Exam Prep Exam 4 (Ch. 9, 10, and 11)

How much medication solution is needed to give the patient 20 mg of the active ingredient? The solution contains 5% active ingredient.

0.1 mL

A 48-year-old male patient has been admitted with a suspected MI. What blood tests should be performed to determine if he has had an MI? 1. CK-MB 2. Troponin I 3. D-Dimer 4. BUN 5. LDL

1 and 2 only

The respiratory therapist is called to the recovery room to assist in the care of a patient who returned 2 hours ago from having a bowel resection. The patient is apneic and on a mechanical ventilator. Which medication(s) could be used to wean the patient from the machine? 1. Flumazenil (Romazicon) 2. Naloxone (Narcan) 3. Dopamine (Intropin) 4. Succinylcholine chloride (Anectine) 5. Diazepam (Valium)

1 and 2 only

For drainage of the superior and inferior lingula segments, the patient should be positioned: 1. With the foot of the bed elevated 14 inches 2. One-fourth turn up from the front-down position on the bed 3. One-fourth turn up from the back-down position on the bed 4. With the foot of the bed elevated 30 degrees 5. Flat on his or her back

1 and 3 only

A patient has been diagnosed with severe COPD. The physician has asked for your recommendations on medications to optimize the patient's breathing. The patient says, "I don't want...to take medicine...all day long." What should be recommended to maximize bronchodilation and convenience? 1. Fluticasone and vilanterol (Breo) 2. Mometasone and formoterol (Dulera) 3. Ipratropium and albuterol (Combivent Respimat) 4. Umeclidinium and vilanterol (Anoro) 5. Tiotropium (Spiriva)

1 and 5 only

An NSR can be identified by: 1. A resting rate of 60-100 beats/min in an adult 2. A P wave before every QRS complex 3. A regular rhythm 4. A QRS complex after every P wave 5. An upright T wave in lead II

1, 2, 3, 4, 5

A patient has COPD with a bronchospasm component. Which of the following classes of medications would be helpful? 1. SABA 2. ICS 3. LAAC 4. LABA

1, 2, 3, and 4

To ensure that a manual ventilator is ready for use, what should be done? 1. Make sure that no gas escapes through the outlet port when it is closed off and the bag is squeezed. 2. Squeeze the bag, and make sure that the air/O2 reservoir intake valve closes properly. 3. Squeeze the bag, and make sure the nonrebreathing valve opens properly. 4. Feel for air leaving the outlet port when the bag is squeezed. 5. Squeeze the bag, and make sure that the air/O2 reservoir intake valve opens properly.

1, 2, 3, and 4 only

A 10-year-old female patient with status asthmaticus has been admitted to the hospital. The physician plans to start her on continuous nebulization of a fast-onset rescue inhaled bronchodilator medication. Which of the following should be recommended as part of her care plan? 1. Admit her to the intensive care unit. 2. She should be given salmeterol (Serevent). 3. She should be given levalbuterol (Xopenex). 4. ECG and pulse oximeter monitoring should be done. 5. She should be given an intravenous corticosteroid.

1, 3, 4, and 5 only

Which of the following medications can be administered down the endotracheal tube during a CPR attempt on an adult? 1. Epinephrine 2. Potassium chloride 3. Atropine 4. Lidocaine

1, 3, and 4 only

To get the best patient results, manual percussion should be performed with 1. The hand cupped 2. A tight, fixed-wrist position 3. The elbows relaxed 4. The hand flat 5. The wrist relaxed

1, 3, and 5 only

A patient has an order for an induced sputum sample to be analyzed for tuberculosis. The best medication for this is

10% saline solution

A respiratory therapist is about to administer an aerosolized bronchodilator to an adult patient. The patient's pretreatment pulse rate before starting is 85 beats/min. The treatment should be stopped if the patient's pulse rate reaches:

110 beats/min

How much active ingredient would be found in 0.6 mL of 2.25% racemic epinephrine (Micronefrin)?

13.5 mg

A patient is starting HFCWO to help mobilize secretions. Which of the following instructions should the patient be given for the initial treatment? 1. Lie on the side with secretions. 2. Sit up straight. 3. Set the controls at a low pressure. 4. Set the controls at a high pressure. 5. Set the unit for nebulization.

2 and 3 only

IPV has been ordered for an adult patient with bronchiectasis. An aerosolized bronchodilator has also been ordered. How should the two treatments be delivered? 1. Bronchodilator given before the IPV 2. Low pressure setting 3. Bronchodilator with IPV 4. High pressure setting 5. Bronchodilator after IPV

2 and 3 only

After an exercise routine, a 59-year-old man experiences sudden chest pain with shortness of breath. ECG monitoring in the Emergency Department reveals the following rhythm strip (shows two identical premature ventricular contractions -unifocal PVCs) What should the respiratory therapist recommend? 1. Synchronized cardioversion 2. 12-lead ECG 3. Defibrillation 4. Administer oxygen 5. Angioplasty

2 and 4 only

The patient benefits from using the Flutter by which of the following? 1. Increased transpleural pressure 2. Airway vibrations 3. Increased intrapleural pressure 4. Rapid variation in airway pressure

2 and 4 only

A patient is being given an aerosolized beta-agonist (sympathomimetic) drug for the first time. Monitoring should be done for what possible adverse effects? 1. Bradycardia 2. Tremor 3. Headache 4. Nervousness and irritability 5. Tachycardia

2, 3, 4, and 5 only

Which of the following can be successfully used with a 6-year-old child? 1. Autogenic drainage 2. Chest physiotherapy 3. Oscillatory positive expiratory pressure 4. ACBT 5. IPV

2, 3, and 4 only

An order is received to perform postural drainage, percussion, and vibration on a patient. No segments are specified. On reviewing the chest X-ray film, the therapist notices infiltrates in the lower right lung field. Which of the following segments should be treated? 1. Apical 2. Lateral basal 3. Superior 4. Medial 5. Posterior basal

2, 3, and 5 only

How should manual vibration be performed as part of CPT? 1. On inspiration 2. At a rate of 20-30 cycles/s 3. On expiration 4. At a rate of 3 cycles/s 5. Throughout the breathing cycle

3 and 4 only

When one rescuer is performing CPR on an intubated

30:2

A 15-year-old patient with cystic fibrosis has large amounts of thick secretions. There is no sign of infection. What should be administered to help manage the secretion problem?

5% saline

A 12-year-old patient does not tolerate postural drainage for secretion clearance. The physician wishes to consider high-frequency airway oscillation. Which of the following options should be recommended first?

Acapella

A 15-year-old female patient with cystic fibrosis has copious amounts of secretions. She cannot tolerate postural drainage therapy because she gets a headache when tipped head-down. Aerosolized bronchodilators and mucolytic agents are ordered every 4 hours by SVN. What else should be recommended?

Add PEP therapy

A patient has been ordered to start PEP therapy. During the initial instruction and patient practice, it is noticed that the pressure is 25 cm H2O and the patient's I:E ratio is 1:5. How should the procedure be revised?

Adjust the PEP device to have the patient exhale through a larger hole.

A premature neonate is being mechanically ventilated in the neonatal intensive care unit. The neonatologist believes that the patient has pulmonary hypertension. What should be recommended?

Administer INOmax

CPR steps have been under way for 15 minutes when an ABG sample is drawn and sent off for analysis. The following results are obtained with 100% oxygen being used to ventilate the patient: pH, 6.97 PaCO2, 30 torr PaO2, 210 torr, HCO3 8 mEq/L What should the therapist recommend at this time?

Administer IV sodium bicarbonate.

Bag/mask ventilation with oxygen is being provided to a 57-year-old adult at a rate of 12/min. The patient's other vital signs include heart rate of 52/min and blood pressure 95/55 mm Hg. What can be done to improve the patient's vital signs?

Administer intravenous epinephrine (adrenaline).

A patient is positioned on the left side with the foot of the bed raised 18 inches. The patient would be draining which lung segment?

Anterior basal

A patient is being discharged and will receive an aerosolized controller-type bronchodilator therapy at home. The best medication for this chronically sick but stable patient is

Arformoterol (Brovana)

An asthma patient is discontinuing systemic corticosteroid. The patient will continue taking aerosolized bronchodilator. The physician wants to know what should be recommended for an inhaled corticosteroid (ICS).

Beclomethasone dipropionate (QVAR)

A physician has ordered PEP therapy with albuterol (AccuNeb). All of the following are needed to start the treatment EXCEPT:

Bedside spirometer

A 59-year-old patient is brought to the hospital with a complaint of sudden, severe substernal chest pain and dyspnea. What initial thing should the respiratory therapist recommend?

Begin ECG monitoring.

You are the respiratory therapist attending the delivery of a preterm neonate. His vital signs are: RR 12 HR 70 beats/min In addition he has peripheral cyanosis and is responding minimally to stimulation. what should be done?

Begin manual ventilation with 100% oxygen

A 2-month-old infant has periods of apnea that result in bradycardia and cyanosis. What medication should be recommended to treat the apnea periods?

Caffeine citrate (Cafcit)

An order is received to administer 5 mL of albuterol (Proventil) by hand-held nebulizer. What should be done?

Call the physician to check on the medication dose.

A patient who is being instructed in PEP therapy complains that it is taking too long to breathe out. What should be done?

Change the expiratory resistance to a larger diameter orifice

A mechanical percussor is ordered to assist with secretion clearance in a patient receiving CPT. The patient is positioned to drain the posterior basal segments of both lower lobes. The percussor is activated and applied to the patient's lower back. After 1 minute, the patient complains of skin discomfort. What should the respiratory therapist do?

Change to another type of pad on the percussor

A patient is using the Flutter and coughs productively. Later, the patient tries to use the device but finds that no air will go through it. What should be done?

Check for an obstruction

A patient with a fluid overload problem has been given a dose of furosemide (Lasix) intravenously. Following rapid diuresis in the patient, an arrhythmia is noticed that did not exist before the medication was given. What should be recommended?

Check the patient's potassium level.

A mouth-to-valve resuscitation device is being used on an apneic patient. The respiratory therapist delivers a breath, but the patient's chest does not rise. What should be done next?

Check the valve for proper position.

An anxious 10-year-old asthma patient is being given a breathing treatment with levalbuterol (Xopenex). The patient's initial heart rate of 110 breaths/min has now increased to 120 breaths/min. What should be done?

Continue the treatment as ordered

A 10-year-old male patient with cystic fibrosis has large amounts of secretions. He cannot tolerate postural drainage because of nausea when he is tipped down. He is receiving aerosolized bronchodilator and mucolytic medications. To improve his condition, the respiratory therapist could recommend all of the following EXCEPT:

Continuous positive airway pressure

A respiratory therapist has finished giving an 8-year-old female patient with asthma an IPPB treatment with 0.5 mL of albuterol (Proventil). It is noticed that the patient's heart rate has increased 15% from before the treatment. Her breath sounds are now clear. What should be recommended to the physician for the patient's next treatment?

Decrease the Proventil to 0.3 mL.

A paramedic and a respiratory therapist are performing CPR procedures on an adult patient. Upon looking at the ECG monitor, the following rhythm strip is seen (V FIB). What should be recommended in this situation?

Defibrillate the patient.

A respiratory therapist notices that a patient with a 28% air-entrainment mask is unresponsive to questions. The ECG rhythm seen (V FIB) below is noticed on the monitor. What should be recommended as a first reaction?

Defibrillate the patient.

Upon entering a patient's room, the respiratory therapist notices that the ECG monitor shows VT. A carotid pulse cannot be felt and the nurse says that he cannot find a blood pressure. What should be recommended?

Defibrillate the patient.

CPT (postural drainage, percussion, and vibration) has been performed for 5 days on a cooperative patient with bronchiectasis. During that time, the patient has been treated with antibiotics, well fed, and hydrated. The patient has produced a total of 20 mL of sputum during the past 24 hours. What should be recommended?

Discontinue the CPT and follow the patient's progress

The respiratory therapist has received an order to perform postural drainage, percussion, and vibration on a 23-year-old female patient. The lateral and medial segments of the right middle lobe are among those that need to be treated. How should the procedure be performed?

Drain but not percuss or vibrate those segments

A respiratory therapist is reviewing a patient's chart and looking for indications for postural drainage. All of the following would be included EXCEPT:

Draining of an empyema

The physician has heard a heart murmur on a 24-year-old patient. A mitral valve regurgitation is suspected. What procedure should be performed to determine if that is the case?

Echocardiogram

During a CPR attempt on a 50-year-old patient, the respiratory therapist successfully intubates the patient and begins ventilating with a manual resuscitator. The physician is unable to start an IV line. How should the CPR drugs be given?

Endotracheal instillation

A 16-year-old female patient has severe and chronic asthma. Her physician wishes to change her medications to prevent her from having asthma attacks. All of the following medications would be helpful EXCEPT:

Epinephrine (Adrenaline)

Blood for an ABG measurement needs to be drawn during a CPR attempt. Which site should be recommended for this?

Femoral

An adult patient is panicking and fighting against the mechanical ventilator. All of the following may be used to control the patient on the ventilator EXCEPT:

Flumazenil (Romazicon)

The respiratory therapist is called to help assess a premature neonate. The patient is having difficulty breathing, and RDS is suspected. All of the following could be recommended EXCEPT:

Flumazenil (Romazicon)

An infant daughter has just been delivered by cesarean section to an anesthetized mother. Because she is not breathing adequately, an endotracheal tube has been inserted. What can be done to improve the infant's condition and get her to breathe?

Give IV naloxone (Narcan).

A 58-year-old female patient with congestive heart failure is being treated with 40% oxygen and diuretics. Within 3 hours she has lost 1500 mL of urine and her pulse oximeter reading has improved from 84% to 93% saturation. Her electrocardiogram shows a heart rate of 110 beats/min with the new observation of premature ventricular contractions. Her recent serum electrolyte values show a potassium level of 3.1 mEq/L. What recommendation could be made in her care?

Give her intravenous potassium.

A 56-year-old patient has been in the Trendelenburg position for 10 minutes receiving percussion and vibration. Tachycardia and dyspnea develop. Which of the following actions should be completed by the respiratory therapist?

Have the patient sit up.

A patient with bilateral pneumonia is positioned for drainage of the lateral and medial segments of the right middle lobe. After 5 minutes in this position, the patient complains of SOB. The electrocardiogram shows the patient to be having premature ventricular contractions. The most likely cause of this is:

Hypoxemia from the position

Electrocardiogram monitoring is justified with a patient in the Intensive Care Unit in all of the following situations EXCEPT:

If it is used to evaluate peripheral perfusion.

A 12-year-old patient with cystic fibrosis had PEP therapy started at 5 cm water. After a few minutes of use, the patient has a strong but unproductive cough. What should be done now?

Increase the PEP level to 10 cm water

A home care patient with asthma has finished a standard dose of 0.25 mL of albuterol (Ventolin). After waiting 15 minutes, the patient performs a peak flow measurement, which shows 65% of personal best. What should be done to improve the patient's condition?

Increase the dose of albuterol

A patient had a bronchoscopy procedure and biopsy taken of a suspected lung tumor. After the biopsy, uncontrolled bleeding occurs. What should be given to control the bleeding?

Instill epinephrine through the bronchoscope at the site of the bleeding

Two respiratory therapists are performing chest compressions, manually ventilating an intubated patient during a resuscitation attempt. The nurse and physician are both unable to start an IV line to give medications. What should be recommended?

Instill the medications down the endotracheal tube.

A patient is in shock from an allergic reaction to a bee sting. In addition, the patient has inspiratory stridor from laryngeal edema. What is the best medication to use to help raise the patient's blood pressure and help her breathing?

Intravenous epinephrine (Adrenalin)

The results of a patient's pulmonary function tests show that the peak expiratory flow rate increased the most when an aerosolized sympathomimetic drug and an aerosolized anticholinergic drug were inhaled. The physician wants to know what should be recommended for this patient.

Ipratropium and albuterol (Combivent Respimat)

A 64-year-old woman was admitted with a diagnosis of MI. She was treated with a clot-dissolving medication and recovered quickly. What procedure should be performed to evaluate the condition of her coronary arteries?

Left-heart catheterization

After finishing an aerosolized dose of acetylcysteine (Mucomyst), a patient has breath sounds that reveal wheezing. These were not present at the start of treatment. What medication should be given before the next Mucomyst treatment?

Levalbuterol (Xopenex)

A ventilator-dependent patient is set up for routine ECG monitoring. Because of refractory hypoxemia, the physician orders 10 cm water of PEEP. Shortly after the PEEP therapy is added, it is noticed that sinus arrhythmia has developed. Which of the following is the best course of action to follow?

Make a record of the rhythm, and inform the nurse and physician of your observation.

A 27-year-old patient with an unstable T-1 spinal cord injury has been admitted for treatment of bronchitis. A bedside assessment is performed and it is found that the patient cannot cough out the secretions. Bedside spirometry reveals the patient has a peak flow of 200 L/min (3.3 L/s). What treatment should be recommended?

Mechanical insufflation-exsufflation

All of the following are contraindications to percussion and vibration EXCEPT:

Mobilizing large amounts of secretions

A respiratory therapist is working in the emergency department when an automobile crash victim arrives by ambulance. The patient is conscious, screaming, and hysterical from the extreme pain of a broken lower leg. What should be recommended for sedation?

Morphine sulfate (Duramorph)

A 10-year-old cystic fibrosis patient has a pulmonary infection and thick secretions. What should be recommended to help the patient cough out the secretions?

Nebulized dornase alfa (Pulmozyme)

A 48-year-old woman had her gallbladder removed. What is most effective in preventing postoperative atelectasis?

PEP therapy

A fully compensatory pause is seen after which type of heartbeat?

PVC

The laboratory results of a patient's sputum sample indicate that the patient has a gram-positive pulmonary infection. Which of the following medications should be recommended?

Penicillin (Ampicillin)

A 35-year-old patient has AIDS and was previously treated for P. carinii pneumonia. What can be used to prevent the infection from reoccurring?

Pentamidine (NebuPent) by SVN

All the following are acceptable ways to ventilate a patient during CPR EXCEPT:

Pneumatic (demand-valve) resuscitator

A 65-year-old patient has been successfully resuscitated in the Emergency Department after suffering an MI. The patient is still unstable with frequent PVCs and needs to be transported to the cardiac care unit for management. Which of the following would be most important for monitoring the patient during the transportation?

Portable ECG machine with defibrillator

Defibrillation should be done immediately in which of the following patient situations?

Pulseless VT

A patient was extubated 30 minutes ago. The patient is hoarse and complains of "tightness in my throat"; inspiratory stridor can be heard. The drug of choice for treating this problem is

Racemic epinephrine (MicroNefrin)

A stroke patient has been admitted and is in a coma. The physician is concerned that the patient may develop atelectasis and pneumonia. What should be recommended to help prevent these problems?

Regular turning

A mechanically ventilated patient who has been paralyzed with a neuromuscular blocking agent should be given a sedative agent for what reason?

Relieve anxiety

A 20-year-old asthmatic patient has received a standard dose of levalbuterol (Xopenex). Breath sounds reveal loud, bilateral wheezes. Over the course of the treatment, the patient's heart rate changed from 98 to 105 beats/min. What would you recommend?

Repeat the treatment and monitor the patient

An 18-month-old infant is diagnosed with bronchiolitis from RSV. Which medication should be recommended?

Ribavirin (Virazole)

A 4-month-old pediatric patient has chronic lung disease secondary to recovering from RDS. The patient now has pneumonia caused by RSV and is on a mechanical ventilator. What can be given to improve the patient's condition?

Ribavirin (Virazole) by SPAG II nebulizer

After several days of receiving postural drainage and percussion therapy to all lobes in the left lung, the patient's chest radiograph shows improvement except for the lateral basal segment of the left lower lobe. In what position should the patient now be placed for postural drainage?

Right side down with the head of the bed down 30 degrees

A 70-year-old patient who had a stroke has aspirated and now has a fever and pulmonary secretions. The respiratory therapist notices on the anteroposterior and right lateral chest radiographs that the posterior segment of the right upper lobe is opaque. What postural drainage position should be used with this patient?

Sitting upright and leaning forward 30 degrees

When a patient's chart is reviewed, it is important to look for contraindications to CPT. These would include all of the following EXCEPT:

Small VC in a bedridden patient

A male patient comes into the Emergency Department appearing ashen gray and complaining of sudden, severe pain beneath his sternum and shortness of breath. He says this began after he exercised vigorously for 45 minutes. After putting an O2 mask on the patient, what should be done?

Start ECG monitoring.

A patient with COPD is being given a new inhaled adrenergic bronchodilator medication by SVN. Within 3 minutes, the patient complains of palpitations. The patient's pulse rate was 85 beats/min before the treatment and is now 125 beats/min. What should be done?

Stop the treatment

The respiratory therapist is working with a patient who begins to expectorate blood after being positioned for drainage of the superior segment of the left lower lobe. Percussion was provided with a mechanical device. After the patient has expectorated 50 mL of blood, what should be recommended as the best action?

Stop the treatment, sit the patient up, and call the physician

The respiratory therapist is using a pneumatically powered mechanical percussor on a patient receiving CPT. The unit is powered by an E cylinder of O2 because piped-in O2 is unavailable. After a few minutes of operation, it is noticed that the percussor begins to slow down and then stops. What should be done?

Switch to an electrically powered percussor

A 10-year-old boy with cystic fibrosis has been having recurrent episodes of P. aeruginosa pneumonia. What should be recommended to prevent further episodes?

TOBI should be taken by SVN every other month.

It is noticed during a diagnostic ECG that the QRS complex is inverted on lead II. What would most likely cause this?

The arm electrodes are reversed

A respiratory therapist is working the night shift when a 17-year-old patient with status asthmaticus is admitted through the emergency department. The patient has already been given Combivent Respimat and an ICS medication. The intern on-call asks for your recommendation on what additional medication to give the patient. What should be recommended?

Theophylline (Aminophylline)

While doing O2 equipment rounds, the respiratory therapist comes upon a cyanotic patient who is not breathing. After repositioning the patient and hyperextending the neck, it is noticed that the patient has open lip ulcers. What would be the best way to ventilate this patient?

Use a mouth-to-valve device stored in the room for this purpose.

The best way to determine pulslessness in a 10 month old is to check:

brachial pulse for 5-10 seconds

You enter the patient's room to check on her nasal cannula. She is slumped over in her chair and appears cyanotic. Your first reaction would be to:

determine whether the patient is responsive

You are working in the ER when a MVC victim is brought in. You would suspect that the driver has a cervical spine injury. What is the best way to open the airway?

jaw-thrust manuever