LJ Exam 7

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 is still smoking B. Nicotine replacement therapy medication should be decreased C. The patient should be dropped from the smoking cessation program D. The patient has been successful at quitting

The correct answer is : A Explanation : A COHb of 12% indicates the patient is still smoking and is not compliant with the smoking cessation program. Obtaining a COHb is the best method of assessing a patient's compliance.

The preferred method of delivery for humidification for a pediatric patient during a transport lasting twelve hours is a (an) A. HME B. heated humidifier C. cascade humidifier D. bubble humidifier

The correct answer is : A Explanation : A heat moisture exchanger (HME), is inexpensive, convenient, and practical for a relatively short duration transport. The other options would be difficult or impossible to manage for a patient transport.

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. place the patient on oxygen at FIO2 1.0 B. monitor respiratory rate q 10 minutes C. recommend blood type and crossmatch evaluation in preparation for blood administration D. recommend a CT scan of the head

The correct answer is : A Explanation : A massive bleed is considered an emergency because the loss of hemoglobin can quickly affect the oxygen transport to tissues, which can result in death. This emergency should be treated by administering 100% oxygen to the patient.

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. cuffed tracheostomy tube B. oral endotracheal tube C. nasal pharyngeal airway D. nasal tracheal tube

The correct answer is : A Explanation : A patient who is ventilator-dependent, and is having difficulty weaning from the ventilator, may benefit most from a tracheostomy tube. Compared to an oral or nasal endotracheal tube, a tracheostomy tube is shorter and therefore has less airway resistance.

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. VT (spont), VC, MIP B. EMG, EEG, CSF C. FVC, TLC, VT D. MEP, LOC, Fev1

The correct answer is : A Explanation : A patient with myasthenia gravis suffers from a slow onset of paralysis of ventilatory muscles and will ultimately not be able to sustain life. Therefore, the patient's ventilatory status should be monitored by routinely evaluating tidal volume and maximum inspiratory pressure.

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 support B. permissive hypercapnia C. T-piece trials of 24 hour periods several times a week D. pressure control ventilation

The correct answer is : A Explanation : A person with a restrictive pulmonary defect has increased pulmonary resistance due to low pulmonary compliance. To overcome the increased resistance and work required to breathe, pressure support is most helpful.

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. Supplemental oxygen by nasal cannula at 5 L/min B. Non-invasive positive pressure ventilatory support (NIPPV) C. Ventilatory assistance with Bi-level D. A cooling blanket

The correct answer is : A Explanation : Because the patient is hypethermic, or has a fever, and the arterial blood gas results are not corrected for temperature, the reported results from the analyzer would be erroneously high. Because the patient's PaO2 is at 80 mmHg and because that result is erroneously high, the patient's real PaO2 is lower than 80 mmHg, making them hypoxic. Supplemental oxygen, therefore, is indicated.

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. Oral consumptions of water B. Cool aerosol treatments C. Heated aerosol treatments D. Ultrasonic nebulizer treatments

The correct answer is : A Explanation : For a patient who is breathing spontaneously and independently with no artificial airway in place, the best way to hydrate secretions is to orally consume water.

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. instruct the patient to inhale through the device B. switch to a flow-type incentive spirometer C. encourage the patient to exhale more forcefully D. obtain a new volume-type spirometer

The correct answer is : A Explanation : Incentive spirometry (volume-type) is a device that measures the inspiratory capacity. The therapy involves the patient to inspire, raising a puck to a desired volume. However, patients often confuse this maneuver and exhale rather than inhale. When this is observation, proper instruction should be provided to the patient. Instruction should be given in non-medical lingo - language that is easily understood by the patient.

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. oxygen by nasal cannula at 5 L/min B. oxygen by nasal cannula at 2 L/min C. administration of Crytodigin (digitalis) D. adminsitration of Nitroclycerin (Isordil)

The correct answer is : A Explanation : Inverted T waves indicate cardiac ischemia, or the absence of oxygen reaching the heart. When this is observed, supplemental oxygen is indicated. The amount of oxygen indicated is the adult therapeutic range, which is 40 to 55%. Of the options offered, this percentage can best be achieved by nasal cannula at 5 L/min. 2 L/min by nasal cannula may be tempting because many emergency room protocols indicate this amount of oxygen delivery for the presence of chest pain. However, this patient is demonstrating inverted T waves, which is a more significant indicator of cardiac ischemia.

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 IPPB treatment C. immobilize the fractured ribs with a chest wrap D. administer cool aerosol by mask

The correct answer is : A Explanation : Marked stridor is an indication for reintubation. In this case, because the patient is a firefighter, significant inflammation in the upper airway is likely present and therefore intubation is considered complex. A risky or complex intubation may be done by use of a bronchoscope or by sending the patient to surgery in case a tracheotomy is required.

While doing routine rounds on patients in the medical-surgical unit, the respiratory therapist discovers a patient is non responsive and has no visible chest movement. The first action of the therapist should be to A. administer manual ventilations with a bag/valve B. check for a pulse C. begin chest compressions D. leave and get help

The correct answer is : A Explanation : No visible chest movement is a direct and immediate indication to provide ventilatory support to the patient. The quickest way to provide this is with a bag/valve and mask.

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. Repeat the analysis with the same blood sample and same analyzer B. Ask the medical director for direction in this situation C. Inform the physician of the suspect blood gas D. Perform a two-point calibration on the analyzers

The correct answer is : A Explanation : Suspicious blood gas results is cause to repeat the analysis utilizing the same blood.

An infant born at 41 weeks of gestation is now 2 days old. The respiratory therapist notices the infant appears jaundice in color. Vital signs are normal. The medical record over the last 24 hours indicates occasional apneic periods lasting 10-20 seconds. Which of the following disorders could account for these observations? A. problem with bilirubin level B. pulmonary immaturity C. hormone imbalance D. maternal history of barbiturate abuse

The correct answer is : A Explanation : The jaundice color, sometimes observed in infants, is related to improper bilirubin level. This can often be treated by exposing the patient to a bilirubin light.

Nitric oxide (NO) will decrease which of the following? A. pulmonary vascular resistance (PVR) B. arterial oxygen content C. systemic vascular resistance (SVR) D. ejection fraction

The correct answer is : A Explanation : The purpose of nitrous oxide therapy is to lower pulmonary pressures and therefore will result in a decrease in pulmonary vascular resistance or PVR.

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. pulmonary edema B. pleural effusion C. atelectasis D. pneumonia

The correct answer is : A Explanation : The radiological term "batwing pattern" is associated with pulmonary edema.

A 16-year-old child is admitted to the emergency room with a medical history of asthma. The physician has ordered a rescue bronchodilator to address bronchoconstriction. Which of the following medications should the respiratory therapist recommend to address issues with airway inflammation? A. Prednisone B. Atrovent C. Xopenex D. Pirbuterol

The correct answer is : A Explanation : There are three components to asthma. The first is bronchoconstriction, which should be resolved through bronchodilator medication. The second is inflammation, which should be addressed through anti-inflammatory medication. The third is secretions, which should be addressed by therapies that mobilize and remove secretions. Of the options offered, the administration of prednisone is most helpful at decreasing inflammation of airways

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. Diuresis B. Crystodigin (digitalis) C. Fluid administration D. Antibiotic therapy

The correct answer is : A Explanation : These hemodynamic values are all high. When all hemodynamic values are elevated, especially CVP, the most likely cause is fluid overload. The most appropriate option in this case is to diurese the patient.

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. add pressure support B. discontinue PEEP C. increase rate D. increase set VT

The correct answer is : A Explanation : This patient appears to be weaning from mechanical ventilation. To determine the ventilatory ability of the patient, it is helpful to first look at the patient's total rate compared to the set rate, and the patient's spontaneous tidal volume. In this case the total rate is 28/min which is excessive. This high rate can be explained by the patient's spontaneous tidal volume which is 220 mL. This volume is far below the 5 mL per kilogram required to sustain life. Together, with the high respiratory rate, this patient will ultimately tire and be unable to sustain independent ventilation. One way that we can help this patient is to add pressure support. This will cause an increase in spontaneous tidal volumes and thus decrease total rate.

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. Use a 12 Fr suction catheter B. Increase suction pressure to 110 mm Hg C. Have the patient orally consume water D. Diurese the patient

The correct answer is : A Explanation : This patient has an 8.0-mm endotracheal tube but is being suctioned by a 10 French catheter. This catheter is too small for the patient. To determine the appropriate maximum size catheter, simply divide the endotracheal tube size by 2 and then multiply that number by 3 three to obtain the maximum size in French units. In this case, the patient should be using a 12 French catheter.

A patient is admitted to the emergency room (ER) after being found unconscious in a closed garage with an automobile running. A note was also found at the scene. Which of the following therapies would be most helpful to the patient? A. hyperbaric oxygen therapy B. mechanical ventilation with high levels of PEEP C. oxygen therapy with a non-rebreathing mask D. oxygen therapy with a partial-rebreathing mask

The correct answer is : A Explanation : This patient most likely has carbon monoxide poisoning. The treatment for this is maximum supplemental oxygen and the use of hyperbaric oxygen therapy.

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. increase in FIO2 B. reduction in FIO2 C. CPAP D. mechanical ventilation

The correct answer is : A Explanation : To achieve a higher PaO2 and relieve hypoxemia, a respiratory therapist can either increase FIO2 or increase positive airway pressure (CPAP or PEEP). In this case, FIO2 is below 60% and therefore should be increased before increasing positive airway pressure.

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. 40 L/min B. 28 L/min C. 80 L/min D. 65 L/min

The correct answer is : A Explanation : To calculate the minimum inspiratory flow rate for a given set of ventilator parameters the I:E ratio can be added together and then multiplied by the minute ventilation. In this case 1+2=3. 3 x 10.0L = 30L/min.

A 14-year old patient with asthma is in the emergency department (ED) with shortness of breath. Two treatments with Albuterol have been given, but the patient is still wheezing and peak flow measurements have not changed. The respiratory therapist should recommend? A. administering ipratropium bromide (Atrovent) B. ordering a chest radiograph C. drawing arterial blood for gas analysis D. administering cromolyn sodium (Intal)

The correct answer is : A Explanation : When a patient is not responsive to a particular bronchodilator medication, it is appropriate to attempt bronchodilation with a different medication. In this case, Atrovent is a good alternative medication because it is also a short term rescue medication, like albuterol, but with a different mode of action.

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. perforated lung B. faulty chest drainage system C. excessive PEEP D. excess suction pressure from the wall

The correct answer is : A Explanation : When both of these conditions, low return volume and excessive bubbling in the water seal compartment, are observed the most likely suspicion should be a perforation in the lung tissue. The excessive bubbling is coming from the delivered tidal volumes to the patient that are not being returned to the ventilator but are being removed by the chest tube drainage system.

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. Decreasing FIO2 to 0.90 B. Maintaining current therapy C. Decreasing FIO2 to 0.50 D. Placing infant on a mechanical ventilator

The correct answer is : A Explanation : When decreasing FIO2 on an infant, changes must be made in small increments.

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. presence and function of CO detector in the home C. square footage of the home D. patient's ability to perform simple maintinence

The correct answer is : A Explanation : When setting up the patient in their home to receive oxygen by concentrator, a number of safety issues must be assessed. Among those, checking electrical load limits and ensuring they are high enough for the electrical needs of the concentrator is one element. The therapist may also examine the home to determine obstacles for ambulating about the home and ensuring pathways are clear. Finally, ensuring there is no source of open flames in what may be an oxygen-rich environment is also important and should be included in the instruction of the patient. The square footage of the home is irrelevant.

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. COHb B. MetHb C. SpO2 D. homocysteine level

The correct answer is : A Explanation : When suspecting a patient has carbon monoxide poisoning, a COHb is the most appropriate data to rule in or rule out CO poisoning.

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. administer heated aerosol therapy by ultrasonic nebulizer B. intubate the patient, perform endotracheal suctioning C. administer aerosolized bronchodilator medication D. spray alcohol into the patient's oropharynx

The correct answer is : B Explanation : A patient with pulmonary edema who has marked congestion, and is consequently hypoxic, should first receive suctioning. Intubating the patient to facilitate that suctioning is appropriate when the level of secretions constitutes an emergency. The presence of marked congestion constitutes an emergency.

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. Place the patient on a 100% nonrebreathing mask B. Begin mask-valve ventilation C. Check for a pulse D. Perform chest compressions

The correct answer is : B Explanation : According to basic life support guidelines, after calling for help, providing ventilation and is the next, most appropriate step.

The radiological report of a chest radiogram indicates a batwing pattern. This description is most consistent with which of the following? A. ARDS B. pulmonary edema C. pleural effusion D. atelectasis

The correct answer is : B Explanation : The radiological report and interpretation of "batwing pattern" is associated with pulmonary edema.

A respiratory therapist should evaluate which of the following first to evaluate the patient's ventilatory status? A. arterial blood gas analysis B. chest movement C. diagnostic chest percussion D. breath sounds

The correct answer is : B Explanation : All of the options offered are helpful in determining the pulmonary and ventilatory status of the patient. However, when asked which should be evaluated first, the answer should be the option that is the quickest and most relevant. In this case, observing chest movement is visual and can provide data quicker than any other method listed. The next best option is to observe breath sounds. Arterial blood gas results is the last best option because it is most time-consuming. If, however, the question asked which is the BEST way to determine the ventilatory status of the patient, arterial blood gases would be the best answer because it is most conclusive.

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 7.51 PaCO2 35 mm Hg PaO2 60 mm Hg HCO3- 29 mEq/L B. pH 7.48 PaCO2 50 mm Hg PaO2 51 mm Hg HCO3- 34 mEq/L C. pH 7.33 PaCO2 55 mm Hg PaO2 52 mm Hg HCO3- 30 mEq/L D. pH 7.28 PaCO2 62 mm Hg PaO2 49 mm Hg HCO3- 33 mEq/L

The correct answer is : B Explanation : An acute on chronic episode occurs when a patient with COPD with compensated respiratory acidosis experiences an exacerbation, which causes the respiratory rate to significantly increase, usually due to hypoxemia. The "acute" increase in minute ventilation drives the pH upward and even the PaCO2 is reduced from its normally high level to a lower level that still may be higher than the normal range but low for the patient. PaO2 is often significantly low in these scenarios. HCO3- will be significantly increased. These are difficult blood gases to interpret, and require critical thinking by the respiratory therapist.

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. tell the patient everything is normal B. instruct the patient use back-up E cylinders until the concentrator can be examined C. tell the patient to call the manufacturer D. instruct the patient to check the flow with a calibration tube

The correct answer is : B Explanation : Anytime a patient complains that they are not receiving enough oxygen, or that they worry that the oxygen concentrator or other oxygen delivery equipment is not operating properly, the first most appropriate action is to ensure proper oxygen delivery to the patient by changing modalities. In this case, having the patient switch to an E cylinder is most appropriate.

Which alarm is most critical for a post-operative mechanically ventilated patient who has a machine rate of 4/min? A. low pressure B. low minute volume C. high respiratory rate D. high pressure

The correct answer is : B Explanation : Because a machine set rate of 4/min is insufficient to maintain a patient's ventilation, it is necessary to set the alarms to assure sufficient ventilation is occurring with spontaneous breathing. Should the patient become sedated or lose their spontaneous respiratory drive, the alarm will notify the therapist to intervene.

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. Tensilon test C. Acute epiglottitis D. Lateral neck x-ray

The correct answer is : B Explanation : Double vision, general fatigue, and drooping facial muscles are signs and symptoms associated with myasthenia gravis. To diagnose this disease a Tensilon test may be done. Tensilon is an anti-cholinergic medication. If the patient feels better momentarily with the administration of Tensilon, myasthenia gravis is confirmed. This is called a myasthenic crisis.

What should a respiratory therapist monitor during the cardioversion of a patient who is alert, conscious, and calm? A. pupillary reaction B. airway patency C. carotid pulse D. temperature

The correct answer is : B Explanation : During a cardioversion, the patient is heavily sedated for at least a few moments, and the airway can become compromised. The respiratory therapist should assure the airway remains open and patent.

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. check the pressure manometer for leaks C. evaluate the MEF D. return to full mechanical ventilation

The correct answer is : B Explanation : Most of the weaning parameters listed are very good and suggest that the patient is strong enough for weaning. The respiratory therapist should not believe the NIF result of -4 cm H2O because it is not consistent with the remainder of the results. A leak is likely present in the manometer set up.

A patient receiving volume-controlled ventilation has a pressure volume loop that shows the inspiratory cycle begins before exhalation is complete. Which of the following is an appropriate response to this situation? A. decrease inspiratory flow rate B. increase inspiratory flow rate C. increase I:E ratio D. decrease expiratory time

The correct answer is : B Explanation : Of the options offered, increasing inspiratory time will result in a greater expiratory time which will allow complete exhalation before inspiration begins.

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. Inspiratory pressure D. Expiratory time

The correct answer is : B Explanation : On a time-cycled ventilator, assuming pressure limit is not changed, an increase in inspiratory flow rate would result in an increase in tidal volume, inspiratory pressure, and expiratory time. Total rate would not be affected.

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. Pass the feeding tube down both nares B. Compare PO2 values in the umbilical and brachial arteries C. Insert a pulmonary artery catheter D. Perform transillumination

The correct answer is : B Explanation : Patent ductus arteriosus is a condition of an infant when a duct fails to close and shunting occurs. This condition is diagnosed by comparing the PO2 values from pre-ductal and post-ductal blood gases. A preductal blood gas is taken from the umbilical artery and a postductal blood gas is usually taken from the right brachial artery. If the PO2 values differ by more than 15 mmHg, patent ductus arteriosus is confirmed and surgery is required to correct the congenital defect.

Which of the following resistors is not associated with pressurizing the circuit for a patient receiving CPAP therapy? A. weighted B. fixed orifice C. water-column D. spring-loaded

The correct answer is : B Explanation : Positive end expiratory pressure or continuous positive airway pressure is achieved in various ways with varying types of resistors. The respiratory therapist should have a working knowledge of how these various resistors function in order to best troubleshoot when errors occur. The fixed orifice-type resistor is not utilized with CPAP.

Which of the following Carboxyhemoglobin levels is consistent with that of a regular, frequent smoker? A. 20% B. 6.5% C. 2.9% D. 1.5%

The correct answer is : B Explanation : Regular frequent smokers will commonly have carboxyhemoglobin levels between 5 and 10%.

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 25 cm H2O Recent arterial blood gases show pH 7.35 PaCO2 44 torr PaO2 68 torr HCO3- 26 mEq/L BE 0 mEq/L Immediately following the increase, cardiac index drops from 2.8 to 1.9. The therapist should now A. Increase FIO2 to 1.0 B. Decrease PEEP to 22 cm H2O C. Increase FIO2 to 0.70 D. Perform an optimal PEEP study

The correct answer is : B Explanation : The arterial blood gas results show adequate ventilation and normal acid-base status. However the patient is hypoxic. To increase arterial oxygenation either PEEP or FIO2 should be increased. Normally, it is best to increase FIO2 first until at 0.6. In this case, the FIO2 is already at 0.60. The next logical step is to increase PEEP. Examination of further data, however, shows that cardiac output has decreased. Cardiac index has fallen from 2.8 to 1.9. A cardiac index of 1.9 is equivalent to a cardiac output of 3.8 L/min. This is below the normal cardiac output of 4-8 L/min. Thus, even though an increase in PEEP is indicated, the degrading cardiac output is an indication to decrease PEEP.

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

The correct answer is : B Explanation : The best way to determine if a patient is compliant with a smoking cessation program is to evaluate the carbon monoxide levels in the hemoglobin. This is done by checking the COHb.

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. schedule the patient for a tracheotomy B. switch to a larger ET tube C. switch to a cuffless ET tube D. add air to the cuff

The correct answer is : B Explanation : The first, most obvious problem in this question is that an adult patient has a 6.0 mm ET tube. For a normal sized adult, this endotracheal tube size is likely too small. Further evidence indicates gas escaping around ET tube. This is also likely due to a small endotracheal tube.

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. loose humidifier bottle B. clogged down-tube C. low water level in the humidifier D. large hole in the cannula

The correct answer is : B Explanation : The most likely cause of the flow meter reading zero is a clogged down-tube. A low water level or loose humidifier bottle would not cause the flow meter to read zero.

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. Venturi mask B. nonrebreathing mask C. nasal cannula D. mechanical ventilator

The correct answer is : B Explanation : The presence of status asthmaticus, specifically the lack of responsiveness to bronchodilator therapy, indicate the patient is in an emergent situation. Clinical emergencies involving the absence or reduction of the vital functions to life should be responded to by administering maximum FIO2 (100%). This can best be done by administering oxygen by a nonrebreathing mask.

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. dehydration B. CHF C. mitral valve stenosis D. pulmonary embolism

The correct answer is : B Explanation : The production of large amounts of pink frothy secretions is most likely related to congestive heart failure and/or fluid overload. These clinical manifestations are not associated with mitral valve stenosis, pulmonary embolism, or dehydration.

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. Utilize a chamber and administer the dose to the patient B. Discard the canister, obtain a new MDI C. Administer the dose to the patient D. Shake the canister and administer the dose to the patient

The correct answer is : B Explanation : The proper way to determine if any medication remains in a metered dose inhaler is to discharge the inhaler and visually note output. If no output is noted, the inhaler must be empty and should be discarded.

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. inflating the balloon and advancing the catheter C. removing the catheter and inserting a new one D. twisting the catheter until pulmonary artery pressures are observed

The correct answer is : B Explanation : The pulmonary catheter should be terminated in the pulmonary artery, which is beyond the right ventricle. Therefore, advancing the catheter is appropriate. The catheter may be advanced by sailing it into position, which is done by inflating the catheter balloon and allowing blood flow to carry the catheter into position and then deflating the balloon once it is in the proper position.

While assessing a patient receiving positive pressure ventilation with a Servo adult ventilator, the therapist notes a sudden low return volume alarm begins sounding. Which of the following could be the cause? A. ARDS B. bronchopleural fistula C. pulmonary embolism D. excess condensate in the ventilator circuit

The correct answer is : B Explanation : The solution to this problem is to determine which answer could lead to a low-pressure alarm. Excess condensate in the ventilator circuit and adult respiratory distress syndrome would more likely lead to high-pressure alarms. A pulmonary embolism is not related to any particular alarm. That leaves a bronchopleral fistula as the only possible cause.

What volumes can the respiratory therapist examine to calculate vital capacity? A. VT + IC B. ERV + VT + IRV C. TLC - FRC D. IRV-RV

The correct answer is : B Explanation : There are numerous ways to calculate vital capacity. In order to solve this question, each option must be taken separately and solved to determine if the desired result can be achieved. In this case, the best formula to calculate vital capacity is adding ERV to VT and IRV.

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. continue current therapy C. troubleshoot the chest tube drainage system D. clamp the chest tube(s) near the patient

The correct answer is : B Explanation : This question indicates that gentle bubbling is noticed in the water-sealed bottle or compartment of the chest tube drainage system. Although this may sound like something is wrong, this is actually a normal finding. In this case. Therapy should be continued. Profuse bubbling is an indication of leak in the tubing or a bronchopleural fistula in the lung tissue.

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. FEF 200-1200 of 74% of predicted B. FEV1/FVC% of 78% C. FEV1 of 75% of predicted D. SVC of 68% of predicted

The correct answer is : B Explanation : To be considered restrictive, the patient must have a slow file capacity or forced vital capacity of less than 80% of predicted. To be considered obstructive a patient must have an FEV1 of less than 80% of predicted or an FEV1/FVC% of less than 75%.

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. 12.0 L/min B. 3.6 L/min C. 4.6 L/min D. 5.4 L/min

The correct answer is : B Explanation : To determine alveolar ventilation, dead space should be subtracted from each tidal volume. The amount of dead space per tidal volume is equivalent to 1 mL/lb of ideal body weight. In this case, the patient weighs 200 lbs and therefore has 150 mL of dead space for every inhaled tidal volume. The amount of gas that goes to the alveoli is, therefore, 300 mL per breath or 3.6 L per minute. This is calculated by subtracting 150 mL from 450 mL (the patient's VT) and then multiplying by the respiratory rate.

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. informing the patient this is an adverse reaction B. instructing the patient this is a normal side affect C. use of a chamber D. stop using the MDI

The correct answer is : B Explanation : Tremors following an albuterol treatment is considered a normal side effect and does not indicate a need to change the therapy. Normal side-effects differ from adverse reactions.

Which is the proper order of steps to prepare a patient with a fenestrated tracheostomy tube for speech? A. insert inner cannula, inflate the cuff, cap the tube B. deflate cuff, remove inner cannula, cap the tube C. cap the tube, remove inner cannula, deflate cuff D. insert inner cannula, deflate cuff, cap the tube

The correct answer is : B Explanation : When changing configuration of a fenestrated tracheostomy tube from a speech configuration to a positive pressure ventilation configuration, there is a proper order in which the transition should be made. The correct order is one that allows the patient to breathe spontaneously throughout the transition. In this case, we are going from a positive pressure configuration to a speaking configuration. The correct order is to first deflate the cuff, remove the inner cannula, and then place the buttons or cap on the tube.

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. provide vigorous manual resuscitation B. perform deep tracheal suctioning C. place the infant on mechanical ventilation D. begin chest compressions

The correct answer is : B Explanation : When the head of an infant is delivered, the first action should be to suction the mouth and the upper airway prior to complete delivery. This is because it is believed that compression of the chest by the vaginal wall during delivery promotes initial ventilation attempts. It is important to clear the airway of fluid and other debris prior to any ventilation attempt.

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. obtain a larger reservoir B. increase flow to the reservoir bag C. remove the one-way valve in the reservoir D. continue current therapy as this is normal

The correct answer is : B Explanation : When using a non-rebreathing mask, the reservoir bag should collapse partially with each breath. If the bag does not collapse at all, there is likely a problem in the seal between the mask and the patient's face. If the reservoir collapses completely, the problem is most likely inadequate flow to the reservoir bag. The solution is to increase the flow.

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. too large B. in the trachea C. incorrectly positioned D. too small

The correct answer is : C Explanation : "Crackling sensations" or "popping sounds" palpated about the neck and clavicle area are associated with subcutaneous emphysema. Subcutaneous emphysema occurs when air enters the dermal spaces (under and inside the skin). This is most likely related to an incorrectly positioned tracheostomy tube.

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. keep the tracheostomy tube cuff inflated B. mechanical ventilatory support C. provide heated humidity D. provide cool aerosol therapy

The correct answer is : C Explanation : A patient who has a tracheostomy tube in place is unable to naturally humidify inspired gases because the natural humidification processes of the body, including the nasal passages and oropharynx, are bypassed. In this case, providing heated humidity, which can make up the entire humidity deficit, is paramount.

A patient intubated with a 7.0 mm endotracheal tube requires suctioning. Which of the following suction catheters would be most effective? A. 16 Fr coude-tipped catheter B. 18 Fr catheter C. 10 Fr catheter D. 14 Fr catheter

The correct answer is : C Explanation : A patient with a 7.0 mm endotracheal tube must not be suctioned with a catheter that has an outer diameter greater than 3.5 mm, or one half of the endotracheal tube size. Suction catheters, however, come in French units. To convert from millimeters to French units simply multiply by three. 3.5 mm X 3 = 10.5 Fr. suction catheters come in sizes 8, 10, 12, 14 French. Thus, the most appropriate size in this case is 10 French.

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 superior vena cava B. over the right ventricle C. in the pulmonary artery D. mid-lung space over the right lung field

The correct answer is : C Explanation : A pulmonary artery catheter is properly placed when the tip is found in the pulmonary artery.

For a patient who is receiving mechanical ventilation, which of the following would cause the most rise in arterial carbon dioxide? A. addition of tubing to the inspiratory side of the circuit B. addition of an MDI interface C. addition of a heat-moisture exchanger (HME) and tubing D. addition of tubing to the expiratory side of the circuit

The correct answer is : C Explanation : Any addition of dead space between the patient and the wye of a ventilator circuit will increase arterial carbon dioxide. Adding tubing to the inspiratory or expiratory side of the circuit will have no effect. An MDI interface is usually located on the inspiratory side of the circuit and will therefore have no affect. An HME device, when added, acts as dead space and will raise arterial carbon dioxide by 1 - 2 mmHg.

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 7.51 PaCO2 29 torr PaO2 254 torr HCO3- 25 mEq/L BE +1 mEq/L The respiratory therapist should recommend A. Decrease PEEP B. Decrease mandatory rate C. Decrease FIO2 D. Sedate the patient

The correct answer is : C Explanation : Arterial blood gas results show hyperventilation and hyperoxygenation. Of these two problems, hyperoxygenation should be corrected first. To do this, one may either lower PEEP or decrease FIO2. Because the oxygen percentage is greater than 60%. FIO2 should be decreased first.

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. Placing head of bed down only 15 degrees B. Provide percussion with the head of bed up in semi-fowlers position C. Administering therapy with an external percussive device (Vest) D. Provide percussion with the bed flat

The correct answer is : C Explanation : Because this patient is having difficulty tolerating the head of bed and down during postural drainage and percussion, the therapy should be modified. When modifying therapy, one must be careful not to dysfunctionalize the therapy. For example, simply raising the head of bed and continuing therapy would not be appropriate because the head of bed must be down 30° to drain the basal segments. Rather, a more appropriate modification of therapy would be to use an alternate therapy that accomplishes the same objective. In this case, using an external percussive device, such as Vest therapy, is most appropriate.

Which of the following may be related to a fluid balance problem in a patient? A. Pleurisy B. Pulmonary tuberculosis C. Congestive heart failure (CHF) D. Elevated CVP

The correct answer is : C Explanation : Congestive heart failure (CHF) often results in fluid-shifting in the body, somtimes known as third-spacing. Pitting edema and orthopnea are also associated with CHF.

Heated humidification would be most important for a patient using A. a Venturi mask set at FIO2 0.5 B. a 6 L/min nasal cannula C. an endotracheal tube D. a face tent with an air entrainment device set at 50%

The correct answer is : C Explanation : Heated humidification is most helpful to patients who cannot receive humidification by natural means. This occurs when an artificial airway is in place and the natural humidification processes of the body are bypassed. An endotracheal tube is an example of such an airway.

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. E cylinder B. H cylinder C. oxygen concentrator D. bulk liquid oxygen conversion system

The correct answer is : C Explanation : Patients who are in need of low-flow oxygen at home (between 1-6 L/min) are best served by using an oxygen concentrator. This is also called a molecular seive device.

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. Decrease the I:E ratio C. Use pressure-controlled ventilation D. Administer surfactant

The correct answer is : C Explanation : Patients with ARDS have markedly decreased pulmonary compliance and therefore excessive peak airway pressures. One appropriate way of improving gas exchange for patients who have excessive peak airway pressures as a result of poor pulmonary compliance is to switch from assist control mode to pressure-control ventilation mode.

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. decrease suction pressure to 100 mmHg B. administer prednisone, IV C. administer 2.0 cc of 10% Mucomyst (Acetylcysteine) D. administer Atropine sulfate by aerosol

The correct answer is : C Explanation : Patients with bronchiectasis are noted as having thick, tenacious secretions. They are in constant need of assistance to thin and mobilize their secretions. Mucomyst, also called acetylcysteine, is one agent that can accomplish this.

A physician suspects a patient has a pleural effusion. Which of the following radiography procedures is helpful in diagnosing the problem? A. AP chest radiograph B. apical lordotic radiograph C. lateral decubitus radiograph D. PA chest radiograph

The correct answer is : C Explanation : Pleural effusion is diagnosed through direct observation of a chest radiograph, specifically, the lateral decubitus x-ray.

A during a routine visit to a patient's home, a home care therapist notes unsanitary conditions including the presence of cockroaches, moldy shower door and spoiled food on the kitchen counter. Which of the following clinical findings is most likely? A. malnourishment B. sarcoidosis C. recurring infections D. polycythemia

The correct answer is : C Explanation : Poor, unsanitary living conditions will increase the likelihood of infections.

After performing bedside pulmonary function testing with a computer and spirometer, the respiratory therapist examines the results and compares them to some predicted values for the patient. When doing so the therapist is comparing the patient results to A. statistical averages based on other tests in the computer B. baseline values for this patient C. a national database D. other patients with the same diagnosis

The correct answer is : C Explanation : Predicted values for a patient comes from the evaluation of patients across the nation and is a statistical derivative of that data.

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 aerosolized alcohol B. administer Albuterol sulfate C. diurese the patient D. administer lactated ringers, IV

The correct answer is : C Explanation : Pulmonary edema and crepitant breath sounds, in conjunction with pitting peripheral edema, is a direct indication for diuresis. These clinical data indicate fluid overload.

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

The correct answer is : C Explanation : Suctioning can cause bradycardia as well as hypotension. This natural physiological response of the body is associated with stimulation of the vagal nerve during suctioning. This is also known as the vagal reflex.

How many minutes will a full E cylinder oxygen tank last when running at 5 L/min? A. 90 minutes B. 1320 minutes C. 123 minutes D. 616 minutes

The correct answer is : C Explanation : The E cylinder tank factor is 0.28. A full E cylinder is 2200 PSI. 2200x0.28 is equal to 616 L. 616 divided by 5 (the liter flow to the patient) is equal to approximately 123 min. That is how long the tank will last in minutes. To get hours, you must further divide by 60 minutes.

A 28-week gestational age infant is requiring high ventilatory pressures on the ventilator. Transillumination shows a halo-effect bilaterally. A recent chest radiogram shows a honeycomb pattern. Which of the following mostly likely represents the patient's condition? A. Diaphragmatic hernia B. Patent ductus arteriosis C. IRDS D. Transposition of the great vessels

The correct answer is : C Explanation : The honeycomb pattern seen on an infant's chest x-ray, in addition to the fact that the infant is premature, is an indication of underdeveloped lungs. The term for this condition is called infant respiratory distress syndrome or IRDS. Transillumination that shows a halo effect bilaterally is an indication that a pneumothorax is not present.

The respiratory therapist notes a biological tape indicator inside an equipment sterilization package indicates the presence of viable spores. The therapist should A. open the package and inspect the mask prior to use B. discard the mask C. send the mask back to sterilization D. wipe the mask down with disinfectant before use

The correct answer is : C Explanation : The presence of viable spores indicates the potential for living microorganisms inside the package. If the package was sterilized correctly there should be no viable spores. Their presence indicates a need to re-sterilize the equipment.

A 40-year-old female presents in the emergency room after being rescued from a building fire where she was found unconscious. Which of the following assessments would be most helpful in the evaluation of the patient? A. single-wavelength pulse oximetery B. beside pulmonary function testing C. hemoximetry D. measurement of PaO2

The correct answer is : C Explanation : The primary concern for a patient who has had significant exposure to smoke is smoke inhalation and carbon monoxide poisoning. Of the options offered, hemoximetry will be most helpful. Pulse oximetry and measurement of PaO2 will only assess oxygenation and pulmonary function testing is not helpful.

A patient who weighs 70 kg (154 lb) is receiving volume-controlled ventilation at the following settings: Mode SIMV Mandatory rate 10 Total rate 28 Set tidal volume 500 mL Spontaneous VT 520 mL FIO2 0.45 PEEP 5 cm H2O Which of the following can be done to decrease the work of breathing? A. increase PEEP to 10 cm H2O B. decrease tidal volume to 400 cc C. increase mandatory rate to 14 D. increase tidal volume to 700 cc

The correct answer is : C Explanation : This patient is breathing 20 breaths per minute over the set rate, which is an indication that the ventilatory demands of the patient are not being met by the ventilator. An increase in mandatory rate is appropriate.

The following arterial blood gas results are recorded for a patient during cardiopulmonary resuscitation: pH 7.14 PaCO2 47 torr PaO2 180 torr HCO3- 14 mEq/L BE -10 mEq/L FIO2 1.0 The respiratory therapist should recommend A. increase manual ventilation rate B. decrease manual ventilation rate C. sodium bicarbonate administration D. administer Verapamil

The correct answer is : C Explanation : This patient shows acidosis as manifested by the pH but has a nearly normal CO2. A further examination of the HCO3 shows that the source of the acidosis is metabolic. Administration of sodium bicarbonate (HCO3-) is appropriate.

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. daily COHb analysis B. daily completion of an asthma action plan C. Nicotine replacement therapy D. removing pulmonary irritants from the house

The correct answer is : C Explanation : To stop smoking, both physiological and emotional barriers must be addressed. The patient may be helped best through nicotine replacement therapy and emotional support. Routine monitoring of the patient's progress is also helpful. Removing irritants from the house will not help the patient stop smoking.

Which of the following is the least important to consider when drawing an arterial blood sample? A. needle size B. patient temperature C. supplemental oxygen delivery mode D. FIO2

The correct answer is : C Explanation : Using the properly sized needle, correcting for patient temperature, and recording an accurate FIO2 are three factors that a respiratory therapist must apply for each arterial blood gas sample. The mode of oxygen delivery is not significant for the proper interpretation of the arterial blood gas.

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. advance the ET tube and auscultate the chest B. withdraw the ET tube by 2 cm, observe chest rise C. recommend a chest radiograph D. remove the ET tube and attempt nasal intubation

The correct answer is : C Explanation : Vesicular breath sounds are normal. This indicates the endotracheal tube is likely in the proper position. However, after quickly determining the position of the endotracheal tube, a chest radiograph is required to confirm position of the tube.

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. leak in the aerosol tubing B. clogged down tube in the nebulizer C. kinked aerosol tubing D. depleted reservoir

The correct answer is : C Explanation : When administering oxygen by any device that has a venturi mechanism, back-pressure on the venturi will slow the speed of gas, decrease room air entrainment, and result in an increase in FIO2. Of the options offered, only excess water in the tubing and a kink in the aerosol tubing would cause this type of back pressure.

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. Acute epiglottitis B. Meningitis C. Bacterial infection D. Laryngotracheobronchitis (croup)

The correct answer is : D Explanation : A low-grade fever and a loud, barky cough is associated with Laryngotracheobronchitis (croup).

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. Suction the HME device to remove secretions B. Replace the HME device with a new one C. Clean the HME by soaking it in normal saline followed by a rinse D. Replace the HME with a heated humidifier

The correct answer is : D Explanation : A patient with thick or significant sputum should not receive humidification by heat moisture exchanger. This device is incapable of providing adequate humidity to thin secretions and should only be used in temporary situations and with patients who have no problem with secretions. In this case, the presence of thick secretions is a clear indicator for heated humidification.

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. asthma B. vocal cord paralysis C. bronchoconstriction D. bronchial carcinoma

The correct answer is : D Explanation : A unilateral wheeze is either associated with foreign body aspiration or a mass in the bronchial tree. If the problem is a foreign body, recent history shows that the problem started when they were eating or playing with small toys (if the patient is a child).. In this case, the finding is documented in the patient's medical record and therefore is not likely an acute problem but a chronic issue. Of the options offered, bronchial carcinoma would be the most likely. Bronchoconstriction is most always bilateral and therefore is not the answer. Vocal cord paralysis is identified by observing a flow volume loop and noting a round shape.

A respiratory therapy department supervisor is seeking ideas for quality improvement in patient care. Which of the following would be appropriate? A. number of treatments given per therapist B. study of acuity index C. department staffing efficiency D. effectiveness of an oxygen titration protocol

The correct answer is : D Explanation : In terms of proving quality in a department, efforts should be focused on improving the quality of patient care. Looking at staffing efficiency or the complexity of the case mix index does not directly affect patient care. However, checking missed therapy and the effectiveness of an oxygen titration protocol is directly related to the quality of patient care and are therefore appropriate as quality improvement efforts.

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. tachycardia is more likely C. an alpha I response is increased D. Placement of the nebulizer can result in variation of medication delivery

The correct answer is : D Explanation : Administering aerosolized bronchodilators through a mechanical ventilator circuit requires careful judgment by the respiratory therapist. Several factors including all listed in this scenario limit the therapist's ability to properly deliver medication. These factors must be taken into consideration for all mechanically ventilated patients, including pediatric patients.

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

The correct answer is : D Explanation : Although COPD patients must not receive more than 28% oxygen by Venturi mask or more than 2 L/min by nasal cannula when they are normal, an emergency situation is cause to ignore these guidelines and administer 100% oxygen to the patient. Ventricular tachycardia is one such emergency.

The low ventilator alarm is sounding on a 28-year-old patient with myasthenia gravis. The respiratory therapist notes the oral endotracheal tube cuff is failing to hold pressure. The ET tube is positioned at 22 cm at the teeth. The therapist should next A. decrease the low tidal volume alarm B. increase the tidal volume C. send to surgery for placement of a tracheostomy D. replace the endotracheal tube

The correct answer is : D Explanation : An endotracheal tube whose cuff is failing to retain air is considered defective and should be replaced.

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. Large volume nebulizer C. Cascade humidifier D. Heat moisture exchanger (HME)

The correct answer is : D Explanation : And HME device is intended for short-term use. Patients who are ventilator-dependent during the night may use this device.

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. patient's inability to count backwards C. dilated pupils D. muscle twitching about the face and neck

The correct answer is : D Explanation : Anectine (succinylcholine chloride) is used to paralyze a patient during an oral intubation procedure. It is considered the best paralytic medication to be used for this purpose because it has the shortest half-life of most other paralytic medications. Once delivered, the intubation procedure may be initiated when muscle twitching about the face and neck is observed. This physical manifestation indicates the patient is adequately paralyzed.

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. increase both IPAP and EPAP by 2 cmH2O B. increase IPAP to 22 cmH2O C. increase EPAP to 12 cmH2O D. decrease EPAP to 8 cmH2O

The correct answer is : D Explanation : Blood gases reveal hypoventilation and over oxygenation. We can correct both of these problems with one change in the BiPAP settings. Because ventilation is determined by the distance between the IPAP and EPAP settings, we can simply lower EPAP. A decrease in expiratory positive airway pressure will decrease oxygenation but also increase ventilation because the distance between inspiratory pressure and expiratory pressure is increased.

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. Membrane integrity of the Sanz electrode B. Membrane integrity of the Severinghaus electrode C. Fluid level of the reference electrode D. Function of the Clark electrode

The correct answer is : D Explanation : Close examination of these blood gas results shows a PaO2 of 210 mmHg. This would be an impossible result for a patient who is breathing room air, or 21% oxygen. Estimation of the alveolar oxygen tension proves this. The maximum oxygen tension that could be found in the alveoli is around 100 mmHg. The arterial oxygen tension can not exceed alveolar oxygen tension. This would suggest a malfunctioning of the oxygen electrode in the blood gas machine. This electrode is sometimes called the Clark electrode.

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 oxygen flow meter is not compensated for back pressure B. The helium expands once delivered into the ambient pressure environment C. The heliox mixture has greater viscosity D. Helium is less dense and therefore reads a lower flow by an oxygen flow meter

The correct answer is : D Explanation : Helium is less dense than oxygen, which results in an erroneous reading when it is running through an oxygen-calibrated flow meter. In other words, the actual total flow of helium-oxygen mixture flowing through the flow meter is higher than is indicated on the flow meter.

Which of the following methods should the respiratory therapist recommend for a patient receiving mechanical ventilation who requires chest physiotherapy? A. pressure control ventilation B. huff coughing C. autogenic drainage D. high-frequency chest wall compression

The correct answer is : D Explanation : High-frequency chest wall compression, also called oscillation or VEST therapy, is a suitable airway clearance method in place of chest percussion for a patient who is on a ventilator.

The respiratory therapist notes the following results of an arterial blood gas with a patient breathing air: pH 7.42 PaCO2 38 torr PaO2 124 torr HCO3- 24 mEq/L BE 0 mEq/L Which of the following could explain the reason for these results? A. blood has coagulated B. hyperventilation C. normal V/Q matching D. air bubbles in the sample

The correct answer is : D Explanation : It is impossible for a patient breathing room air to have a PaO2 this high. Calculation of the alveolar air equation shows that the maximum possible oxygen tension in the alveoli is approximately 97 mmHg. A PaO2 very much higher than this is not possible on room air. Circumstances that could lead to this error include too much heparin in the syringe or the presence of bubbles in the arterial sample.

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

The correct answer is : D Explanation : Of the options offered, only the nicotine patch will be helpful for a patient who is trying to stop smoking. Other medications listed here relate to the heart or long-term bronchodilation.

Which of the following calculations can be used to determine FRC? A. VC - RV B. TLC - ERV - RV C. RV + ERV + VT D. TLC - IRV - VT

The correct answer is : D Explanation : One must be familiar with all of the components of total lung capacity in order to answer this question. This kind of question can be time consuming because the calculation possibilities are limitless. To answer this type of question, one must simply calculate each answer until the correct calculation is found. In this case, FRC can be determined by subtracting inspiratory reserve volume (IRV) and tidal volume (VT) from total lung capacity (TLC). It is a good idea to memorize the chart of components that make up total lung capacity.

A negative effect of mechanical PEEP is reduced A. FIO2 B. A-aDO2 C. atelectasis D. venous return

The correct answer is : D Explanation : PEEP results in greater intrathoracic pressure. It causes difficulty for the cardiovascular system to function properly. Our natural negative pressure ventilation is thought to aid in venous return. Positive pressure would have the opposite effect, making it more difficult for blood to return to the right atrium.

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. interview the patient for family medical history of drug abuse B. sedate the patient with Ativan C. perform pulmonary function testing D. begin following the ventilator weaning protocol

The correct answer is : D Explanation : Patients receiving mechanical ventilatory support, who have no pulmonary problems, should be weaned or removed from mechanical ventilatory support as soon as their underlying problem is resolved. In this case, the barbiturate overdose has likely run its course. It is appropriate to determine if the patient is ready to come off the ventilator by beginning a ventilator weaning protocol.

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

The correct answer is : D Explanation : Pulse oximetry may be affected by the ambient light level, the presence of fingernail polish, and blood pressure.

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. Trendelenburg - 15 degrees B. Trendenlenburg - 30 degrees C. Prone position D. Supine position

The correct answer is : D Explanation : Secretions in the upper lobes in the anterior segments of the lungs can best be drained by placing the patient in supine position.

Which of the following data represents subjective information? A. cyanosis in the lips B. scattered infiltrates on a chest radiography C. decreased tidal volume D. dyspnea

The correct answer is : D Explanation : Subjective information is that clinical data that can be only reported by the patient - it cannot be independently observed by the caregiver. Of the options listed, dyspnea is in this category

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. excess secretions in the ET tube B. ET tube cuff herniation C. pneumothorax D. partial extubation

The correct answer is : D Explanation : The apparent increase in dynamic compliance (the bag is easier than normal to squeeze) indicates the patient may be partially extubated.

The following pulmonary function graphic is available. The data is reproducible. Based on this data, the respiratory therapist will recommend A. repeat the test due to poor patient effort B. administer a bronchodilator C. perform a transesophageal echo (TE) D. obtain CT scan of the upper airway

The correct answer is : D Explanation : The flow volume loop is round in shape. This is consistent with a fixed upper airway obstruction. This type of loop is commonly caused from a cancerous mass in the upper airway. A CT scan of the upper airway will provide more detail.

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. Increase the size of the fixed orifice resistor B. Suction the patient C. Adjust the threshold resistor D. Increase the flowrate

The correct answer is : D Explanation : The patient is demonstrating signs of air hunger and is not in sync with the ventilator. Most likely the patient requires more flow to satisfy inspiratory demand.

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. excess condensate in the circuit B. secretions in the airway C. loose circuit connection D. bubbling in the water seal chamber

The correct answer is : D Explanation : The presence of a low-return-volume alarm for a patient who also has a chest tube drainage system in place, is an indication that volume may be being lost to a perforation in the lung tissue and out through the chest tube drainage system. If this is happening, excessive bubbling in the water seal chamber may be observed. Consequently, to determine the source of the problem examining the ventilator circuit connections and looking for excessive bubbling in the water seal compartment are two methods that will help find the source of the problem.

A patient is in the cardiac intensive care unit. Hemodynamic monitoring has been instituted with a Swan-Ganz catheter. From where should the respiratory therapist obtain a measurement of central venous pressure (CVP)? A. jugular vein B. distal lumen of the PA catheter C. subclavian vein D. proximal lumen of the PA catheter

The correct answer is : D Explanation : The proximal lumen of a pulmonary artery catheter is situated inside or right before the right atrium. The value measured here is called CVP.

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. accept the results and place the ventilator into service B. tag the ventilator as non-functional and isolate it from functional equipment C. notify the medical director and seek advice D. check for a leak in the circuit or the circuit's connections

The correct answer is : D Explanation : The purpose of a preoperational test on a ventilator is to ensure proper connections and assembly of those necessary parts. The reduced return tidal volume observed would most logically be caused by a failure to make a good connection between the ventilator circuit in the ventilator.

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. TLC B. FRC C. VC D. ERV

The correct answer is : D Explanation : The volume being observed when a patient exhales maximally after passively excelling normal tidal volume is called expiratory reserve volume or ERV.

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. Dysfunctional membrane on the Sanz electrode B. Oxygen toxicity C. Damaged Severinghaus electrode D. Improperly functioning Clark electrode

The correct answer is : D Explanation : This blood gas shows a PaO2 of 279 mmHg. However, the patient is only on 40% oxygen. When one calculates the alveolar area equation the maximum oxygen tension found in the alveoli is about 230 mmHg. Therefore, a PaO2 of 374 mmHg is impossible and suggests the analyzer is in error. The error would be related to the PO2 electrode, which is also called the Clark electrode.

Which of the following should the respiratory therapist evaluate to determine if the patient's perfusion is adequate? A. pulse oximetery B. arterial blood gas analysis C. blood urea nitrogen level (BUN) D. urine output

The correct answer is : D Explanation : Urine output is the most significant indicator of perfusion and is therefore the best assessment of perfusion adequacy.

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. vocal cord paralysis B. unilateral wheezing C. inability to vocalize D. stridor

The correct answer is : D Explanation : When a patient inadvertently or purposely removes an endotracheal tube, it is not likely they have evacuated the cuff prior to withdrawl. Consequently, they may have caused inflammation to the vocal folds or upper airway tissues during the removal. If inflammation ispresent, it will likely be manifested by stridor.

When considering appropriate staffing levels and proper care of patients, a respiratory therapy supervisor would include which of the following A. frequency of declined therapy B. previously missed therapy C. staff member preference D. Individual skills of staff members

The correct answer is : D Explanation : When planning appropriate staffing levels for patient care, frequency of therapy, type of therapy ordered, and the individual skills of the staff are all important considerations. Department budgetary goals should not affect staffing.

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. document the pressure by arterial line B. replace the art line C. replace the blood pressure cuff D. document the pressure taken by cuff

The correct answer is : D Explanation : When there is a difference in a blood pressure reading from a sphygmomanometer (cuff), and an arterial line, the blood pressure coming from the cuff should be reported. This is because the blood pressure from an arterial line is more apt to be incorrect.