THERAPIST MULTIPLE-CHOICE EXAMINATION:
PRACTICE TEST
The physician orders a 35% aerosol mask to be set up for a patient who requires an
inspiratory flow of 42 L/min. What is the minimum flow rate to which the flowmeter must
be set to meet this patient's in- spiratory flow demands?
A. 6 L/min
B. 8 L/min
C. 10 L/min
D. 12 L/min - Answers :B, The air/O2ratio for a 35% oxygen mixture is 5 : 1. To
calculate total flow output from this device, add the ratio parts together and multiply by
the liter flow: 6 ×6 = 36 L/min, 6 ×8 = 48 L/min, 6 × 10 = 60 L/min, 6 ×12 = 72 L/min.
Total flow needed: 42 L/min. The minimum flow necessary is 8, giving a total flow of 48
L/min. (Analysis)
A premature 3-week-old infant is receiving 1 L/min
of O via a nasal cannula and has a PaO of 43 torr22
and a PaCO2 of 40 torr. The respiratory therapist should recommend which of the
following?
A. Increase the cannula flow to 2 L/min.
B. Intubate and institute mechanical ventilation
C. Initiate CPAP of 4 cm H2O and 50% O2
D. Increase the cannula flow to 5 L/min. - Answers :A, A PaO2 of 43 torr represents
hypoxemia. The normal PaO2 for an infant is 50-70 torr. Increasing the cannula flow by
1 L/min is the most appropriate choice to return the PaO2 to normal. With a normal
PaCO2 of 40 torr, mechanical ventilation is not indicated. (Analysis)
what is normal PaO2 for infant ? - Answers :50-70 torr.
A patient arrives in the emergency department after being pulled from a burning house.
The respiratory therapist should recommend obtaining which of the following
measurements to best determine the sever- ity of the patient's smoke inhalation?
A. SpO2
B. HbCO
C. PaO2
D. Hb - Answers :B, To best determine the severity of smoke inhalation, an HbCO level
should be determined with a co-oximeter. The SpO2 value should never be evaluated
on a patient suspected of CO poisoning because a pulse oximeter is not capable of
determining what is bound to hemoglobin.
Pulse oximeters work on the principle of spectrophotometry where lightweight probes
direct filtered light of specific wavelengths through the skin or digit. The light absorbed
differs for saturated and desaturated blood, whether it's saturated with oxygen or a
combination of oxygen and carbon monoxide. Therefore the reading will be erroneously
high when HbCO is present. (Analysis)
,To best determine the severity of smoke inhalation, an HbCO level should be
determined with ? - Answers :co-oximeter
The physician has ordered O2 to be administered to an active 3-year-old with an SpO2
of 86%. Which of the following delivery devices would you recommend for this patient?
A. 1- to 2-L nasal cannula
B. Air-entrainment mask
C. Simple O2 mask
D.O2 hood - Answers :A, An active 3-year-old generally tolerates a cannula much better
than any kind of mask and is too large for an O2hood. (Application)
We determine the plateau or static pressure by holding the volume in the patient's lungs
for?
what is the formula for static compliance ? - Answers :1 to 2 s.
This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted from the
plateau pressure and this number is divided into the VT. The results determine how
compliant the lungs are.
A 60-kg (132-lb) 52-year-old man is admitted to the ICU for the treatment of refractory
hypoxemia. He is currently on VC-SIMV and pressure support of 10 cm H2O with an
FiO2 of 0.60. Other pertinent data are below:
pH 7.49
PaCO2 30 torr
PaO2 59 torr
Heart rate 120min
Respiratory rate 12
Spontaneous VT 400 ml
Ventilator VT 500 mL
PEEP 5 cm H2O
Total respiratory rate 22/min
Which of the following should the respiratory therapist recommend at this time?
A. Increase the pressure support level to 15 cm H2O
B. Increase PEEP to 8 cm H2O
C. Increase the FiO2 to 0.70 D. Decrease VT to 400 mL - Answers :B, Refractory
hypoxemia typically results from atelectasis, pneumonia, or pulmonary edema, whereby
increasing oxygen levels do not correct the hypoxemia. Although the patient is
hyperventilating, VT should not be decreased. The hyperventilation is a result of the low
PaO2, therefore it should be increasing the PaO2 first is necessary. We should not
exceed 60% oxygen to try to correct hypoxemia, so increasing the PEEP level is most
appropriate. (Analysis)
,Refractory hypoxemia typically results from ? - Answers :atelectasis
pneumonia
pulmonary edema
A peripheral lung mass is to be biopsied. Which of the following procedures should be
recommended to obtain the tissue sample?
A. Electromagnetic navigational bronchoscopy (ENB)
B. Fiberoptic bronchoscopy
C. Bronchoalveolar lavage (BAL)
D. Rigid bronchoscopy - Answers :. A, ENB is diagnostic tool that combines
conventional bronchoscopy with
virtual bronchoscopy that allows bronchoscopic instruments to reach peripheral lung
areas that traditional fiberoptic bronchscopes can't reach. (Analysis)
A 70-kg (154-lb) male patient is receiving mechanical ventilation. The respiratory
therapist notes the patient's
SpO2 drops from 97% to 86%. The right lung is expanding more than the left, with clear
breath sounds on the right but absent breath sounds on the left. The patient's ET tube is
taped at the 29-cm mark at the lip. Which of the following should the respiratory
therapist do at this time?
A. Withdraw the tube to the 24-cm mark
B. Recommend an immediate chest x-ray
C. Advance the ET tube 2 cm
D. Obtain immediate ABG levels - Answers :A, The ET tube should be positioned 2 to 6
cm above the level of the carina. That means the ET tube should be at the 21- to 25-cm
mark at the teeth. In this question, the tube is at the 29-cm mark and the patient has
decreased breath sounds in the left lung, which indicates the tube is in the right
mainstem bronchus and must be withdrawn.
how far should The ET tube should be positioned to the main carina?
That means the ET tube should be at the ______ to ________-cm mark at the teeth. -
Answers :2 to 6 cm above the level of the carina.
21- to 25
the tube is at the 29-cm mark and the patient has decreased breath sounds in the left
lung, which indicates? - Answers :the tube is in the right mainstem bronchus and must
be withdrawn.
Which one of the following sets of ABG measure- ments would indicate compensated
respiratory acidosis?
A. pH 7.26, PCO2 60 torr, PO2 68 torr, HCO326 mEq/L, BE 0
, B. pH 7.42, PCO2 39 torr, PO2 87 torr, HCO322 mEq/L, BE 1
C. pH 7.25, PCO2 61 torr, PO2 75 torr, HCO326 mEq/L, BE 1
D. pH 7.37, PCO2 58 torr, PO2 60 torr, HCO331 mEq/L, BE 8 - Answers :. D, A blood
gas level is considered compensated when both the PaCO2and HCO3−are abnormal
and the pH level is normal. Respiratory acidosis is caused by an elevated PaCO2,
which drops the pH to below normal levels. If the patient's lungs are not ventilated better
to decrease the PaCO2, the HCO3−levels in the blood begin to increase (renal
compensation), which increases the pH toward normal. When the pH reaches the
normal range, it is called fully compensated. The most common example of this type of
blood gas level is the patient with severe COPD who has chronic retention of CO2and
remains in a constant state of compensation. (Application)
the following data have been collected on 75-kg male pt receiving volume-controlled
ventilation :
TV 600 mL pH 7.29
SIMV PaCO 50 torr
Vent rate 4 PaO2 72
spontaneous rate HCO 26
FIO2 0.35
On the basis of these data, which of the following should the respiratory therapist
recommend?
A. Increase the VT to 650 mL
B. Increase the FiO2 to 0.40
C. Increase the ventilator rate to 8/min
D. Change to assist-control mode at a rate of 15/min - Answers :C, This patient's
increased PaCO2 level indicates hypoventilation, which can be reversed by increasing
the minute ventilation. This can be accomplished by increasing the ventilator rate or VT,
both of which are choices. We must assume the patient is being weaned from the
ventilator based on the low ventilator rate (SIMV rate of 4). Weaning is accomplished as
we reduce the ventilator rate and allow the patient to breathe more on his or her own. If
the patient's PaCO2 begins to increase during weaning, we increase the rate, not the
VT. The ventilator VT is at the maximum level of 8 mL/kg based on the patient's weight
of 75 kg (8 x 75 = 600), therefore increasing the ventilator rate is the most acceptable
choice.
The ability of the patient to follow instructions would be indicated by which of the
following?
A. Orientation to person
B. Performance of tasks when asked
C. Ability to feed himself
D. Awareness of time - Answers :B, If the patient is able to perform simple tasks when
asked, this best determines his or her ability to follow instructions. This is important
before administering an incentive spirometry or IPPB treatment, which requires the
patient to be able to follow instructions well or the treatment will not be effective.
(Recall)
PRACTICE TEST
The physician orders a 35% aerosol mask to be set up for a patient who requires an
inspiratory flow of 42 L/min. What is the minimum flow rate to which the flowmeter must
be set to meet this patient's in- spiratory flow demands?
A. 6 L/min
B. 8 L/min
C. 10 L/min
D. 12 L/min - Answers :B, The air/O2ratio for a 35% oxygen mixture is 5 : 1. To
calculate total flow output from this device, add the ratio parts together and multiply by
the liter flow: 6 ×6 = 36 L/min, 6 ×8 = 48 L/min, 6 × 10 = 60 L/min, 6 ×12 = 72 L/min.
Total flow needed: 42 L/min. The minimum flow necessary is 8, giving a total flow of 48
L/min. (Analysis)
A premature 3-week-old infant is receiving 1 L/min
of O via a nasal cannula and has a PaO of 43 torr22
and a PaCO2 of 40 torr. The respiratory therapist should recommend which of the
following?
A. Increase the cannula flow to 2 L/min.
B. Intubate and institute mechanical ventilation
C. Initiate CPAP of 4 cm H2O and 50% O2
D. Increase the cannula flow to 5 L/min. - Answers :A, A PaO2 of 43 torr represents
hypoxemia. The normal PaO2 for an infant is 50-70 torr. Increasing the cannula flow by
1 L/min is the most appropriate choice to return the PaO2 to normal. With a normal
PaCO2 of 40 torr, mechanical ventilation is not indicated. (Analysis)
what is normal PaO2 for infant ? - Answers :50-70 torr.
A patient arrives in the emergency department after being pulled from a burning house.
The respiratory therapist should recommend obtaining which of the following
measurements to best determine the sever- ity of the patient's smoke inhalation?
A. SpO2
B. HbCO
C. PaO2
D. Hb - Answers :B, To best determine the severity of smoke inhalation, an HbCO level
should be determined with a co-oximeter. The SpO2 value should never be evaluated
on a patient suspected of CO poisoning because a pulse oximeter is not capable of
determining what is bound to hemoglobin.
Pulse oximeters work on the principle of spectrophotometry where lightweight probes
direct filtered light of specific wavelengths through the skin or digit. The light absorbed
differs for saturated and desaturated blood, whether it's saturated with oxygen or a
combination of oxygen and carbon monoxide. Therefore the reading will be erroneously
high when HbCO is present. (Analysis)
,To best determine the severity of smoke inhalation, an HbCO level should be
determined with ? - Answers :co-oximeter
The physician has ordered O2 to be administered to an active 3-year-old with an SpO2
of 86%. Which of the following delivery devices would you recommend for this patient?
A. 1- to 2-L nasal cannula
B. Air-entrainment mask
C. Simple O2 mask
D.O2 hood - Answers :A, An active 3-year-old generally tolerates a cannula much better
than any kind of mask and is too large for an O2hood. (Application)
We determine the plateau or static pressure by holding the volume in the patient's lungs
for?
what is the formula for static compliance ? - Answers :1 to 2 s.
This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted from the
plateau pressure and this number is divided into the VT. The results determine how
compliant the lungs are.
A 60-kg (132-lb) 52-year-old man is admitted to the ICU for the treatment of refractory
hypoxemia. He is currently on VC-SIMV and pressure support of 10 cm H2O with an
FiO2 of 0.60. Other pertinent data are below:
pH 7.49
PaCO2 30 torr
PaO2 59 torr
Heart rate 120min
Respiratory rate 12
Spontaneous VT 400 ml
Ventilator VT 500 mL
PEEP 5 cm H2O
Total respiratory rate 22/min
Which of the following should the respiratory therapist recommend at this time?
A. Increase the pressure support level to 15 cm H2O
B. Increase PEEP to 8 cm H2O
C. Increase the FiO2 to 0.70 D. Decrease VT to 400 mL - Answers :B, Refractory
hypoxemia typically results from atelectasis, pneumonia, or pulmonary edema, whereby
increasing oxygen levels do not correct the hypoxemia. Although the patient is
hyperventilating, VT should not be decreased. The hyperventilation is a result of the low
PaO2, therefore it should be increasing the PaO2 first is necessary. We should not
exceed 60% oxygen to try to correct hypoxemia, so increasing the PEEP level is most
appropriate. (Analysis)
,Refractory hypoxemia typically results from ? - Answers :atelectasis
pneumonia
pulmonary edema
A peripheral lung mass is to be biopsied. Which of the following procedures should be
recommended to obtain the tissue sample?
A. Electromagnetic navigational bronchoscopy (ENB)
B. Fiberoptic bronchoscopy
C. Bronchoalveolar lavage (BAL)
D. Rigid bronchoscopy - Answers :. A, ENB is diagnostic tool that combines
conventional bronchoscopy with
virtual bronchoscopy that allows bronchoscopic instruments to reach peripheral lung
areas that traditional fiberoptic bronchscopes can't reach. (Analysis)
A 70-kg (154-lb) male patient is receiving mechanical ventilation. The respiratory
therapist notes the patient's
SpO2 drops from 97% to 86%. The right lung is expanding more than the left, with clear
breath sounds on the right but absent breath sounds on the left. The patient's ET tube is
taped at the 29-cm mark at the lip. Which of the following should the respiratory
therapist do at this time?
A. Withdraw the tube to the 24-cm mark
B. Recommend an immediate chest x-ray
C. Advance the ET tube 2 cm
D. Obtain immediate ABG levels - Answers :A, The ET tube should be positioned 2 to 6
cm above the level of the carina. That means the ET tube should be at the 21- to 25-cm
mark at the teeth. In this question, the tube is at the 29-cm mark and the patient has
decreased breath sounds in the left lung, which indicates the tube is in the right
mainstem bronchus and must be withdrawn.
how far should The ET tube should be positioned to the main carina?
That means the ET tube should be at the ______ to ________-cm mark at the teeth. -
Answers :2 to 6 cm above the level of the carina.
21- to 25
the tube is at the 29-cm mark and the patient has decreased breath sounds in the left
lung, which indicates? - Answers :the tube is in the right mainstem bronchus and must
be withdrawn.
Which one of the following sets of ABG measure- ments would indicate compensated
respiratory acidosis?
A. pH 7.26, PCO2 60 torr, PO2 68 torr, HCO326 mEq/L, BE 0
, B. pH 7.42, PCO2 39 torr, PO2 87 torr, HCO322 mEq/L, BE 1
C. pH 7.25, PCO2 61 torr, PO2 75 torr, HCO326 mEq/L, BE 1
D. pH 7.37, PCO2 58 torr, PO2 60 torr, HCO331 mEq/L, BE 8 - Answers :. D, A blood
gas level is considered compensated when both the PaCO2and HCO3−are abnormal
and the pH level is normal. Respiratory acidosis is caused by an elevated PaCO2,
which drops the pH to below normal levels. If the patient's lungs are not ventilated better
to decrease the PaCO2, the HCO3−levels in the blood begin to increase (renal
compensation), which increases the pH toward normal. When the pH reaches the
normal range, it is called fully compensated. The most common example of this type of
blood gas level is the patient with severe COPD who has chronic retention of CO2and
remains in a constant state of compensation. (Application)
the following data have been collected on 75-kg male pt receiving volume-controlled
ventilation :
TV 600 mL pH 7.29
SIMV PaCO 50 torr
Vent rate 4 PaO2 72
spontaneous rate HCO 26
FIO2 0.35
On the basis of these data, which of the following should the respiratory therapist
recommend?
A. Increase the VT to 650 mL
B. Increase the FiO2 to 0.40
C. Increase the ventilator rate to 8/min
D. Change to assist-control mode at a rate of 15/min - Answers :C, This patient's
increased PaCO2 level indicates hypoventilation, which can be reversed by increasing
the minute ventilation. This can be accomplished by increasing the ventilator rate or VT,
both of which are choices. We must assume the patient is being weaned from the
ventilator based on the low ventilator rate (SIMV rate of 4). Weaning is accomplished as
we reduce the ventilator rate and allow the patient to breathe more on his or her own. If
the patient's PaCO2 begins to increase during weaning, we increase the rate, not the
VT. The ventilator VT is at the maximum level of 8 mL/kg based on the patient's weight
of 75 kg (8 x 75 = 600), therefore increasing the ventilator rate is the most acceptable
choice.
The ability of the patient to follow instructions would be indicated by which of the
following?
A. Orientation to person
B. Performance of tasks when asked
C. Ability to feed himself
D. Awareness of time - Answers :B, If the patient is able to perform simple tasks when
asked, this best determines his or her ability to follow instructions. This is important
before administering an incentive spirometry or IPPB treatment, which requires the
patient to be able to follow instructions well or the treatment will not be effective.
(Recall)
