Lindsey Jones #7
A patient remains hypoxic even when receiving supplemental oxygen at FIO2 0.45 by air-entrainment device. The respiratory therapist should recommend which of the following? A. mechanical ventilation B. increase in FIO2 C. CPAP D. reduction in FIO2
B
A 5-year old patient with acute epiglottitis has just received a tracheotomy and is returned to the emergency department for monitoring. The patient is now breathing through a tracheostomy tube. Which of the following is most important at this time? A. provide heated humidity B. provide cool aerosol therapy C. mechanical ventilatory support D. keep the tracheostomy tube cuff inflated
A
A negative effect of mechanical PEEP is reduced A. venous return B. FIO2 C. atelectasis D. A-aDO2
A
A patient breathing spontaneously through a 7.5 mm endotracheal tube self-extubates. The ET tube is found lying on the floor with the cuff still inflated. Which is the most important physical sign for which the respiratory therapist should monitor over the next few hours? A. stridor B. unilateral wheezing C. inability to vocalize D. vocal cord paralysis
A
A patient complains of tremors following 2 puffs of Albuterol by metered dose inhaler. The tremors happen within 30 minutes after every treatment and subside within 20 minutes. The respiratory therapist should recommend A. instructing the patient this is a normal side affect B. use of a chamber C. informing the patient this is an adverse reaction D. stop using the MDI
A
A patient is receiving bi-level therapy to decrease work of breathing. Current settings and blood gas results are: IPAP 18 cm H2O EPAP 10 cm H2O FIO2 0.21 pH 7.32 PaCO2 48 torr PaO2 110 torr HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should make which of the following changes? A. decrease EPAP to 8 cmH2O B. increase both IPAP and EPAP by 2 cmH2O C. increase IPAP to 22 cmH2O D. increase EPAP to 12 cmH2O
A
A patient with a history of Congestive Heart failure (CHF) is experiencing pulmonary edema. Oxygen saturation is 87% and the patient has marked congestion of the lungs. Currently, the patient is receiving supplemental oxygen by nonrebreathing mask. Which of the following is the most appropriate action? A. intubate the patient, perform endotracheal suctioning B. spray alcohol into the patient's oropharynx C. administer aerosolized bronchodilator medication D. administer heated aerosol therapy by ultrasonic nebulizer
A
A patient with a history of Status Asthmaticus arrives in the emergency room (ER) after having received multiple bronchodilator treatments. Paramedics report breath sounds have not improved. The physician orders supplemental oxygen. The respiratory therapist will recommend which of the following? A. nonrebreathing mask B. nasal cannula C. Venturi mask D. mechanical ventilator
A
A patient with bronchiectasis has thick and tenacious secretions. The respiratory therapist is unable to adequately suction the patient with a 10 Fr catheter with the suction pressure set at 110 mmHg. Which of the following would be most helpful? A. administer 2.0 cc of 10% Mucomyst (Acetylcysteine) B. administer Atropine sulfate by aerosol C. administer prednisone, IV D. decrease suction pressure to 100 mmHg
A
A physician has just inserted a balloon-tipped flow directed pulmonary artery catheter. When the chest radiographic report returns, the respiratory therapist will expect to see which of the following descriptions if the line is properly placed? A. in the pulmonary artery B. over the right ventricle C. mid-lung space over the right lung field D. in the superior vena cava
A
A respiratory therapist enters the patient's room to do a routine breathing treatment and finds the patient has no obvious chest movement. After calling for help, the first action of the therapist should be to A. Begin mask-valve ventilation B. Perform chest compressions C. Place the patient on a 100% nonrebreathing mask D. Check for a pulse
A
A respiratory therapist should evaluate which of the following first to evaluate the patient's ventilatory status? A. chest movement B. diagnostic chest percussion C. arterial blood gas analysis D. breath sounds
A
A respiratory therapy supervisor is responsible for making suggestions in the initial development of a smoking cessation program. Which of the following would be part of an effective smoking cessation program? A. Nicotine replacement therapy B. removing pulmonary irritants from the house C. daily COHb analysis D. daily completion of an asthma action plan
A
After assisting the repositioning of a tracheostomy patient, the respiratory therapist palpates a crackling sensation about the neck and clavicle area. The therapist should conclude the tracheostomy tube is A. incorrectly positioned B. in the trachea C. too small D. too large
A
Heated humidification would be most important for a patient using A. an endotracheal tube B. a 6 L/min nasal cannula C. a Venturi mask set at FIO2 0.5 D. a face tent with an air entrainment device set at 50%
A
In preparation for a patient who will be receiving oxygen at 3 L/min at home, the respiratory therapist should recommend which of the following devices for primary oxygen delivery? A. oxygen concentrator B. E cylinder C. H cylinder D. bulk liquid oxygen conversion system
A
In preparation for use of an oxygen concentrator in a patient's home, the respiratory therapist should evaluate which of the following environmental conditions? A. electrical load limits B. square footage of the home C. presence and function of CO detector in the home D. patient's ability to perform simple maintinence
A
Nitric oxide (NO) will decrease which of the following? A. pulmonary vascular resistance (PVR) B. ejection fraction C. arterial oxygen content D. systemic vascular resistance (SVR)
A
The respiratory therapist is asked to estimate the alveolar minute ventilation on a spontaneously breathing 68 kg (150 lb) female who is receiving oxygen therapy by air-entrainment mask at FIO2 0.50. The following data is available Exhaled VT 450 mL mPAP 15 torr PaCO2 40 torr PaO2 70 torr Respiratory rate 12/min The therapist should report an alveolar minute ventilation of: A. 3.6 L/min B. 4.6 L/min C. 5.4 L/min D. 12.0 L/min
A
The respiratory therapist notes a biological tape indicator inside an equipment sterilization package indicates the presence of viable spores. The therapist should A. send the mask back to sterilization B. wipe the mask down with disinfectant before use C. open the package and inspect the mask prior to use D. discard the mask
A
When considering appropriate staffing levels and proper care of patients, a respiratory therapy supervisor would include which of the following A. Individual skills of staff members B. previously missed therapy C. staff member preference D. frequency of declined therapy
A
Which alarm is most critical for a post-operative mechanically ventilated patient who has a machine rate of 4/min? A. low minute volume B. low pressure C. high pressure D. high respiratory rate
A
Which is the proper order of steps to prepare a patient with a fenestrated tracheostomy tube for speech? A. deflate cuff, remove inner cannula, cap the tube B. insert inner cannula, inflate the cuff, cap the tube C. insert inner cannula, deflate cuff, cap the tube D. cap the tube, remove inner cannula, deflate cuff
A
Which of the following Carboxyhemoglobin levels is consistent with that of a regular, frequent smoker? A. 6.5% B. 20% C. 1.5% D. 2.9%
A
Which of the following may be related to a fluid balance problem in a patient? A. Congestive heart failure (CHF) B. Elevated CVP C. Pleurisy D. Pulmonary tuberculosis
A
While in the emergency room, the respiratory therapist receives a patient who was working as a firefighter when the burning building collapsed. He was rescued and brought to the ER. The therapist observes paradoxical chest movement in the right chest and hears marked stridor of the upper airway. The therapist should next do which of the following? A. intubate the patient with a bronchoscope B. administer cool aerosol by mask C. administer IPPB treatment D. immobilize the fractured ribs with a chest wrap
A
A 39-year-old unconscious male is brought to the emergency room after a suspected suicide attempt. He was found in his garage with the car running and the exhaust vented to the interior portion of the vehicle. Which of the following should be examined immediately? A. SpO2 B. COHb C. homocysteine level D. MetHb
B
A 65-year-old male patient has been ventilator dependent for several weeks. Weaning attempts have failed. The patient will be transferring to a long-term care facility where daily weaning trials will commence. Which of the following artificial airways would be most appropriate for the patient? A. nasal tracheal tube B. cuffed tracheostomy tube C. oral endotracheal tube D. nasal pharyngeal airway
B
A neonate who was born at 38 weeks of gestation is receiving oxygen therapy by oxyhood and a heated aerosol device at FIO2 1.0. Arterial blood gases show pH 7.41 PaO2 98 torr PaCO2 40 torr HCO3- 24 mEq/L BE -1 mEq/L The respiratory therapist will recommend which of the following? A. Maintaining current therapy B. Decreasing FIO2 to 0.90 C. Placing infant on a mechanical ventilator D. Decreasing FIO2 to 0.50
B
A patient diagnosed with myasthenia gravis is receiving mechanical ventilatory support by an adult volume-ventilator. To determine if the disease has run its course, which of the following would be helpful information? A. MEP, LOC, Fev1 B. VT (spont), VC, MIP C. EMG, EEG, CSF D. FVC, TLC, VT
B
A patient in the emergency room (ER) is showing inverted T waves on the 12-lead ECG tracing. The physician is interested in decreasing the work of the heart. The respiratory therapist should suggest A. administration of Crytodigin (digitalis) B. oxygen by nasal cannula at 5 L/min C. oxygen by nasal cannula at 2 L/min D. adminsitration of Nitroclycerin (Isordil)
B
A patient is in acute ventilatory failure. The physician is preparing to perform oral intubation of the patient in preparation for mechanical ventilatory support. Prior to intubation, the physician delivers Anectine (succinylcholine chloride). What evidence should the therapist watch for to indicate the medication has taken enough effect to perform intubation? A. cessation of respirations B. muscle twitching about the face and neck C. dilated pupils D. patient's inability to count backwards
B
A patient is receiving volume-controlled ventilation. A chest tube drainage system is in place. The low-volume ventilator alarm is sounding continuously and the respiratory therapist notices profuse bubbling in the water seal chamber. Which of the following should the therapist suspect? A. faulty chest drainage system B. perforated lung C. excess suction pressure from the wall D. excessive PEEP
B
A patient is receiving volume-controlled ventilation. The ventilator settings and corresponding clinical data are as follows: Mode Assist/control Mandatory rate 16 Total rate 16 FIO2 1.0 PEEP 25 cm H2O Pulse 118/min Blood pressure 138/74 mm Hg (stable) PAP 14 mmHg C.O. 5.8 L/min pH 7.49 PaCO2 31 torr PaO2 254 torr HCO3- 25 mEq/L BE +1 mEq/L The respiratory therapist should recommend A. Sedate the patient B. Decrease FIO2 C. Decrease mandatory rate D. Decrease PEEP
B
A patient receiving oxygen therapy at 40% has the following arterial blood gas results: pH 7.41 PaCO2 39 torr PaO2 349 torr HCO3- 24 mEq/L The respiratory therapist detects an error in the results. Which of the following could be the cause of the error? A. Damaged Severinghaus electrode B. Improperly functioning Clark electrode C. Oxygen toxicity D. Dysfunctional membrane on the Sanz electrode
B
A patient receiving volume-controlled ventilation has an oxygen saturation of 87% within moments after the low pressure ventilator alarm begins to sound. After providing manual ventilation with a bag valve, the respiratory therapist observes the bag is easier than normal to squeeze and that oxygen saturation continues to fall. Which of the following could be the cause of this observation? A. pneumothorax B. partial extubation C. ET tube cuff herniation D. excess secretions in the ET tube
B
A patient with a history of congestive heart failure has been transferred to the cardiac intensive care unit with fulminating pulmonary edema, crepitations in the left lung field, and +3 pitting peripheral edema. A non-rebreathing mask is in place on the patient and the oxygen flow rate is set to 15 L/min. Which of the following would best resolve the patient's condition? A. administer Albuterol sulfate B. diurese the patient C. administer lactated ringers, IV D. administer aerosolized alcohol
B
A patient with pneumonia has thick secretions and is complaining of difficulty coughing and expectorating sputum. Which of the following should the therapist recommend as the most effective method of hydrating secretions? A. Cool aerosol treatments B. Oral consumptions of water C. Heated aerosol treatments D. Ultrasonic nebulizer treatments
B
An adult patient in the emergency department is febrile with a temperature of 40 deg C (104 deg F) taken rectally. Arterial blood gas analysis is done and the following results are reported with the patient breathing room air. The results are not corrected for temperature. pH 7.35 PaCO2 46 torr PaO2 80 torr HCO3- 26 mEq/L BE +1 mEq/L The respiratory therapist should recommend A. A cooling blanket B. Supplemental oxygen by nasal cannula at 5 L/min C. Non-invasive positive pressure ventilatory support (NIPPV) D. Ventilatory assistance with Bi-level
B
An infant delivered 2 hours prior is consistently cyanotic regardless of high levels of oxygenation administration. The physician would like to rule out patent ductus arteriosis. Which of the following tests should the respiratory therapist recommend A. Perform transillumination B. Compare PO2 values in the umbilical and brachial arteries C. Pass the feeding tube down both nares D. Insert a pulmonary artery catheter
B
In which of the following positions can the respiratory therapist expect to place a patient who will receive chest physiotherapy and postural drainage to address secretions found in the upper lobes, anterior segments of the lungs? A. Trendenlenburg - 30 degrees B. Supine position C. Prone position D. Trendelenburg - 15 degrees
B
The respiratory therapist notices a patient in the intensive care unit has a blood pressure of 110/80 mm Hg by arterial line and a blood pressure 120/85 when taken by sphygmomanometer with a cuff on the right arm. The therapist should A. replace the art line B. document the pressure taken by cuff C. document the pressure by arterial line D. replace the blood pressure cuff
B
The respiratory therapist reads a patient's medical record and notes a unilateral wheeze on the left is documented. Which of the following may be associated with this finding? A. bronchoconstriction B. bronchial carcinoma C. asthma D. vocal cord paralysis
B
The respiratory therapist reviews the results of a patient diagnosed with mixed restrictive and obstructive pulmonary defects. Which of the following data is NOT associated with this diagnosis? A. SVC of 68% of predicted B. FEV1/FVC% of 78% C. FEV1 of 75% of predicted D. FEF 200-1200 of 74% of predicted
B
What is the best method for a therapist to determine if a patient is compliant with a smoking cessation program? A. ask the patient's peers B. evaluate COHb C. ask the patient D. ask the patient's spouse
B
Which of the following ABG results would the respiratory therapist expect to see for a patient who is experiencing an acute on chronic episode with known COPD? A. pH 7.33 PaCO2 55 mm Hg PaO2 52 mm Hg HCO3- 30 mEq/L B. pH 7.48 PaCO2 50 mm Hg PaO2 51 mm Hg HCO3- 34 mEq/L C. pH 7.28 PaCO2 62 mm Hg PaO2 49 mm Hg HCO3- 33 mEq/L D. pH 7.51 PaCO2 35 mm Hg PaO2 60 mm Hg HCO3- 29 mEq/L
B
Which of the following methods would be most helpful to a patient weaning from mechanical ventilation who has a documented restrictive pulmonary defect and has been having difficulty in recent weaning attempts? A. pressure control ventilation B. pressure support C. permissive hypercapnia D. T-piece trials of 24 hour periods several times a week
B
Which of the following should the respiratory therapist evaluate to determine if the patient's perfusion is adequate? A. arterial blood gas analysis B. urine output C. pulse oximetery D. blood urea nitrogen level (BUN)
B
Which of the following would NOT increase if inspiratory flow is increased on a time-cycled ventilator and pressure is not limited? A. Tidal volume B. Total rate C. Expiratory time D. Inspiratory pressure
B
While performing a test discharge of a metered dose inhaler (MDI) prior to administering to a patient, the respiratory therapist is unable to visually confirm the discharge of any particles or aerosol. The therapist should A. Administer the dose to the patient B. Discard the canister, obtain a new MDI C. Shake the canister and administer the dose to the patient D. Utilize a chamber and administer the dose to the patient
B
While performing oxygen rounds, the respiratory therapist visits a patient who is ordered to receive 5 L/min by nasal cannula with a bubble humidifier. The therapist finds the oxygen flow meter is reading 0 L/min, even though the knob is not in the off position, and there is no flow to the patient. Which of the following may cause this? A. low water level in the humidifier B. clogged down-tube C. loose humidifier bottle D. large hole in the cannula
B
A 4-year-old patient is demonstrating ventilatory difficulty with use of intercostal accessory muscles. The patient has a low grade fever and a loud, barky cough. Which of the following mostly likely represents the patient's condition? A. Bacterial infection B. Meningitis C. Laryngotracheobronchitis (croup) D. Acute epiglottitis
C
A 9-year-old asthmatic patient has previously responded well to Xopenex via small-volume nebulizer. The patient is intubated and has been placed on mechanical ventilation for acute respiratory failure. The physician orders Xopenex to be delivered via SVN through the ventilator circuit. Which of the following is an important consideration for effective medication delivery? A. particle deposition will be increased B. an alpha I response is increased C. Placement of the nebulizer can result in variation of medication delivery D. tachycardia is more likely
C
A patient is receiving volume-controlled ventilation in the Assist/control mode at the following settings Mandatory rate 16 VT 550 mL FIO2 0.6 PEEP 22 cm H2O Recent arterial blood gases show pH 7.35 PaCO2 44 torr PaO2 68 torr HCO3- 26 mEq/L BE 0 mEq/L In response to the blood gas, PEEP is increased from 22 to 25 cm H2O. Immediately following the increase, cardiac index drops from 2.8 to 1.9. The therapist should now A. Perform an optimal PEEP study B. Increase FIO2 to 0.70 C. Decrease PEEP to 22 cm H2O D. Increase FIO2 to 1.0
C
A physician suspects a patient has a pleural effusion. Which of the following radiography procedures is helpful in diagnosing the problem? A. apical lordotic radiograph B. PA chest radiograph C. lateral decubitus radiograph D. AP chest radiograph
C
A radiological report is placed in the medical record that describes the results of a chest radiograph. The report indicates a batwing pattern. This finding is consistent with A. pneumonia B. atelectasis C. pulmonary edema D. pleural effusion
C
A respiratory therapist is initiating mechanical ventilation at the following settings and preferences: Mode Assist/control Mandatory rate 20 VT 500 mL FIO2 0.5 PEEP 5 cm H2O I:E 1:2 Which of following is the minimum inspiratory flow setting? A. 80 L/min B. 65 L/min C. 40 L/min D. 28 L/min
C
After analyzing arterial blood on a patient with a history of arterial blood gas analysis, the respiratory therapist concludes the results are not possible. They are very different than the patient's historical blood gas results. Quality control records show no evidence of any trends, shifts, or out-of-control situations in the last month. The therapist should A. Inform the physician of the suspect blood gas B. Ask the medical director for direction in this situation C. Repeat the analysis with the same blood sample and same analyzer D. Perform a two-point calibration on the analyzers
C
After three weeks participating in a smoking cessation program, the patient's COHb is 12%. Which of the following can the respiratory therapist conclude? A. The patient should be dropped from the smoking cessation program B. The patient has been successful at quitting C. The patient is still smoking D. Nicotine replacement therapy medication should be decreased
C
An adult female complains of double vision, dysphasia, and fatigue. Symptoms improve with rest. The respiratory therapist notes the patient is drooling and is having difficulty enunciating words. Which of the following should the therapist recommend? A. Spinal tap B. Lateral neck x-ray C. Tensilon test D. Acute epiglottitis
C
For which of the following vagal reflex response should the respiratory therapist monitor in a patient that is receiving nasotracheal suctioning: A. hypertension B. third degree heart block C. bradycardia D. increased systemic vascular resistance
C
The head of 41-gestational week infant has just been delivered through the birth canal. The respiratory therapist notices meconium staining about the infant's face. Which of the following actions should the therapist recommend next A. begin chest compressions B. provide vigorous manual resuscitation C. perform deep tracheal suctioning D. place the infant on mechanical ventilation
C
The preferred method of delivery for humidification for a pediatric patient during a transport lasting twelve hours is a (an) A. heated humidifier B. bubble humidifier C. HME D. cascade humidifier
C
The radiological report of a chest radiogram indicates a batwing pattern. This description is most consistent with which of the following? A. ARDS B. atelectasis C. pulmonary edema D. pleural effusion
C
The respiratory therapist analyzes the oxygen percentage coming from the end of the aerosol tubing on a large-volume, nebulizer. The analysis shows a higher oxygen percentage than the set FIO2 on the air-entrainment device. Which of the following could be the reason for this disparity? A. depleted reservoir B. clogged down tube in the nebulizer C. kinked aerosol tubing D. leak in the aerosol tubing
C
What volumes can the respiratory therapist examine to calculate vital capacity? A. VT + IC B. IRV-RV C. ERV + VT + IRV D. TLC - FRC
C
Which of the following is the least important to consider when drawing an arterial blood sample? A. patient temperature B. needle size C. supplemental oxygen delivery mode D. FIO2
C
Which of the following may be done to increase the effectiveness of gas distribution for a patient with ARDS who is receiving volume-controlled ventilation in the assist-control mode? A. Switch to SIMV mode B. Administer surfactant C. Use pressure-controlled ventilation D. Decrease the I:E ratio
C
Which of the following methods should the respiratory therapist recommend for a patient receiving mechanical ventilation who requires chest physiotherapy? A. autogenic drainage B. pressure control ventilation C. high-frequency chest wall compression D. huff coughing
C
While instructing a patient on the use of a volume-type incentive spirometer, the therapist observes the patient exhaling forcefully in the spirometer, but no volume is registering on the spirometer. The therapist should A. encourage the patient to exhale more forcefully B. switch to a flow-type incentive spirometer C. instruct the patient to inhale through the device D. obtain a new volume-type spirometer
C
While receiving nasal CPAP delivered by an infant ventilator, the patient is retracting and creating a fluctuating baseline pressure on the monometer. What should the respiratory therapist do? A. Suction the patient B. Adjust the threshold resistor C. Increase the flowrate D. Increase the size of the fixed orifice resistor
C
A 12-year-old patient diagnosed with bronchiectasis is receiving postural drainage and percussion to drain the basal segments of the right lung. While draining with the head of the bed down 30 degrees, the patient begins to exhibit signs of distress including frequent PVCs and a decrease in oxygen saturation. After discontinuing the therapy, the respiratory therapist should recommend A. Provide percussion with the bed flat B. Provide percussion with the head of bed up in semi-fowlers position C. Placing head of bed down only 15 degrees D. Administering therapy with an external percussive device (Vest)
D
A burn trauma patient who is also suspect for carbon monoxide poisoning is receiving oxygen therapy by a nonrebreathing mask. The respiratory therapist observes that the reservoir bag collapses completely with each inspiration. The therapist should A. remove the one-way valve in the reservoir B. continue current therapy as this is normal C. obtain a larger reservoir D. increase flow to the reservoir bag
D
A motorcycle accident victim is in the emergency room with multiple wounds including a contusion to the head and torn deep muscle tissue in the right leg. The patient is bleeding massively. The respiratory therapist should first A. monitor respiratory rate q 10 minutes B. recommend blood type and crossmatch evaluation in preparation for blood administration C. recommend a CT scan of the head D. place the patient on oxygen at FIO2 1.0
D
A patient in ICU has a balloon-tipped pulmonary artery catheter in place. The following hemodynamic data is observed CVP 10 torr mPAP 19 torr PWP 24 torr MAP 112 torr Arterial blood gas analysis reveals: pH 7.38 PaCO2 43 torr PaO2 70 torr HCO3- 21 mEq/L BE -3 mEq/L Which of the following should the respiratory therapist recommend? A. Crystodigin (digitalis) B. Fluid administration C. Antibiotic therapy D. Diuresis
D
A patient in the cardiac intensive care unit has marked congestion and is expectorating large amounts of pink, frothy secretions. Oxygen saturation by pulse oximetry is 85%. This finding is most consistent with A. mitral valve stenosis B. dehydration C. pulmonary embolism D. CHF
D
A patient intubated with a 7.0 mm endotracheal tube requires suctioning. Which of the following suction catheters would be most effective? A. 14 Fr catheter B. 16 Fr coude-tipped catheter C. 18 Fr catheter D. 10 Fr catheter
D
A patient receiving heliox therapy at 80% / 20% mixture by nonrebreathing mask has a total flow of 18 L/min to the mask. The oxygen flow meter that is adapted to fit on the heliox tank is indicating a flow rate of 10 L/min. The therapist would best explain the difference to the physician by saying A. The heliox mixture has greater viscosity B. The oxygen flow meter is not compensated for back pressure C. The helium expands once delivered into the ambient pressure environment D. Helium is less dense and therefore reads a lower flow by an oxygen flow meter
D
A patient receiving oxygen therapy at home complains the oxygen concentrator is not working and that the flow feels insufficient. The respiratory therapist should A. instruct the patient to check the flow with a calibration tube B. tell the patient to call the manufacturer C. tell the patient everything is normal D. instruct the patient use back-up E cylinders until the concentrator can be examined
D
A patient receiving volume-controlled ventilation who was admitted 3 days prior for drug overdose is beginning to awake from a barbiturate-induced coma. There is no history of pulmonary disease in the patient's medical record. As the patient becomes alert, the respiratory therapist should recommend A. sedate the patient with Ativan B. perform pulmonary function testing C. interview the patient for family medical history of drug abuse D. begin following the ventilator weaning protocol
D
A patient with COPD is receiving oxygen therapy at 2 L/min by nasal cannula. During a routine check, the respiratory therapist finds the patient unresponsive. The ECG waveform on the monitor is consistent with ventricular tachycardia. The therapist should immediately A. Begin chest compressions B. Perform cardioversion C. Defibrillate at 360 joules with synchronization set to ON D. Place the patient on a nonrebreathing oxygen mask and check for a pulse
D
A patient, who is on a 3-chamber chest-tube drainage system, is receiving volume controlled ventilation in the assist/control mode. The low return volume alarm begins to sound. Which of the following should the respiratory therapist troubleshoot to determine the cause of the alarm? A. secretions in the airway B. excess condensate in the circuit C. loose circuit connection D. bubbling in the water seal chamber
D
A respiratory therapist has achieved the following weaning parameters on a post-operative patient who experienced a total knee replacement. The SpO2 is 97% on 35% oxygen. Spont VT 480 mL VC 1600 mL VE 7.0 L MIP -4 cm H2O The next best action would be to A. reduce FIO2 to 0.30 B. return to full mechanical ventilation C. evaluate the MEF D. check the pressure manometer for leaks
D
A respiratory therapist is having difficulty obtaining an oxygen saturation reading from a pulse oximeter. Which of the following should the therapist evaluate to determine the cause of the problem? A. C(a-v)O2 B. PaO2 C. CVP D. Presence of finger nail polish
D
A respiratory therapist is preparing a patient who will be transferred home and will be ventilator dependent during the night. Which of the following devices would be most helpful to ensure adequate hydration of the patient's airway during the night? A. Heated wire ventilator circuit with water traps B. Cascade humidifier C. Large volume nebulizer D. Heat moisture exchanger (HME)
D
A respiratory therapist notes endotracheal suctioning is ineffective as the patient's secretions have become thick and tenacious. The patient is intubated with an 8.0 mm endotracheal tube and is being suctioned at a pressure of 100 mm Hg with a 10 Fr closed system suction catheter. Which of the following modifications in therapy would be most beneficial to the patient? A. Have the patient orally consume water B. Diurese the patient C. Increase suction pressure to 110 mm Hg D. Use a 12 Fr suction catheter
D
A victim of a multiple trauma motorcycle accident is receiving mechanical ventilation and has chest tubes inserted in the right lung. The respiratory therapist notices gentle bubbling in the water-seal bottle and a small amount of fluid dripping into the fluid collection bottle. The following data is also available: Mode Assist/control Mandatory rate 18 Total rate 18 VT (set) 550 mL VT(exhaled) 534 mL Peak pressure 28 cm H2O Plateau pressure 18 cm H2O The therapist should A. suction the patient B. clamp the chest tube(s) near the patient C. troubleshoot the chest tube drainage system D. continue current therapy
D
After confirming the blood gas analyzer is "in control", the respiratory supervisor introduces arterial blood from a patient breathing room air and obtains the following results: pH 7.39 PaCO2 41 torr PaO2 210 torr HCO3- 24 mEq/L BE -2 mEq/L Which of the following should the respiratory therapist investigate? A. Fluid level of the reference electrode B. Membrane integrity of the Severinghaus electrode C. Membrane integrity of the Sanz electrode D. Function of the Clark electrode
D
At patient in pulseless ventricular tachycardia is receiving chest compressions while being orally intubated. Immediately after ET tube insertion, the respiratory therapist checks breath sounds and notices vesicular sounds bilaterally. The therapist should next do which of the following: A. remove the ET tube and attempt nasal intubation B. withdraw the ET tube by 2 cm, observe chest rise C. advance the ET tube and auscultate the chest D. recommend a chest radiograph
D
During the weaning process of a 70 year-old patient, the respiratory therapist notes the following ventilator settings and clinical information: Mode SIMV Mandatory rate 8 Total rate 28 VT 500 mL VT(spont) 220 mL FIO2 0.4 PEEP 5 cm H2O The respiratory therapist should do which of the following? A. increase rate B. increase set VT C. discontinue PEEP D. add pressure support
D
How many minutes will a full E cylinder oxygen tank last when running at 5 L/min? A. 90 minutes B. 616 minutes C. 1320 minutes D. 123 minutes
D
In preparation for a smoking cessation class, the therapist should include information on which of the following agents? A. Aminophylline B. Sub-lingual Lidocaine spray C. Pronestyl D. nicotine patch
D
The high pressure alarm is sounding on a patient who is receiving long-term mechanical ventilation. After manually ventilating the patient with a bag-valve, the respiratory therapist notices a large amount of thick sputum is lodged in the heat moisture exchanger (HME). The therapist should A. Replace the HME device with a new one B. Suction the HME device to remove secretions C. Clean the HME by soaking it in normal saline followed by a rinse D. Replace the HME with a heated humidifier
D
The respiratory therapist is performing a preoperational test of a ventilator. The therapist notices the return volume is 200 mL less than the set tidal volume. The therapist should A. tag the ventilator as non-functional and isolate it from functional equipment B. notify the medical director and seek advice C. accept the results and place the ventilator into service D. check for a leak in the circuit or the circuit's connections
D
The respiratory therapist measures the volume when a patient maximally exhales after passively exhaling a normal tidal volume. Which of the following volumes has the therapist observed? A. FRC B. VC C. TLC D. ERV
D
The respiratory therapist responds to an adult patient on a ventilator whose low pressure alarm is sounding. The therapist determines the 6.0 mm ET tube is in proper position according to the markings. Gas escaping around the ET tube is audible. The therapist should A. add air to the cuff B. switch to a cuffless ET tube C. schedule the patient for a tracheotomy D. switch to a larger ET tube
D
What should a respiratory therapist monitor during the cardioversion of a patient who is alert, conscious, and calm? A. temperature B. pupillary reaction C. carotid pulse D. airway patency
D
Which of the following calculations can be used to determine FRC? A. VC - RV B. RV + ERV + VT C. TLC - ERV - RV D. TLC - IRV - VT
D
Which of the following resistors is not associated with pressurizing the circuit for a patient receiving CPAP therapy? A. water-column B. weighted C. spring-loaded D. fixed orifice
D
While performing a routine ventilator a check on a patient with a balloon-tipped flow-directed pulmonary artery catheter in place, the respiratory therapist notices the inflection points on the waveform indicate the tip of the pulmonary artery catheter is improperly placed in the right ventricle. To correct this problem, the therapist should recommend A. recording the pulmonary artery pressure as shown on the waveform B. removing the catheter and inserting a new one C. twisting the catheter until pulmonary artery pressures are observed D. inflating the balloon and advancing the catheter
D
