Questions to Work On/ Remember

In preparation for a helium dilution study, a respiratory therapist is calibrating the helium analyzer. While exposing the analyzer to ambient room air, what will the analyzer read for helium concentration?

0% To calibrate a helium analyzer, sometimes called a Wheatstone Bridge, the device must be calibrated to room air for the low calibration and to a known level of helium for the high calibration. Because room air has no significant level of helium, helium analyzers should read 0% when exposed to ambient room air conditions.

The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered?

0.50 mL

A patient is on CPAP at 10 cmH2O and 0.30 FIO2 with the heated humidifier set at 40° C. As the gas is delivered to the patient through large bore tubing, which of the following will occur? 1. Excess water will rain out 2. Humidity deficit will occur 3. Relative humidity will decrease 4. Relative humidity will remain 100%

1. Excess water will rain out 4. Relative humidity will remain 100%

Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? 1. FEV1 2. PEFR 3. FRC 4. RV

1. FEV1 2. PEFR

A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation? 1. Increase the pressure limit 2. Increase the sensitivity 3. Increase the mandatory rate 4. Decrease the inspiratory time

1. Increase the pressure limit 3. Increase the mandatory rate

Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation? 1. Select a ventilator that uses demand valves rather than a reservoir IMV system. 2. Calculate oxygen cylinder duration of flow. 3. Selecting a ventilator that incorporates an internal air compressor.

1. Select a ventilator that uses demand valves rather than a reservoir IMV system. 2. Calculate oxygen cylinder duration of flow.

When selecting a suction catheter to be used in an oral endotracheal tube, the respiratory therapist should select a catheter whose diameter should not exceed what fraction of the internal diameter of the endotracheal tube?

1/2 The outer diameter of a suction catheter should not exceed one half of the inner diameter of an endotracheal tube.

Sleep apnea can be defined as repeated episodes of complete cessation of airflow for

10 seconds or longer.

During chart review prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm3. Based on this finding, what should the therapist do? 1. Perform ABG as normal. 2. Refuse to perform the ABG. 3. Hold pressure on the puncture site for a longer time after sample is collected. 4. Recommend that an ABG should be performed on the patient only if absolutely necessary.

2. Refuse to perform the ABG. 4. Recommend that an ABG should be performed on the patient only if absolutely necessary.

A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PvO2 46 torr PCWP 19 mm Hg PAP (mean) 10 mm Hg CVP 12 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend 1. IV fluid challenge 2. positive inotropic agent 3. inhaled nitric oxide 4. diuretic therapy

2. positive inotropic agent 4. diuretic therapy

What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea?

5 to 15

A 55 year-old post cardiac surgery patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.

5.0 vol%

A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance?

50 mL/cm H2O

A patient on the general medical ward is on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient?

55 L/min

A healthy adult female can exhale what portion of her forced vital capacity in the first second?

70%

The respiratory therapist is assisting in the elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST? A. Check the inlet valve. B. Check the patient valve. C. Replace the manual resuscitation bag. D. Check for excessive oxygen flow.

A. Check the inlet valve.

A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? A. Enough to achieve a pressure of 25-35 cmH2O. B. Enough to achieve a minimal occluding volume. C. A minimum of 20 mL. D. Until firm tension is felt in the pilot balloon.

A. Enough to achieve a pressure of 25-35 cmH2O.

Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? A. Increased fremitus B. Decreased intensity of breath sounds C. Diminished diaphragmatic excursion D. Hyperresonance to percussion

A. Increased fremitus

While administering 3.5 mg of albuterol to a patient with asthma in the ICU, the respiratory therapist notes that the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment for this patient? A. Reduce the dose of albuterol. B. Discontinue the treatment. C. Change to 3 puffs of beclomethasone dipropionate (Vanceril®). D. Change to 0.63 mg of levalbuterol (Xopenex®).

A. Reduce the dose of albuterol.

While reviewing quality control data for the blood gas lab, the respiratory therapist notes the following data plot for the pH electrode: random error A. Repeat the previous control analysis B. Remove the analyzer from service C. Reset the analyzation module on the analyzer D. Recalibrate the pH electrode

A. Repeat the previous control analysis

A sudden decrease in end-tidal CO2 occurs in a mechanically ventilated patient. A repeat analysis yields the same results. Which of the following situations might have accounted for these readings? A. The ventilator circuit has become disconnected. B. There is a leak around the endotracheal tube. C. There is an increase in alveolar dead space. D. The carbon dioxide absorber is exhausted.

A. The ventilator circuit has become disconnected.

A post-operative patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as A. a persistent bronchopleural fistula. B. a resolved pneumothorax. C. back-pressure from the suction chamber. D. normal function of the water seal chamber.

A. a persistent bronchopleural fistula.

A patient admitted to the ED is noted to have pulse and blood pressure variations with respirations. This is most indicative of A. cardiac tamponade. B. severe pneumonia. C. congestive heart failure. D. large pleural effusion.

A. cardiac tamponade.

The most serious complication associated with airway suctioning is A. hypoxemia. B. bradycardia. C. mucosal trauma. D. gag reflex stimulation.

A. hypoxemia.

In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a A. rotameter. B. 3.0 L syringe. C. Wright respirometer. D. pneumotachometer.

B. 3.0 L syringe.

The respiratory therapist obtains a SpO2 reading of 90% on a patient receiving oxygen therapy via 50% venti-mask. This would indicate a PO2 value of approximately A. 55 torr B. 60 torr C. 65 torr D. 70 torr

B. 60 torr

A patient receiving high frequency oscillation ventilation (HFOV) has demonstrated excess CO2 retention on a recent arterial blood gas. Which of the following could be adjusted to correct this situation? A. Mean airway pressure B. Amplitude (∆P) C. Inspiratory time D. Oxygen concentration

B. Amplitude (∆P)

A post-operative patient is receiving mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 mm Hg and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? A. Decrease the PEEP. B. Increase the FIO2. C. Initiation diuretic therapy. D. Continue to monitor closely.

B. Increase the FIO2.

A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? A. Initiate bronchial hygiene therapy. B. Obtain a sputum gram stain. C. Administer IPV. D. Insert a CASS tube.

B. Obtain a sputum gram stain.

A 68 year-old patient with advanced emphysema is receiving oxygen by nasal cannula at 1 L/min. The physician has ordered that the patient's SpO2 be maintained at 90%. ABG on 1 L/min are pH 7.34, PaCO2 65 torr, PaO2 55 torr, HCO3 35 mEq/L. What should the respiratory therapist recommend FIRST? A. Initiate NIPPV B. Titrate oxygen flow to the nasal cannula C. Change to a simple mask D. Change to a non-rebreather mask

B. Titrate oxygen flow to the nasal cannula

Which of the following values should the respiratory therapist report as indicative of pulmonary embolism in a patient with acute dyspnea? A. QS/QT of 10% B. VD/VT of 60% C. CL of 60 mL/cm H2O D. RAW of 2.4 cm H2O/L/sec

B. VD/VT of 60% normal is 20-40%

Adverse effects of inhaled NO include all of the following EXCEPT A. methemoglobinemia. B. aplastic anemia. C. rebound pulmonary hypertension. D. nitrogen dioxide toxicity.

B. aplastic anemia.

A 59 year-old post CABG patient has a C(a-v)O2 that has increased from 5 mL/dL to 8 mL/dL. The respiratory therapist should report to the physician that the patient's A. hemoglobin is increasing. B. cardiac output is decreasing. C. VD/VT ratio has increased. D. oxygen consumption has decreased.

B. cardiac output is decreasing. if C(a-v)O2 increases, CO decreases

An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a nonrebreathing mask with an oxygen flowmeter set at 10 L/min. What is the actual flow being delivered to the mask? A. 10 L/min B. 13 L/min C. 16 L/min D. 18 L/min

C. 16 L/min

A trauma patient in the ED is spontaneously breathing oxygen via nasal cannula at 2 L/min. Vital signs are heart rate 110/min, respiratory rate 32/min, blood pressure 90/60 mmHg. The pulse oximeter is reading 88%. Which of the following should the respiratory therapist recommend to maximize the patient's FIO2? A. Simple oxygen mask at 8 L/min B. Non-rebreathing mask at 15 L/min C. CPAP at 10 cmH2O and 0.60 FIO2 D. NPPV of 18/5 cmH2O and 0.60 FIO2

C. CPAP at 10 cmH2O and 0.60 FIO2

A patient who has significant decreases in airflow during sleep but does not have a complete cessation of breathing is having what type of episodes? A. Obstructive sleep apnea B. Dyspnea A. Obstructive sleep apnea B. Dyspnea C. Hypopnea D. Central sleep apnea D. Central sleep apnea

C. Hypopnea

The physician asks the respiratory therapist to set a mechanically ventilated patient's PEEP at an optimal level. The PEEP level is optimal when A. PEEP levels are less than 18 cm H2O. B. PaO2 is 60 torr or greater. C. Oxygen delivery to the tissues is maximal. D. C(a-v)O2 is decreasing.

C. Oxygen delivery to the tissues is maximal.

The respiratory therapist notices the low pressure alarm sounding from the ventilator for the patient in ICU Bed 1. As the therapist enters the room, she notes that during inspiration, the pressure manometer reads 6 cm H2O. The therapist's first action should be to A. look for a kink in the circuit. B. change modes of ventilation. C. check the exhalation valve. D. suction the patient.

C. check the exhalation valve.

What is the most appropriate position for a female patient who is 5'3" tall, weighs 200 kg and is complaining of difficulty breathing? A. Sims B. Trendelenburg C. lateral Fowlers D. Fowlers

C. lateral Fowlers

A patient is receiving oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80, HCO3 38 mEq/L. The most likely explanation for these results is that A. the sample was not iced properly. B. there was excess heparin in the syringe. C. the numbers were not reported correctly. D. The sample contains venous blood.

C. the numbers were not reported correctly.

A respiratory therapist is calibrating a thermal conductivity helium analyzer. What should the analyzer read when exposed to room air? A. 100% B. 79% C. 21% D. 0%

D. 0%

The respiratory therapist is preparing to administer inhaled nitric oxide to a neonate with respiratory distress syndrome. The most appropriate initial dose of iNO for this patient is A. 5 ppm. B. 10 ppm. C. 15 ppm. D. 20 ppm.

D. 20 ppm.

A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the RT recommend? A. Helium dilution study B. DLCO C. Plethysmography D. Bronchial provocation

D. Bronchial provocation Performing a bronchial provocation test (BPT) using a direct or indirect stimulus to identify bronchial hyper-responsiveness (BHR) reduces the possibility of over and under-diagnosis of asthma based on history and symptoms. This review discusses some long-held beliefs of BPTs to include or exclude a diagnosis of asthma or exercise-induced bronchoconstriction (EIB)

Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions? A. Post-traumatic chest trauma B. Community-acquired pneumonia C. Spinal cord injury D. Chronic bronchitis

D. Chronic bronchitis

The patient in ICU Bed 6 is noted to have a meniscus in the left chest with a blunted left costophrenic angle on the morning chest radiograph. On physical exam, the respiratory therapist finds that the breath sounds are decreased on the left with a dull percussion note. What treatment should the therapist recommend? A. Insertion of an anterior chest tube. B. Bronchoalveolar lavage. C. Needle aspiration of the 4th left intercostal space. D. Perform a left posterior thoracentesis.

D. Perform a left posterior thoracentesis.

Which of the following should the respiratory therapist utilize in order to determine the severity of respiratory distress in a newborn? A. Transillumination B. APGAR score C. Ballard score D. Silverman score

D. Silverman score

The sharp rise in exhaled CO2 at the beginning of exhalation on a capnographic tracing is representative of A. tidal volume. B. pulmonary shunt. C. V/Q mismatch. D. alveolar gas that has participated in gas exchange.

D. alveolar gas that has participated in gas exchange.

While making oxygen rounds, the respiratory therapist hears a high-pitched sound coming from a bubble humidifier. The patient is receiving oxygen by air-entrainment mask at 28% and the oxygen flowmeter is set at 12 L/min. The therapist should A. replace the cracked humidifier. B. increase the FIO2 on the air-entrainment mask. C. increase the flow from the flowmeter. D. eliminate the bubble humidifier.

D. eliminate the bubble humidifier.

A 72 year-old female post stem cell transplant patient in the ICU is complaining of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B-type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition? A. severe heart failure B. respiratory distress syndrome C. severe renal failure D. moderate heart failure

D. moderate heart failure

All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT A. carbon monoxide poisoning. B. decompression sickness. C. anaerobic infections. D. pulmonary hypertension.

D. pulmonary hypertension.

What is needed to determine arterial oxygen content?

Hemoglobin level You must know what is required to calculate arterial oxygen content. If you look at the formula you'll realize you need to know arterial saturation, hemoglobin level, and PaO2 only. Venous saturation is not relevant, but would be relevant if we were calculating venous oxygen content.

Which of the following devices is needed to determine a patient's airway resistance?

body box There is a procedure involving panting where airway resistance can be determined. In order to do that procedure all conditions must be standardized, including temperature, pressure, and even humidity to some degree. Only a body box can provide this controlled environment

Placement of a pulmonary artery catheter is associated with which of the following most common complications?

cardiac arrhythmias Several complications may arise from the placement of a pulmonary artery catheter, otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the most common complication of the options offered. Another serious complication is perforation of a vessel or cardiac muscle during the insertion.

When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with a blender set at 50%, the respiratory therapist notes an oxygen concentration of 35% near the patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct the problem, the therapist should

change the nebulizer entrainment port to 100% When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen control on the nebulizer should be set to 100%. This will prevent additional entrainment of room air which will cause a decrease in FIO2

Which of the following laboratory examinations is most appropriate to further evaluate a patient with kidney failure and CHF?

creatinine When a patient has congestive heart failure, one of the concerns is fluid shifting in the body. This fluid shifting shows up in the form of pitting edema, among additional physical signs. Not only does this relate to cardiac condition, it has implications regarding the kidney. There are two examinations that are helpful in evaluating this condition. One is creatinine and the other is BUN, or blood urea nitrogen. Both are good tests but creatinine is considered more accurate than BUN.

A 32-gestational week newborn is receiving mechanical ventilation via a 3.0 mm endotracheal tube. Which of the following are associated with ongoing assessment of renal function?

diaper weight and blood draw volumes are recorded NPO (nothing by mouth) indicates that a newborn is not feeding in the usual manner. Intravenous fluids are vital and must be recorded for an intubated patient. Fluid output is measured by diaper weight and carefully recorded blood draws. Humidification of gas through the endotracheal tube must be maintained at an invasive temperature rather than a noninvasive because the nasal passages are bypassed.

A patient presents to the emergency room with fulminating pulmonary edema. Which of the following would be experienced with this emergency?

elevated left ventricular filling pressure with low QT Fulminating pulmonary edema is a serious condition often resulting from left-sided heart failure. Left ventricular filling pressure, a.k.a. pulmonary capillary wedge pressure (PCWP), would likely be elevated while cardiac output (QT) would drop. The back pressure or congestion would become relieved in the lungs, creating severe pulmonary congestion.

During the placement of a pulmonary artery catheter, the respiratory therapist observes the waveform on the monitor and notices it is repeatedly rising and falling from 0 mmHg to 25 mmHg, which is an indication that the tip of the catheter is in the right ventricle of the heart. Based on this information, the respiratory therapist will recommend

inflate the catheter balloon to sail the tip to the proper location 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

The respiratory therapist is providing patient education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will

retard bacterial growth.

A patient with a tracheostomy is receiving supplemental oxygen via tracheostomy collar connected to a large volume nebulizer set at 40%. The respiratory therapist analyzes the FIO2 at the tracheostomy collar with a galvanic fuel cell analyzer. The analysis shows the FIO2 to be 55%. Which of the following could be the cause of the increase in FIO2?

too much water in the circuit 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 would cause this type of back pressure.

A galvanic fuel cell oxygen analyzer may read erroneously high under which of the following conditions?

when a volume-controlled ventilator at high inspiratory pressures A galvanic fuel-cell oxygen analyzer may read erroneously when ambient pressures change significantly, such as when a patient is receiving high inspiratory pressure or when a patient changes altitude quickly.