - CORRECT ANSWER Utilized until the patient's COHb level returns to the normal range Explain: A. CO has 200 times more affinity to hemoglobin than oxygen. 100 % oxygen must be provided until the CO has been displaced. B. The SpO2 does not differentiate between carboxyhemoglobin and oxyhemoglobin. C. The SpO2 does not differentiate between carboxyhemoglobin and oxyhemoglobin. D. CO must be displaced from hemoglobin to allow satisfactory oxygen delivery to tissues, regardless of previous diagnoses." "Which of the following is the definitive method of monitoring the effectiveness of equipment sterilization? A. Heat sensitive tape B. Chemical sensitive indicator C. Biologic indicator D. Time and temperature graph - CORRECT ANSWER Biologic indicator Explain: A. Heat sensitive tape will only indicate that a particular temperature has been reached during the process, but does not evaluate the effectiveness of the sterilization process. B. Chemical sensitive indicators typically indicate that a particular chemical reaction has occurred within the package, but does not evaluate the effectiveness of the sterilization process C. Biologic indicators, or spore tests, indicate whether a highly resistant microorganism has been killed within the package. This is the most accepted method for monitoring effectiveness of heat/stem sterilization. D. A time and temperature graph only monitors these conditions during equipment processing, but does not evaluate the effectiveness of the sterilization process" "A patient with a tracheostomy has 40% O2 and aerosol delivered by a tracheostomy mask. If the patient develops an Escherichia coli infection of the stoma and airways, the most likely source is A. Improper manufacturer sterilization of the mask B. Nebulizer water used past its expiration date C. Inadequate hand washing by the health care workers D. The patient's own upper airway bacteria - CORRECT ANSWER Inadequate hand washing by the health care workers Explain: A. It is unlikely that this organism would survive the manufacturer's sterilization process. B. It is unlikely that sterile water would grow this organism, even when it is used after its expiration date. C. This organism is found in the