TMC Exam C, FORM M, Lindsey Jones G, TMC I

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Which of the following could be used to determine the level of carbon monoxide poisoning for the purpose of definitive diagnosis and treatment?

Hemoximetry

a. withdraw the endotracheal tube by several centimeters

Immediately after oral intubation, the respiratory therapist notes the endotracheal tube marking are at 28 cm at the lips. Additionally, chest movement is asymmetrical. The first recommendation of the therapist should be to a. withdraw the endotracheal tube by several centimeters b. perform diagnostic chest percussion bilaterally c. obtain a chest radiogram d. advance the endotracheal tube until chest movement is symmetrical

b. myocardial ischemia and infarction

Immediately after performing a 12-lead ECG, the respiratory therapist notices "flipped" T waves and elevation of S-T segments. The therapist should conclude the patient is experiencing a. hypokalmeia and ischemia b. myocardial ischemia and infarction c. premature ventricular contractions d. hyperkalemia and infarction

c. suction the mouth

Immediately upon delivery of a 40-week gestational age infant, the respiratory therapist notices a straw color stain about the infant's face. Which of the following actions should the therapist take next? a. provide ventilation with a bag-valve mask b. clean the infant's face, then reassess c. suction the mouth d. obtain a one-minute APGAR score

While performing a routine check of a patient receiving mechanical ventilatory support, the respiratory therapist makes a small adjustment to the ET tube cuff pressure by injecting 2.0 cc of air into the cuff. Immediately after, the high-pressure alarm on the ventilator is activated. The therapist should

attempt to pass a suction catheter through the ET tube

A patient has a balloon-tipped, flow-directed catheter in place in the pulmonary artery. Which pressure can the respiratory therapist expect to obtain from the proximal lumen? A. CVP B. MAP C. PAP D. PCWP

The correct answer is : A 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.

Which of the following medications should the respiratory therapist recommend to provide a neurmuscular blockade and facilitate intubation? A. Xanax B. Pavulon C. Ativan D. Morphine

The correct answer is : B Explanation : The drugs most commonly used to provide a neurmuscular blockade (paralyze) to the patient and facilitate intubation are Anectine (succinylcholine), Pavulon (pancuronuim bromide), Curare (d-tubocurarine) and Vecuronium. The others listed here are merely anxiety controlling medication and will not provide paralysis.

A 12-year-old patient is in the clinic with difficulty breathing. Audible wheezing without a stethoscope is present. Which of the following would be helpful in further assessing the patient's current ventilatory status?

bedside peak flow measurement

An 18-year-old patient is brought to the emergency department (ED) after being found unconscious on a park bench. The patient remains unresponsive. An open bottle of opioid medication is found on his person. The therapist notices erratic, shallow breathing. Which of the following would be helpful in directly assessing the adequacy of the patient's ventilatory drive?

VT and RR

b. determine FRC

What is the primary purpose for a helium dilution test? a. quantify alveolar deadspace b. determine FRC c. directly measure TLC d. determine alveolar diffusion capacity

c. IC

Which of the following volumes is being observed when a patient is using a volume-type incentive spirometer? a. ERV b. TLC c. IC d. IRV

d. 20 mmHg

Which pressure should not be exceeded when adding air to an oral endotracheal tube cuff? a. 30 mmHg b. 15 mmHg c. 25 mmHg d. 20 mmHg

A respiratory therapist is calibrating a transcutaneous electrode and monitor prior to patient use on a newborn, premature infant. For a CO2 calibration, the respiratory therapist should

expose the electrode to the ambient environment.

The purpose of a holding chamber, used in conjunction with a metered dose inhaler, is to

facilitate delivery of optimally-sized particles

Which of the following would be most helpful in reducing the risk for nosocomial infection in a hospital?

handwashing with soap and water

A 52-year-old female with metastasized cervical cancer is admitted to the hospital for observation. Within 48 hours, cancerous processes caused a deterioration in the patient's ventilation, which necessitated the need for mechanical ventilatory support. Current data: Vent settings Mode VC, A/C FIO2 0.60 PEEP 5 cm H2O Rate 16/min VT 450 mL ABGs pH 7.41 PaCO2 39 torr PaO2 75 torr P(barometric) 726 mm Hg The respiratory therapist should conclude that the patient

has venous admixture.

A time-cycled, pressure-limited ventilator is failing to reach the set pressure with each breath while ventilating a newborn on the following settings: PIP 24 cm H2O PEEP 4 cm H2O (f) 35/min FIO2 0.30 The respiratory therapist should

increase the flow.

After increasing the mandatory rate on a volume-controlled ventilator, an alarm begins to sound. The respiratory therapist notices that the delivered tidal volume is only 412 mL. The respiratory therapist should most likey need to

increase the peak flow rate.

A patient is admitted for monitoring due to a positive result on a Tensilon Test (edrophonium). The patient is assessed every 6 hours. The following bedside data is recorded in the medical record: 12 hrs prior 6 hrs prior Current VC (L) 3.8 2.4 1.6 VT (L) 0.5 0.6 0. 5MIP (cm H2O) -42 -35 -32 The respiratory therapist should recommend

increasing frequency of assessment to every 2 hours.

A female patient has left-side pneumonia brought on by a gram-positive bacterial infection. How shall the patient be positioned to achieve maximum pulmonary drainage?

lying on her right side

A respiratory therapist is adjusting the ET tube cuff pressure on a patient receiving positive pressure ventilatory support. The therapist is using the minimum leak technique to adjust the volume in the cuff. After insertion of air into the cuff, the therapist auscultates the neck and notices a slight passage of air around the cuff at the top of each mechanical inspiration. The therapist should

maintain current cuff pressure.

After instructing a patient and demonstrating the proper use of a metered dose inhaler with a valved holding chamber, the patient performs the maneuver by placing the chamber in his mouth, actuating the cannister, and then exhaling prior to performing inhalation. The respiratory therapist should

re-instruct the patient to inhale immediately after actuation of the cannister.

Immediately after placing an indwelling arterial catheter, the respiratory therapist checks the blood pressure through the transducer and notices it varies widely with the blood pressure taken by arm cuff. Most likely, the therapist needs to

zero the transducer.

A respiratory therapy supervisor is responsible for making suggestions in the initial development of a smoking cessation program. Which of the following would be part of an effective smoking cessation program? A. Nicotine replacement therapy B. removing pulmonary irritants from the house C. daily COHb analysis D. daily completion of an asthma action plan

After assisting the repositioning of a tracheostomy patient, the respiratory therapist palpates a crackling sensation about the neck and clavicle area. The therapist should conclude the tracheostomy tube is A. incorrectly positioned B. in the trachea C. too small D. too large

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. a national database B. other patients with the same diagnosis C. statistical averages based on other tests in the computer D. baseline values for this patient

During the flow volume loop maneuver, the therapist notes a nearly round loop with virtually no inflection points. Which of the following may represent the patient's condition? A. laryngeal cancer B. obstructive pulmonary defect C. laryngotracheobronchitis D. restrictive pulmonary defect

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

In preparation for a patient who will be receiving oxygen at 3 L/min at home, the respiratory therapist should recommend which of the following devices for primary oxygen delivery? A. oxygen concentrator B. E cylinder C. H cylinder D. bulk liquid oxygen conversion system

In preparation for use of an oxygen concentrator in a patient's home, the respiratory therapist should evaluate which of the following environmental conditions? A. electrical load limits B. square footage of the home C. presence and function of CO detector in the home D. patient's ability to perform simple maintinence

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

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. replace the endotracheal tube B. send to surgery for placement of a tracheostomy C. decrease the low tidal volume alarm D. increase the tidal volume

To determine potential post-operative risk of a patient preparing for surgery, the respiratory therapist should recommend which of the following? A. measurement of inspiratory capacity B. pulmonary diffusion studies C. pulmonary stress test D. cardiac stress test

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

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

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

Which of the following would NOT be an indication for implementing mechanical ventilatory support? A. VT of 6 mL/kg B. impending ventilatory failure C. VC of 8 mL/kg D. acute ventilatory failure

d. obtain a chest radiograph

2pm --> 5 pm Peak airway pressure: 45 --> 56 static airway pressure: 35 --> 46 PEEP: 5 --> 5 delivered tidal volume: 750 --> 750 inspiratory flow: 55 --> 55 What is the next action the respiratory therapist should take? a. perform bronchial hygiene b. decrease tidal volume c. increase inspiratory flow d. obtain a chest radiograph

Utilization of a speaking valve on a patient with a long-standing tracheostomy tube serves which of the following purposes? 1. increases diaphragmatic muscle strength 2. increases cough explosiveness 3. helps maintain patient dignity 4. facilitates better communication of patient needs

3 and 4 only

A patient with suspected drug overdose is being evaluated by the respiratory therapist for adequacy of ventilation. In addition to assessing respiratory rate and rhythm, spontaneous tidal volume is evaluated. Spontaneous tidal volume should minimally be at which value for the patient to be considered normal?

5 mL/kg

Which of the following PaO2 ranges is acceptable for a patient with ARDS according to the ARDSnet protocol?

55 to 80 mm Hg

A respiratory therapist has orders to perform a 12-lead ECG on a patient who has chest pain. When placing the chest leads, what best describes the proper placement for chest lead V4?

5th interspace, mid-clavicular line

How many milligrams of drug are in 3.0 mL of medication whose strength is specified to be 2.5%?

75 mg

a. decrease EPAP only

A patient is receiving non-invasive positive pressure ventilation by mask with an IPAP of 16 cmH2O and an EPAP of 8 cmH2O. Corresponding blood gas data is as follows: pH 7.29 / PaCO2 51 / PaO2 108 / HCO3 24 / BE 0 Which adjustment is most appropriate? a. decrease EPAP only b. increase IPAP and EPAP c. increase IPAP only d. decrease EPAP and IPAP

c. decreasing dynamic compliance

A patient is receiving volume-controlled ventilation in the assist/control mode. The following data are available: 2pm --> 5pm --> 7pm Peak Pressure: 35 -->53 --> 55 Plateau Pressure: 22-->24 --> 23 Exhaled VT: 696 --> 702 --> 700 The respiratory therapist would categorize the most significant problem noted from this data as a. decreasing static compliance b. increasing dynamic compliance c. decreasing dynamic compliance d. increasing static compliance

b. increase alveolar ventilation

A patient is undergoing a full cardiopulmonary arrest. The patient is intubated and is being monitored with an infrared capnographic device. PetCO2 data is showing 3%. Which of the following is most appropriate? a. obtain PaCO2 by a Douglas bag b. increase alveolar ventilation c. recalibrate the capnometer d. clean the infrared device

a. normal cardiac response, abnormal blood pressure response

A patient is undergoing a maximal exercise tolerance test. During the exam, as workload is increased, an increase in heart rate from 90 to 120 bpm while blood pressure remained steady at 110/88 mmHg is noted. Which of the following can be correctly stated about the exam results? a. normal cardiac response, abnormal blood pressure response b. abnormal cardiac response, normal blood pressure response c. normal cardiac response, normal blood pressure response d. abnormal cardiac response, abnormal blood pressure response

a. a fracture in the plastic wye

A patient receiving positive pressure ventilation has a low-pressure alarm sounding. Which of the following could be the cause? a. a fracture in the plastic wye b. herniated cuff c. excess secretions in the airway d. kinked ET tube

d. increase minute ventilation

A patient receiving volume-controlled ventilation has an infrared CO2 detector attached at the end of the ET tube. The capnograph shows a PetCO2 of 47 torr. The respiratory therapist should a. continue current therapy b. increase expiratory time c. increase inspiratory flow rate d. increase minute ventilation

b. HME

A patient will be receiving short-term mechanical ventilatory support after surgery. Which of the following methods of humidification is appropriate? a. cool, passover humidification b. HME c. centrifugal nebulizer d. large volume nebulization

a. PEEP

A patient with ARDS is showing signs of refractory hypoxemia after 22 days of volume controlled ventilation. Which of the following ventilator controls is most effective at combating refractory hypoxemia? a. PEEP b. Tidal volume c. injector line d. amplitude

c. heliox therapy

A patient with increased airway resistance from a fixed upper airway obstruction would benefit most from which of the following? a. bronchodilator therapy b. epinephrine c. heliox therapy d. aerosolized atropine

A patient is in acute ventilatory failure. The physician is preparing to perform oral intubation of the patient in preparation for mechanical ventilatory support. Prior to intubation, the physician delivers Anectine (succinylcholine chloride). What evidence should the therapist watch for to indicate the medication has taken enough effect to perform intubation? A. cessation of respirations B. muscle twitching about the face and neck C. dilated pupils D. patient's inability to count backwards

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. distal lumen of the PA catheter B. proximal lumen of the PA catheter C. jugular vein D. subclavian vein

A patient is receiving volume-controlled ventilation. A chest tube drainage system is in place. The low-volume ventilator alarm is sounding continuously and the respiratory therapist notices profuse bubbling in the water seal chamber. Which of the following should the therapist suspect? A. faulty chest drainage system B. perforated lung C. excess suction pressure from the wall D. excessive PEEP

A patient is receiving volume-controlled ventilation. The ventilator settings and corresponding clinical data are as follows: Mode Assist/control Mandatory rate 16 Total rate 16 FIO2 1.0 PEEP 25 cm H2O Pulse 118/min Blood pressure 138/74 mm Hg (stable) PAP 14 mmHg C.O. 5.8 L/min pH 7.49 PaCO2 31 torr PaO2 254 torr HCO3- 25 mEq/L BE +1 mEq/L The respiratory therapist should recommend A. Sedate the patient B. Decrease FIO2 C. Decrease mandatory rate D. Decrease PEEP

A patient receiving oxygen therapy at 40% has the following arterial blood gas results: pH 7.41 PaCO2 39 torr PaO2 349 torr HCO3- 24 mEq/L The respiratory therapist detects an error in the results. Which of the following could be the cause of the error? A. Damaged Severinghaus electrode B. Improperly functioning Clark electrode C. Oxygen toxicity D. Dysfunctional membrane on the Sanz electrode

A patient receiving volume-controlled ventilation has an oxygen saturation of 87% within moments after the low pressure ventilator alarm begins to sound. After providing manual ventilation with a bag valve, the respiratory therapist observes the bag is easier than normal to squeeze and that oxygen saturation continues to fall. Which of the following could be the cause of this observation? A. pneumothorax B. partial extubation C. ET tube cuff herniation D. excess secretions in the ET tube

A patient remains hypoxic even when receiving supplemental oxygen at FIO2 0.45 by air-entrainment device. The respiratory therapist should recommend which of the following? A. mechanical ventilation B. increase in FIO2 C. CPAP D. reduction in FIO2

A pulmonary rehabilitation patient is being monitored for compliance to a smoking cessation program. Which of the following values would be most helpful to evaluate? A. SPO2 B. COHb C. PaO2 D. metHb

The respiratory therapist reviews the results of a patient diagnosed with mixed restrictive and obstructive pulmonary defects. Which of the following data is NOT associated with this diagnosis? A. SVC of 68% of predicted B. FEV1/FVC% of 78% C. FEV1 of 75% of predicted D. FEF 200-1200 of 74% of predicted

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

When evaluating a patient's pulmonary condition, the therapist should include which of the following in the assessment? A. language skills and social status B. occupation and smoking history C. marital status and disease history D. insurance and disease history

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. ordering a chest radiograph B. drawing arterial blood for gas analysis C. administering ipratropium bromide (Atrovent) D. administering cromolyn sodium (Intal)

A 4-year-old patient is demonstrating ventilatory difficulty with use of intercostal accessory muscles. The patient has a low grade fever and a loud, barky cough. Which of the following mostly likely represents the patient's condition? A. Bacterial infection B. Meningitis C. Laryngotracheobronchitis (croup) D. Acute epiglottitis

A 9-year-old asthmatic patient has previously responded well to Xopenex via small-volume nebulizer. The patient is intubated and has been placed on mechanical ventilation for acute respiratory failure. The physician orders Xopenex to be delivered via SVN through the ventilator circuit. Which of the following is an important consideration for effective medication delivery? A. particle deposition will be increased B. an alpha I response is increased C. Placement of the nebulizer can result in variation of medication delivery D. tachycardia is more likely

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

Which of the following must be done to transition a patient with a fenestrated tracheostomy tube, who is receiving positive pressure ventilation, to a speaking configuration? A. sever the pilot valve line B. change the tracheostomy tube C. deflate the cuff, install the cap D. insert the inner cannula

While receiving nasal CPAP delivered by an infant ventilator, the patient is retracting and creating a fluctuating baseline pressure on the monometer. What should the respiratory therapist do? A. Suction the patient B. Adjust the threshold resistor C. Increase the flowrate D. Increase the size of the fixed orifice resistor

A respiratory therapist is preparing a patient who will be transferred home and will be ventilator dependent during the night. Which of the following devices would be most helpful to ensure adequate hydration of the patient's airway during the night? A. Heated wire ventilator circuit with water traps B. Cascade humidifier C. Large volume nebulizer D. Heat moisture exchanger (HME)

The high pressure alarm is sounding on a patient who is receiving long-term mechanical ventilation. After manually ventilating the patient with a bag-valve, the respiratory therapist notices a large amount of thick sputum is lodged in the heat moisture exchanger (HME). The therapist should A. Replace the HME device with a new one B. Suction the HME device to remove secretions C. Clean the HME by soaking it in normal saline followed by a rinse D. Replace the HME with a heated humidifier

The physician has asked the respiratory therapist to help determine oxygen consumption by the tissues. The therapist should suggest evaluation of which of the following? A. CvO2 B. CaO2 C. PaO2 D. C(a-v)O2

The respiratory therapist measures the volume when a patient maximally exhales after passively exhaling a normal tidal volume. Which of the following volumes has the therapist observed? A. FRC B. VC C. TLC D. ERV

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 respiratory therapist responds to an adult patient on a ventilator whose low pressure alarm is sounding. The therapist determines the 6.0 mm ET tube is in proper position according to the markings. Gas escaping around the ET tube is audible. The therapist should A. add air to the cuff B. switch to a cuffless ET tube C. schedule the patient for a tracheotomy D. switch to a larger ET tube

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

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

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. leave and get help B. check for a pulse C. begin chest compressions D. administer manual ventilations with a bag/valve Correct

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. polycythemia C. sarcoidosis D. recurring infections

A motorcycle accident victim is in the emergency room with multiple wounds including a contusion to the head and torn deep muscle tissue in the right leg. The patient is bleeding massively. The respiratory therapist should first A. monitor respiratory rate q 10 minutes B. recommend blood type and crossmatch evaluation in preparation for blood administration C. recommend a CT scan of the head D. place the patient on oxygen at FIO2 1.0

A patient in ICU has a balloon-tipped pulmonary artery catheter in place. The following hemodynamic data is observed CVP 10 torr mPAP 19 torr PWP 24 torr MAP 112 torr Arterial blood gas analysis reveals: pH 7.38 PaCO2 43 torr PaO2 70 torr HCO3- 21 mEq/L BE -3 mEq/L Which of the following should the respiratory therapist recommend? A. Crystodigin (digitalis) B. Fluid administration C. Antibiotic therapy D. Diuresis

A patient in the cardiac intensive care unit has marked congestion and is expectorating large amounts of pink, frothy secretions. Oxygen saturation by pulse oximetry is 85%. This finding is most consistent with A. mitral valve stenosis B. dehydration C. pulmonary embolism D. CHF

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

A patient is in the emergency room (ER) with paradoxical chest movement on the right side. The trachea is deviated from mid-line. Which of the following should the respiratory therapist suspect? A. pleural effusion B. pulmonary embolism C. pulmonary edema D. fractured ribs and a pneumothorax

a. hemoglobin

Which of the following is needed to determine C(a-v)O2? a. hemoglobin b. VD/VT c. PvO2 d. PaO2

Which of the following sputum characteristics would be helpful in assessing the nature and status of pulmonary congestion on a patient? 1. color 2. amount 3. odor 4. viscosity

1, 2, 3 and 4

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

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

Which of the following units of measure are associated with systemic vascular resistance? A. L/min/m3 B. dynes-min/cm2 C. dm2 /min D. dynes/sec/cm5

The correct answer is : D Explanation : SVR = (MAP-CVP)/C.O. X 80 The unit of measure is dynes, or more specifically, dynes/sec/cm5.

d. spontaneous tidal volume

Which of the following is considered objective information? a. dysphagia b. chest pain c. dyspnea d. spontaneous tidal volume

A 39-year-old female patient presents to the emergency room with wheezing and fever. She has a history of reactive airways disease secondary to pulmonary infections. What should the respiratory therapist recommend for initial treatment? A. oxygen by NRB B. complete PFT C. supplemental fluids D. antibiotics

The correct answer is : D Explanation : The respiratory therapist would likely be searching for a response that resolves wheezing resulting from RAD. There is no response available like this, therefore, following the order of priority, one will find an answer to resolve the underlying problem, which is a pulmonay infection. Antibiotics are indicated. A PFT would not be appropriate for a compromised patient. There is nothing in the scenario that suggests the patient needs 100% oxygen, nor is there anything that suggests supplemental fluids are needed.

A long-term care patient who experienced a stroke has left-sided paralysis about the face and mouth. The patient is unable to produce a seal with her lips while performing IPPB treatments. How would a respiratory therapist expect the IPPB machine to respond in this situation? A. Deliver a higher FIO2 B. Fail to cycle into inhalation C. Deliver a higher FIO2 D. Fail to cycle into exhalation

The correct answer is : D Explanation : The scenario suggests that a leak will occur when administering IPPB. Circuit leaks result in a failure to reach a preset pressure, which then results in failure to cycle into exhalation.

During movement of an orally intubated patient from an emergency transport vehicle to the emergency department, the respiratory therapist suspects an inadvertent position change of the endotracheal tube. To confirm the position of the ET tube, the respiratory therapist should A. auscultate breath sounds bilaterally B. perform diagnostic chest percussion C. observe chest movement and symmetry of chest rise D. obtain a chest radiograph

The correct answer is : D Explanation : There are many ways to determine the position of the ET tube but only one way to provide conclusive evidence of its location. That one way is a chest x-ray which allows direct observation of the location of the end of the tube. The end of the tube should be located 2 to 5 cm above the carina.

An infant is receiving CPAP to help resolve hypoxemia. Radiological examination reveals a perforation in the right lung. Cyanosis persists with increasing respiratory acidosis. The respiratory therapist should suggest A. increase CPAP B. decrease CPAP C. increase FIO2 D. high frequency jet ventilation

The correct answer is : D Explanation : There are two ways to deal with a perforation in one of the lungs. When the patient is receiving mechanical ventilation, the respiratory therapist must be careful not to expose that lung to too much pressure. This can be accomplished by either employing independent lung ventilation with a double lumen endotracheal tube, or by employing high-frequency jet ventilation, which will keep mean airway pressure low and avoid further damage to the lung.

While providing manual ventilation with a bag-valve and mask assembly to a patient who is in full cardiopulmonary arrest, the respiratory therapist is suddenly unable to squeeze the bag. After removing the bag-valve from the patient, the therapist tests the bag and finds the same results. The therapist should A. provide mouth-to-mouth ventilation B. change out the inlet valve assembly C. remove the valve assembly, reattempt ventilation D. obtain another bag-valve

The correct answer is : D Explanation : This bag-valve is obviously not functioning correctly. When this happens, the first, quickest, and best action is to replace the device altogether. If this is not possible then some minor troubleshooting may be done if it can be done quickly..

A patient with bilateral pneumonia is receiving pressure-controlled ventilation with the following arterial blood results on the settings below: Mode PCV Mandatory rate 22 PIP 25 cm H20 FIO2 0.65 PEEP 15 cm H2O pH 7.29 PaCO2 51 torr PaO2 65 torr HCO3- 26 mEq/L BE +2 mEq/L Which of the following should be increased? A. FIO2 B. Rate C. PEEP D. PIP

The correct answer is : D Explanation : This event is demonstrating hypoventilation as manifested by a high PaCO2. On a time-cycled ventilator the most appropriate control to adjust in order to decrease CO2 is the peak inspiratory pressure (PIP).

a. provide manual ventilation

The high pressure alarm is sounding on a patient receiving volume controlled ventilation. The respiratory therapist should FIRST a. provide manual ventilation b. suction the patient c. observe the alarm panel to determine source d. cancel the alarm

A respiratory therapist is administering epinephrine directly down the ET tube of a patient in full cardiopulmonary arrest. What is the most important procedural consideration?

The normal dose should be doubled.

b. poor hand washing among staff

Which of the following is most likely to increase nosocomial infection in a hospital? a. use of an HME for 48 hours b. poor hand washing among staff c. frequent disconnection in the ventilator circuit d. use of alcohol-based hand cleaners

To facilitate drainage of secretions consolidated in the bases of the lungs, the respiratory therapist should anticipate placing the patient in which of the following positions?

head-of-bed down 30 degrees

Which of the following is a central goal of pulmonary rehabilitation on a patient diagnosed with advanced stage COPD?

maintenance of ADLs

A 5-year old female patient is brought to the clinic in moderate respiratory distress. The mother believes the child has a small toy in her lungs. If this suspicion is true, what finding might the respiratory therapist expect to observe?

monophonic wheezing upon auscultation

Which of the following exams can be used to quantify pulmonary residual volume (RV) on a patient?

nitrogen washout

A patient has the following chest radiograph. The radiology report suggests the presence of a concave superior interface. Which diagnosis is most likely?

pleural effusion

How many milliliters of a medication whose strength is 5% is needed to deliver 25 mg of that medication?

0.50 mL....This is done by multiplying the drug strength by 10. mg/mL = 5% x 10 = 50 mL = 25 mg / 50 mg/mL = 0.50 mL

A patient with COPD is on mechanical ventilation on the following settings: Mode VC SIMV FIO2 0.45 VT 0.4 L Mandatory rate 12/min PEEP 4 cm H2O I:E 1:2 To minimize the development of autoPEEP, which of the following could be changed? 1. decrease in inspiratory time 2. increase in expiratory time 3. increase in inspiratory flow rate 4. decrease in mandatory rate

1, 2, 3, and 4

When performing suctioning through an endotracheal tube on a patient receiving volume-controlled mechanical ventilatory support in the A/C mode, what is the maximum time that the application of suctioning should not exceed?

15 seconds

A physician asks the respiratory therapist to calculate the patient's Vd/Vt ratio. Which of the following equipment should be utilized to obtain the appropriate values? 1. CO-Ox 2. capnograph 3. blood gas analyzer 4. pneumotachometer

2 and 3 only

A respiratory therapist is helping a patient with COPD prepare to be discharged home. The therapist is reviewing alternative methods of performing activities of daily living (ADLs) with the patient. Which of the following are considered ADLs? 1-Mowing the lawn 2-Shaving 3-Grocery shopping 4-Walking around the neighborhood

2 and 3 only

Which of the following conditions could cause a tracheal shift to the right? 1. atelectasis in the left 2. sputum consolidation on the right 3. pneumothorax on the right 4. lobectomy on the right.

2 and 4 only

A patient who receives oxygen by E cylinder compressed gas is planning an 8-hour trip in a car. The prescribed flow rate of oxygen is 2 L/min. With how many full E cylinder tanks should the patient travel with to have sufficient oxygen for the entire trip?

2 tanks

What is the oxygen index for a patient who has the following clinical and laboratory data? ABG pH 7.35 PaCO2 45 torr PaO2 75 torr HCO3- 25 mEq/L BE 0 mEq/L Vent settings Mode VC, A/C Rate 14/min VT 500 mL FIO2 0.60 PEEP 8 cm H2O mPAW 25 cm H2O C.I. 3.0 L/min/m2

20.... OI = (mPAW x O2%) / PaO2

Approximately how many hours will an H cylinder of oxygen at 1800 PSI last for a patient who is receiving oxygen by nasal cannula flowing at 3 L/min?

31 hrs

A physician has just inserted a balloon-tipped flow directed pulmonary artery catheter. When the chest radiographic report returns, the respiratory therapist will expect to see which of the following descriptions if the line is properly placed? A. in the pulmonary artery B. over the right ventricle C. mid-lung space over the right lung field D. in the superior vena cava

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

For a 77-kg (170-lb) patient with ARDS, which of the following target tidal volume settings would be appropriate when initiating mechanical ventilation?

350 mL

A respiratory therapist enters the patient's room to do a routine breathing treatment and finds the patient has no obvious chest movement. After calling for help, the first action of the therapist should be to A. Begin mask-valve ventilation B. Perform chest compressions C. Place the patient on a 100% nonrebreathing mask D. Check for a pulse

A respiratory therapist is determining a VD/VT ratio. Which of the following is needed to complete this analysis? A. PetCO2 and PaCO2 B. VT and VA C. FIO2 and PaO2 D. PECO2 and PaO2

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

A patient in the intensive care unit is receiving mechanical ventilation by PC SIMV. Capnography reveals increasing PECO2 while SpO2 remains steady. Which of the following can be concluded?

Dead space ventilation is decreasing

The measurement of a patient's FRC is 50% higher when measured by body box compared to the results when measured by helium dilution method. Which of the following is the likely reason for the difference in this patient? A. increased non-ventilated lung space B. poor patient effort during the helium dilution C. small leak during the helium dilution maneuver D. presence or choanale atresia

A patient who has bedside screening spirometry has flow-volume loops that are short and wide in appearance. This is associated with a(n)

obstructive pulmonary defect.

b. oropharyngeal airway

A 45 year-old patient is recovering in the intensive care unit after undergoing a surgical procedure to repair a hernia. The patient remains unconscious. To prevent soft tissue obstruction, the respiratory therapist should recommend a(n) a. double-lumen endobronchial tube b. oropharyngeal airway c. bite block d. nasopharyngeal airway

d. normal

A patient in a body box performs a maneuver that shows airway resistance (Raw) to be 1.2 cmH2O/L/sec. Which of the following conditions most likely represents the patient's condition? a. ARDS b. myasthenia gravis c. history of smoking d. normal

Which of the following is required for an air/oxygen proportionator (blender) to function properly?

50 PSI sources gases

c. pulmonary hypertension

A patient in the cardiac intensive care unit has a Swan-Ganz pulmonary artery catheter in place. The following data is available: CVP: 6 torr mPAP: 18 torr PCWP: 8 torr C.I.: 2.0 L/min/m2 Which of the following most likely represents the patient's condition? a. dehydration b. cor pulmonale c. pulmonary hypertension d. left heart failure

d. confirm asystole in a second lead

A patient in the emergency department (ED) becomes unconscious and has a cardiac rhythm consistent with asystole. The respiratory therapist should IMMEDIATELY a. begin chest compressions b. administer epinephrine c. adminster Atropine d. confirm asystole in a second lead

A patient with a history of Congestive Heart failure (CHF) is experiencing pulmonary edema. Oxygen saturation is 87% and the patient has marked congestion of the lungs. Currently, the patient is receiving supplemental oxygen by nonrebreathing mask. Which of the following is the most appropriate action? A. intubate the patient, perform endotracheal suctioning B. spray alcohol into the patient's oropharynx C. administer aerosolized bronchodilator medication D. administer heated aerosol therapy by ultrasonic nebulizer

Into which interspace should a chest tube be inserted for the purpose of draining serosanguinous fluid from the pleural space and for the re-expansion of lung tissue?

5th interspace

d. sputum culture and sensistivity

A patient in the emergency room expectorates thick, yellow sputum. A CBC shows the following: RBC: 6.0 mill/cu mm Hb: 17 g/dL HCT: 64% WBC: 22,000 cu mm The patient could benefit most from which of the following? a. Acetylcysteine b. aerosolized Amphotericin B c. aerosolized Nystatin d. sputum culture and sensistivity

d. mass in the left lobe

A spiral CT scan would be most helpful in evaluating which of the following? a. atelectasis b. asbestosis c. pneumonia d. mass in the left lobe

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. Pirbuterol C. Xopenex D. Atrovent

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. hemoximetry B. single-wavelength pulse oximetery C. measurement of PaO2 D. beside pulmonary function testing

A 5-year old patient with acute epiglottitis has just received a tracheotomy and is returned to the emergency department for monitoring. The patient is now breathing through a tracheostomy tube. Which of the following is most important at this time? A. provide heated humidity B. provide cool aerosol therapy C. mechanical ventilatory support D. keep the tracheostomy tube cuff inflated

A patient breathing spontaneously through a 7.5 mm endotracheal tube self-extubates. The ET tube is found lying on the floor with the cuff still inflated. Which is the most important physical sign for which the respiratory therapist should monitor over the next few hours? A. stridor B. unilateral wheezing C. inability to vocalize D. vocal cord paralysis

A patient complains of tremors following 2 puffs of Albuterol by metered dose inhaler. The tremors happen within 30 minutes after every treatment and subside within 20 minutes. The respiratory therapist should recommend A. instructing the patient this is a normal side affect B. use of a chamber C. informing the patient this is an adverse reaction D. stop using the MDI

A 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

A patient is receiving bi-level therapy to decrease work of breathing. Current settings and blood gas results are: IPAP 18 cm H2O EPAP 10 cm H2O FIO2 0.21 pH 7.32 PaCO2 48 torr PaO2 110 torr HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should make which of the following changes? A. decrease EPAP to 8 cmH2O B. increase both IPAP and EPAP by 2 cmH2O C. increase IPAP to 22 cmH2O D. increase EPAP to 12 cmH2O

A patient with a history of Status Asthmaticus arrives in the emergency room (ER) after having received multiple bronchodilator treatments. Paramedics report breath sounds have not improved. The physician orders supplemental oxygen. The respiratory therapist will recommend which of the following? A. nonrebreathing mask B. nasal cannula C. Venturi mask D. mechanical ventilator

a. 5 L/min nasal cannula

A spontaneously breathing patient has the following arterial blood gas results: pH 7.38 / PaCO2 42 / PaO2 76 / HCO3 24 / BE 0 Which of the following supplemental oxygen levels is most appropriate? a. 5 L/min nasal cannula b. Venturi mask at 30% c. non-rebreathing mask d. 2 L/min nasal cannula

A patient with bronchiectasis has thick and tenacious secretions. The respiratory therapist is unable to adequately suction the patient with a 10 Fr catheter with the suction pressure set at 110 mmHg. Which of the following would be most helpful? A. administer 2.0 cc of 10% Mucomyst (Acetylcysteine) B. administer Atropine sulfate by aerosol C. administer prednisone, IV D. decrease suction pressure to 100 mmHg

The respiratory therapist is asked to estimate the alveolar minute ventilation on a spontaneously breathing 68 kg (150 lb) female who is receiving oxygen therapy by air-entrainment mask at FIO2 0.50. The following data is available Exhaled VT 450 mL mPAP 15 torr PaCO2 40 torr PaO2 70 torr Respiratory rate 12/min The therapist should report an alveolar minute ventilation of: A. 3.6 L/min B. 4.6 L/min C. 5.4 L/min D. 12.0 L/min

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

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

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

Which of the following test results would be helpful in determining whether a patient should receive Bi-level therapy with supplemental oxygen? A. PetCO2 B. DLCO C. MVV D. SBN2

While in the emergency room, the respiratory therapist receives a patient who was working as a firefighter when the burning building collapsed. He was rescued and brought to the ER. The therapist observes paradoxical chest movement in the right chest and hears marked stridor of the upper airway. The therapist should next do which of the following? A. intubate the patient with a bronchoscope B. administer cool aerosol by mask C. administer IPPB treatment D. immobilize the fractured ribs with a chest wrap

b. switch to a 9.0-mm ET tube

A 100-kg (220-lb), 6-ft, 2-in (188-cm) adult male is orally intubated with a 7.0-mm endotracheal tube. The therapist reports difficulty removing secretions with the suction pressure set to 120 mmHg. The respiratory therapist will FIRST a. increase suction pressure to 130 mmHg b. switch to a 9.0-mm ET tube c. lubricate the suction catheter d. decrease suction pressure to 100 mmHg

c. non-invasive postive pressure ventilation (NPPV)

A 33-year-old female has been rehabilitated from a motor vehicle accident where she suffered a spinal injury. She has been admitted to the emergency department with flu-like symptoms, is febrile, and is expectorating yellow sputum. Arterial blood gas results are: pH 7.27 / PaCO2 52 / PaO2 67 / HCO3 25 / BE -1 The respiratory therapist should recommend a. high frequency chest wall oscillation (HFCWO) b. intermittent postive pressure ventilation (IPPV) c. non-invasive postive pressure ventilation (NPPV) d. pressure support ventilation (PSV)

a. these are normal findings

A 38-week gestational age infant is receiving supplemental oxygen by oxyhood. An air/oxygen blender is set at 40% and the heated large volume aerosol is set at 100%. A capillary blood sample reveals the following values: pH 7.45 / PcCO2 35 / PcO2 47 / HCO3 22 / BE -2 SpO2 is reading 97% and the patient appears to have good color. The therapist should conclude which of the following? a. these are normal findings b. nasal CPAP of 4 cmH2O should be implemented c. FIO2 should be increased d. the air/oxygen blender should be set to 100%

b. intubate with a bronchoscope

A 4-year-old patient in the emergency room (E.R.) shows significant signs of respiratory distress including inspiratory stridor and tachypnea. The patient is drooling. The physician feels the patient has acute epiglottitis and orders intubation. Which of the following methods of intubation would be most appropriate? a. perform oral intubation with stylet b. intubate with a bronchoscope c. visualize the orpharynx with a tonsil suction device d. nasal intubation with magill forceps

d. serum electrolytes

A 42-year-old female presents in the emergency department (ED) complaining of body aches and general malaise. The patient reports sickness over the last two days with excessive vomiting and diarrhea. Which of the following laboratory tests should the respiratory therapist suggest? a. arterial blood gas b. blood urea nitrogen (BUN) c. theophylline level d. serum electrolytes

c. increase tidal volume

A 45-year-old 74-kg (163-lb) adult female is receiving mechanical ventilatory support. Settings are as follows: Mode: assist/control Mandatory rate: 12 Total rate: 16 Tidal volume: 400 mL FIO2: 0.6 PEEP: 5 cmH2O The patient is appears to be anxious. SpO2 is 86%. The respiratory therapist will recommend which of the following? a. increase inspiratory flow rate b. increase FIO2 c. increase tidal volume d. decrease mandatory rate

d. increase pressure support to 10 cmH2O

A 60 kg (132 lb) male patient is undergoing weaning from mechanical ventilation. The following clinical and laboratory data is available: Mode: SIMV Mandatory rate: 4 Total rate: 28 FIO2: 0.40 VT (set): 400 mL VT (spont): 280 mL Pressure support: 5 cmH2O pH 7.44 / PaCO2 35 / PaO2 82 / HCO3 24 / BE +1 The respiratory therapist should recommend which of the following changes? a. administer sedative medication b. discontinue mechanical ventilation c. switch to pressure-control ventilation d. increase pressure support to 10 cmH2O

b. decrease tidal volume

A 65-kg (143-lb) patient with pneumonia is receiving mechanical ventilator support by a Servo adult ventilator on the following settings with corresponding arterial blood gas values: Mode: assist/control Mandatory rate: 10/min VT: 700 mL FiO2: 0.50 pH 7.48 / PaCO2 33 / PaO2 98 / HCO3 24 / BE 0 Which of the following actions is most appropriate? a. increase tidal volume b. decrease tidal volume c. decrease FiO2 d. decrease mandatory rate

c. idiopathic pulmonary fibrosis

A 68-year-old male patient has the following pulmonary function values: Fev1/FVC% : 79% FVC: 62% of predicted FEF 25-75: 81% of predicted FEF 200-1200: 84% of predicted Which of the following could represent the patient's diagnosis? a. bronchiectasis b. chronic bronchitis c. idiopathic pulmonary fibrosis d. chronic asthma

b. performing a defribrillation at 150 joules biphasic

A 74-year old male has ventricular tachycardia. The patient is not alert and will not respond to verbal commands. A pulse is not palpable. The respiratory therapist will respond by a. adminstering aminophylline, IV b. performing a defribrillation at 150 joules biphasic c. cardioverting the patient at 100 joules d. administering sodium bicarbonate

c. use an air-entrainment mask set at 28%

A COPD patient complains of shortness of breath while exercising with a 2 L/min nasal cannula. During exercise, SPO2 is noted to fall to 84%. Which of the following would be most helpful to the patient during exercise? a. decrease flow to 1 L/min nasal cannula b. avoid exercising c. use an air-entrainment mask set at 28% d. use a non-rebreathing mask

d. racemic epinephrine

A child has been extubated and is demonstrating mild stridor. Which of the following agents would be most helpful to administer by aerosol? a. albuterol b. Atropine c. Aminophylline d. racemic epinephrine

c. COHb

A family is found sleeping in their vehicle on the side of the road during a long trip. The officer who found them reports the family was difficult to arouse. Which of the following would be the most appropriate examination? a. drug toxicology screen b. arterial blood gas analysis c. COHb d. pulse oximetry

d. in mixed venous oxygen saturation

A left-to-right cardiac shunt, due to a leak in the septum wall of the heart, would be best indicated by an increase a. in PCWP b. in mPAP c. in arterial to venous oxygen content difference d. in mixed venous oxygen saturation

b. decreased PAO2

A mountain hiker is air-lifted off a mountain from an altitude of 19,000 ft. The patient was found complaining of shortness of breath. The patient is anxious, cyanotic, and is exhibiting signs of pulmonary edema. The most likely explanation for these signs and symptoms is a. altitude sickness b. decreased PAO2 c. hypercapnia d. oxygen toxicity

d. place the infant on supplemental oxygen

A neonate delivered 3 minutes ago has an APGAR score of 5. The therapist should do which of the following? a. perform CPR b. obtain umbilical cord blood gas values c. get an arterial blood gas d. place the infant on supplemental oxygen

d. mixed venous-arterial blood

A patient has a balloon-tipped, flow-directed catheter in place in the pulmonary artery. Which of the following will be obtained when extracting blood from the distal lumen of the pulmonary artery catheter? a. coagulated blood b. arterial blood c. venous blood d. mixed venous-arterial blood

d. blood glucose level

A patient has the following arterial blood gas results and ventilatory parameters: pH 7.12 / PaCO2 30 / PaO2 80 / HCO3 9 / BE +15 RR: 34 VT (spont): 400 mL Which of the following would provide helpful diagnostic information? a. creatinine b. BUN c. venous level of HCO3 d. blood glucose level

b. decreasing pulmonary vascular resistance

A patient has the following input/output history and other clinical information: Yesterday --> Today IN: 1900 cc --> 1600 cc OUT: 2200 cc --> 1900 cc C.O.: 6.1 L/min --> 3.7 L/min BP: 120/78 --> 120/82 CVP: 3 --> 3 PAP: 12 --> 12 PCWP: 7 --> 7 These data would result in which of the following? a. decrease in V/Q mismatching b. decreasing pulmonary vascular resistance c. increase in left end-diastolic pressure d. increase in CVP

a. place the patient on a non-rebreathing mask

A patient in the emergency room is receiving oxygen by nasal cannula at 3 L/min. Blood gases reveal the following: pH 7.53 / PaCO2 30 / PaO2 51 / HCO3 23 / BE -1 The respiratory therapist should immediately a. place the patient on a non-rebreathing mask b. decrease flow to 1 L/min c. increase flow to 5 L/min d. place the patient on a Venturi mask at 40%

d. look for a leak between the water seal chamber and the patient

A patient is being mechanically ventilated VC ventilation. A chest tube drainage system is in place and 1100 mL of fluid has been collected from the left chest. A low volume alarm on the ventilator begins to sound. The respiratory therapist notices vigorous bubbling in the water seal chamber. The following data is available: pH 7.45 / PaCO2 36 / PaO2 80 / HCO3 24 / BE -1 Mode: assist/control VT: 500 mL Exhaled VT: 296 mL Mandatory rate: 12/min Total rate: 10/min FIO2: 0.60 The respiratory therapist's first action should be to a. increase rate to 14 b. decrease suction pressure to the system c. discontinue chest tubes d. look for a leak between the water seal chamber and the patient

c. suction for less than 10 seconds

A patient is being suctioned by the respiratory therapist. The therapist suctions the patient by inserting the catheter for 10-15 seconds and applying intermittent suction while withdrawing the catheter. During the last several attempts, the therapist notices multiple PVCs on the ECG monitor during the procedure. Which of the following can the therapist do to correct the problem? a. apply continuous suctioning when withdrawing the catheter b. decrease suction pressure c. suction for less than 10 seconds d. switch to a larger catheter

c. 14 L/min

A patient is on 60%/40% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min? a. 18 L/min b. 10 L/min c. 14 L/min d. 16 L/min

d. reduce the total flow of gas mixture to the patient

A patient is receiving heliox therapy with a mixture of 70% / 30% by nonrebreathing mask to reduce airway resistance. The therapist also observes the reservoir bag is not collapsing at all with each inspiration. After ensuring the face mask is sealed around the face properly, the therapist should a. obtain a partial rebreathing mask b. discard the valve between the mask and the reservoir c. obtain an arterial blood gas d. reduce the total flow of gas mixture to the patient

b. increase flow to 15 L/min

A patient is showing signs of respiratory distress with a respiratory rate to 30/min and a spontaneous tidal volume of 800 mL. The patient is receiving oxygen at 60% by large volume nebulizer with the flow set at 10 L/min. The respiratory therapist should suggest to a. increase FiO2 to 1.0 and the flow to 15 L/min b. increase flow to 15 L/min c. sedate the patient d. decrease the FiO2 to 0.50

d. try a different location with the pulse ox probe

A patient on the medical floor is receiving supplemental oxygen at 4 L/min by nasal cannula. A pulse oximeter is showing an SPO2 of 74% with a heart rate of 68 bpm. The respiratory therapist determines the pulse by palpation is 98 bpm. The therapist should a. increase the flow rate to 5 L/min b. switch the patient to 50% Venturi mask c. replace the electrode with a new one d. try a different location with the pulse ox probe

b. reduce future treatment dosage to 0.25 mL

A patient receiving 0.5 mL Albuterol by small volume nebulizer complains of tingling fingers, nervousness, and heart palpitations. The therapist should a. decrease dosage to 0.15 mL b. reduce future treatment dosage to 0.25 mL c. have the patient pause at the top of each breath d. instruct the patient in performing shallow inspirations

d. change to an 80%/20% heliox mixture

A patient receiving heliox therapy at 70%/30% mixture by non-rebreathing mask has the following arterial blood gas results: pH 7.35 / PaCO2 45 / PaO2 110 / HCO3 24 / BE 0 Which of the following actions is appropriate? a. change to a heliox mixture of 60%/40% b. discontinue heliox therapy c. switch to a partial rebreathing mask d. change to an 80%/20% heliox mixture

a. increase flow

A patient receiving oxygen by non-rebreathing mask is breathing rapidly and deeply. The reservoir bag collapses completely with each inspiration. The therapist should a. increase flow b. check for adequate mask seal c. switch to a Venturi mask at 50% d. continue current therapy

b. decrease FIO2 to 0.28

A patient with COPD is found with shallow respirations and is disoriented to time and place. The patient is receiving oxygen by Venturi mask set at 45%. SpO2 is 99%. The therapist should first do which of the following? a. institute mechanical ventilation b. decrease FIO2 to 0.28 c. switch to a nonrebreathing mask set at 12L/min d. swtich to a nasal cannula at 5 L/min

b. increase inspriatory flow rate

A patient with COPD is receiving volume-controlled ventilation with an I:E ratio of 1:3. A chest radiograph shows increased air-trapping. The physician orders a change in the I:E ratio to decrease air-trapping. Which of the following will accomplish this? a. increase inspiratory time b. increase inspriatory flow rate c. decrease expiratory time d. decrease inspiratory flow rate

b. loop diuretics

A patient with fulminating pulmonary edema has the following data obtained from a Swan-Ganz pulmonary artery catheter: CVP: 10 mmHg PAP: 25 mmHg PCWP: 15 mmHg C.O.: 3.9 L/min The patient would benefit most from which of the following? a. blood expanding agents b. loop diuretics c. Penicillin-class antibiotics d. administration of whole blood

a. discontinue ventilatory support

A patient with myasthenia gravis receiving volume-controlled ventilation is able to exhale a vital capacity of 2.4 L, has a spontaneous VT of 450 mL and is able to achieve -38 cmH2O on the MIP manometer. As the patient becomes alert, the respiratory therapist should recommend a. discontinue ventilatory support b. adminster a maintenance dose of Tensilon c. sedating the patient. continuing to monitor d. checking VC q4 hours

b. nonrebreathing mask

A patient with pulmonary fibrosis has the following arterial blood gas results while receiving supplemental oxygen via nasal cannula at 5 L/min: pH 7.35 / PaCO2 45 / PaO2 42 / HCO3 24 / BE -1 The respiratory therapist should recommend changing to which of the following devices? a. simple mask set to 7 L/min b. nonrebreathing mask c. Venturi mask d. partial rebreathing mask

b. increase IPAP to 20, EPAP to 8 cmH2O

A patient with rocky mountain spotted fever is receiving non-invasive positive pressure breathing by mask at the following settings: IPAP: 18 cmH2O EPAP: 6 cmH2O Corresponding blood gases are: pH 7.36 / PaCO2 43 / PaO2 72 / HCO3 24 / BE 0 FiO2: 0.60 The respiratory therapist should recommend which of the following change(s)? a. increase EPAP to 10 cmH2O b. increase IPAP to 20, EPAP to 8 cmH2O c. increase FIO2 to 0.7 d. increase IPAP to 22 cmH2O

c. decrease rate and/or increase flow

A physician is concerned about autoPEEP developing in a patient receiving volume-controlled ventilation on the following settings: Mode: assist/control VT: 600 mL Rate: 16 FIO2: 1.0 PEEP: 10 cmH2O Insp flow: 50 L/min I:E : 1:2 Which of the following adjustments will reduce autoPEEP? a. increase PEEP b. increase VT c. decrease rate and/or increase flow d. decrease PEEP

c. 500 mL

A post-operative patient was able to achieve an inspiratory capacity of 2000 mL prior to surgery. After repeated attempts, the patient is only able to achieve 400 mL. Which of the following represents an appropriate patient goal? a. 1000 mL b. 1600 mL c. 500 mL d. 400 mL

c. 20 mL/cmH2O

A pressure-volume ventilator graphic is observed on a patient receiving mechanical ventilation. The patient's estimated dynamic compliance is (see second pic) a. 50 mL/cmH2O b. 44 mL/cmH2O c. 20 mL/cmH2O d. 32 ml/cmH2O

c. series of oblique chest radiographs

A radiology report of a chest x-ray indicates a round-shaped infiltrate measuring 2 cm in diameter in the left lung. Which of the following tests would be helpful in further identifying the nature of this infiltrate? a. V/Q scan b. transesophageal echo (TE) c. series of oblique chest radiographs d. sputum culture

b. withdraw the ET tube by 4 cm

A radiology report of a chest x-ray indicates the oral endotracheal tube is 1 cm beyond the carina, in the right mainstem bronchus. The respiratory therapist should a. withdraw the ET tube by 2 cm b. withdraw the ET tube by 4 cm c. advance the ET tube by 1 cm d. withdraw the ET tube by 1 cm

b. ventilator circuit bronchoscopy adapter

A respiratory therapist is asked to assist a physician for a diagnostic bronchoscopy on a mechanically ventilated patient. What special equipment should be brought to the room? a. laryngoscope and blade b. ventilator circuit bronchoscopy adapter c. ventilator circuit endotracheal tube wedge d. Wrights respirometer

d. Bodai adapter

A respiratory therapist is asked to assist a physician with a bronchoscopy procedure on a patient who is ventilator dependent and requires high levels of PEEP. Which of the following equipment should be used? a. closed in-line suction catheter b. manual PEEP valve c. Magill forceps d. Bodai adapter

b. pressure manometer

A respiratory therapist is asked to determine a patient's inspiratory muscle strength. Which of the following equipment is required for this evaluation? a. Fleisch pneumotrachometer b. pressure manometer c. respirometer d. peak flow meter

a. ABG and alveolar oxygen tension

A respiratory therapist is considering a patient's readiness to wean from mechanical ventilation. To determine the A-aDO2, the therapist will need which of the following? a. ABG and alveolar oxygen tension b. VD/VT and PAO2 c. CaO2 and PAO2 d. VD/VT and ABG

d. daily peak flow measurements

A respiratory therapist is designing a regimen for a patient with asthma in an attempt to minimize episodes of bronchoconstriction. Which of the following should be included in the regimen a. IGE blocker b. routine alveolar diffusion testing c. cromolyn sodium (Intal) d. daily peak flow measurements

b. order a chest radiograph

A respiratory therapist is helping transport a patient from the helicopter to the intensive care unit. During the transport, the therapist notices the endotracheal tube securing devices have become unsecure. The BEST way for the therapist to determine the position of the tube is to a. auscultate breath sounds b. order a chest radiograph c. examine tube markings d. inspect symmetry of chest rise

b. peak flow meter

A respiratory therapist is ordered to do a bedside assessment of the effectiveness of a bronchodilator on a patient with an acute asthmatic episode. Which of the following equipment will be needed to perform this evaluation? a. maximum inspiratory pressure manometer b. peak flow meter c. Collins water-seal spirometer d. respirometer

d. respirometer

A respiratory therapist is preparing to measure SVC on a patient in the emergency department. Which of the following equipment is required? a. Collins water-seal spirometer b. Geissler tube c. Wheatstone bridge d. respirometer

a. distal end of the pulmonary artery catheter

A respiratory therapist is preparing to obtain a mixed venous sample for the purpose of PvO2 measurement. From which of the following locations should the sample be taken? a. distal end of the pulmonary artery catheter b. capillary bed c. proximal end of the PA catheter d. right atrium

b. pursed-lip breathing

A respiratory therapist is providing instruction to a home-care patient regarding different methods of increasing the effectiveness of airway clearance. The therapist may suggest all of the following techniques EXCEPT a. serial coughing b. pursed-lip breathing c. autogenic drainage d. huff coughing

b. change the electrode

A therapist is unable to obtain a reading with a galvanic-type oxygen analyzer when attempting to measure oxygen percentage inside an isolette while the red warning flag is active. The therapist should? a. replace the batteries b. change the electrode c. discontinue the red-flag warning system d. replace the electrolyte solution

b. stroke volume x heart rate

A therapist working in the cardiac care unit is asked to determine a patient's cardiac output. Which of the following calculations can best provide an estimate of cardiac output? a. VO2 x CaO2 x 10 b. stroke volume x heart rate c. ejection fraction x stroke volume d. C(a-v)O2 / cardiac index

A respiratory therapist observes a chest radiographic assessment that shows hyperlucency with no vascular markings on the right, and tracheal deviation to the left. There are no distinctive spaces between the vertebrae. The therapist should

obtain another chest-radiograph

After three weeks participating in a smoking cessation program, the patient's COHb is 12%. Which of the following can the respiratory therapist conclude? A. The patient should be dropped from the smoking cessation program B. The patient has been successful at quitting C. The patient is still smoking D. Nicotine replacement therapy medication should be decreased

While performing nasotracheal suctioning, the respiratory therapist notices excessive blood on the outside of the suction catheter upon removal, despite the use of water-soluble lubricant. The therapist should consider

using a nasal pharyngeal airway (a trumpet).

c. aerosolized Albuterol and Atrovent

An adult patient in the emergency room is wheezing bilaterally after multiple metered dose inhaler treatments with Albuterol at home. The patient may best benefit from which of the following? a. continous bronchodilator therapy with Albuterol at 3 mg/hr b. aerosolized Pulmicort( (Budesonide) c. aerosolized Albuterol and Atrovent d. aerosolized Atropine

d. switch to Albuterol

An adult patient with asthma is receiving Xopenex by small volume nebulizer T.I.D. at a dosage of 0.63 mg. The patient complains of dizziness, tingling in his fingers, and anxiety with each treatment. The therapist should a. switch to Atropine sulfate b. decrease dosage to 0.31 mg c. switch to cromolyn sodium (Intal) d. switch to Albuterol

b. excess water in the tubing

An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the oxygen coming from the end of the tubing and finds it is 60%. Which of the following most likely explains this finding? a. poorly calibrate analyzer b. excess water in the tubing c. low flow through the jet orifice d. leak in the tubing

An adult female complains of double vision, dysphasia, and fatigue. Symptoms improve with rest. The respiratory therapist notes the patient is drooling and is having difficulty enunciating words. Which of the following should the therapist recommend? A. Spinal tap B. Lateral neck x-ray C. Tensilon test D. Acute epiglottitis

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

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

A 65-year-old male patient has been ventilator dependent for several weeks. Weaning attempts have failed. The patient will be transferring to a long-term care facility where daily weaning trials will commence. Which of the following artificial airways would be most appropriate for the patient? A. nasal tracheal tube B. cuffed tracheostomy tube C. oral endotracheal tube D. nasal pharyngeal airway

Which of the following non-disposable equipment should be sterilized after use?

bronchoscope

A left-to-right shunt, due to a leaking septum wall in the heart, is best determined by an increase in mixed venous oxygen saturation. From what location would the respiratory therapist recommend blood extraction for analysis to determine mixed venous oxygen saturation? A. aorta B. pulmonary artery C. vena cava D. pulmonary vein

c. add 50 mL deadspace

An 84-kg (185-lb) 6-ft 1-in (185-cm) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: Mandatory rate: 16 VT: 600 mL FIO2: 0.5 PEEP: 10 cmH2O ABGs pH 7.46 / PaCO2 34 / PO2 100 / HCO3 24 / BE 0 Which of the following represents the most appropriate action? a. decrease PEEP b. decrease rate to 10 c. add 50 mL deadspace d. decrease VT to 500 mL

a. increase rate to 20

An 84-kg (185-lb) 6-ft 1-in (185-cm) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: Mandatory rate: 18.min VT: 600 mL FIO2: 0.4 PEEP: 5 cmH2O ABGs pH 7.28 / PaCO2 56 / PO2 71 / HCO3 27 / BE +3 Which of the following represents the most appropriate action? a. increase rate to 20 b. increase FIO2 to 0.5 c. increase VT to 650 d. increase PEEP to 8 cmH2O

c. perforation in the lung tissue

An adult male patient who is receiving volume-controlled ventilation has a chest tube drainage system in place with a chest tube in the right anterior lung. Suction pressure at the wall is set to 120 mmHg. The therapist notices profuse bubbling in the water seal chamber. The low volume alarm is sounding and the digital display on the ventilator indicates a return volume of 220 mL. Which of the following clinical conditions should the respiratory therapist suspect? a. leak in the tubing between the patient and the fluid collection chamber b. leak in the tubing between the fluid collection and water seal chambers c. perforation in the lung tissue d. leak in the ventilator circuit

Which of the following antimicrobial medication is best suited to treat a blood-borne organism that is gram-positive.

Amoxicillin

d. increase PEEP to 22 cmH2O

An 80-kg (176-lb) female patient is receiving mechanical ventilation on the following settings: Mode: assist/control Mandatory rate: 14/min Total rate: 14/min VT: 550 mL FiO2: 0.60 PEEP: 20 cmH2O ABG: pH 7.38 / PaCO2 42 / PaO2 62 / HCO3 26 / BE +2 The respiratory therapist should a. increase the FIO2 to 0.7 b. order a chest radiograph c. increase FiO2 to 1.0 d. increase PEEP to 22 cmH2O

c. combined metabolic and respiratory acidosis

Arterial blood gases on a patient in the cardiac intensive care unit are as follows: pH 7.10 / PaCO2 52 / PaO2 65 / HCO3 15 / BE -9 Which of the following represents an accurate interpretation of these results? a. metabolic compensated respiratory acidosis b. metabolic acidosis c. combined metabolic and respiratory acidosis d. respiratory acidosis

b. ensure the caregiver understands all instructions to perform the therapy

As part of the instruction of a 5-year-old child who will be using a small volume nebulizer at home, the respiratory therapist should also a. provide the patient with a telephone number that can be used to ask questions b. ensure the caregiver understands all instructions to perform the therapy c. have the patient record the treatments in a daily journal d. remind the child of the consequences of abusing the medication

Which of the following drugs can be administered through an endotracheal tube for the purpose of treating bradycardia?

Atropine

b. bronchoscopy

Auscultation of a child's breath sounds reveals unilateral wheezing in the right side. Which of the following should the respiratory therapist recommend to be most helpful to the patient? a. Salmeterol b. bronchoscopy c. Atropine D. Albuterol

A 39-year-old unconscious male is brought to the emergency room after a suspected suicide attempt. He was found in his garage with the car running and the exhaust vented to the interior portion of the vehicle. Which of the following should be examined immediately? A. SpO2 B. COHb C. homocysteine level D. MetHb

A neonate who was born at 38 weeks of gestation is receiving oxygen therapy by oxyhood and a heated aerosol device at FIO2 1.0. Arterial blood gases show pH 7.41 PaO2 98 torr PaCO2 40 torr HCO3- 24 mEq/L BE -1 mEq/L The respiratory therapist will recommend which of the following? A. Maintaining current therapy B. Decreasing FIO2 to 0.90 C. Placing infant on a mechanical ventilator D. Decreasing FIO2 to 0.50

A patient diagnosed with myasthenia gravis is receiving mechanical ventilatory support by an adult volume-ventilator. To determine if the disease has run its course, which of the following would be helpful information? A. MEP, LOC, Fev1 B. VT (spont), VC, MIP C. EMG, EEG, CSF D. FVC, TLC, VT

A patient in the emergency room (ER) is showing inverted T waves on the 12-lead ECG tracing. The physician is interested in decreasing the work of the heart. The respiratory therapist should suggest A. administration of Crytodigin (digitalis) B. oxygen by nasal cannula at 5 L/min C. oxygen by nasal cannula at 2 L/min D. adminsitration of Nitroclycerin (Isordil)

A patient with a history of congestive heart failure has been transferred to the cardiac intensive care unit with fulminating pulmonary edema, crepitations in the left lung field, and +3 pitting peripheral edema. A non-rebreathing mask is in place on the patient and the oxygen flow rate is set to 15 L/min. Which of the following would best resolve the patient's condition? A. administer Albuterol sulfate B. diurese the patient C. administer lactated ringers, IV D. administer aerosolized alcohol

A patient with pneumonia has thick secretions and is complaining of difficulty coughing and expectorating sputum. Which of the following should the therapist recommend as the most effective method of hydrating secretions? A. Cool aerosol treatments B. Oral consumptions of water C. Heated aerosol treatments D. Ultrasonic nebulizer treatments

An adult patient in the emergency department is febrile with a temperature of 40 deg C (104 deg F) taken rectally. Arterial blood gas analysis is done and the following results are reported with the patient breathing room air. The results are not corrected for temperature. pH 7.35 PaCO2 46 torr PaO2 80 torr HCO3- 26 mEq/L BE +1 mEq/L The respiratory therapist should recommend A. A cooling blanket B. Supplemental oxygen by nasal cannula at 5 L/min C. Non-invasive positive pressure ventilatory support (NIPPV) D. Ventilatory assistance with Bi-level

An infant delivered 2 hours prior is consistently cyanotic regardless of high levels of oxygenation administration. The physician would like to rule out patent ductus arteriosis. Which of the following tests should the respiratory therapist recommend A. Perform transillumination B. Compare PO2 values in the umbilical and brachial arteries C. Pass the feeding tube down both nares D. Insert a pulmonary artery catheter

In which of the following positions can the respiratory therapist expect to place a patient who will receive chest physiotherapy and postural drainage to address secretions found in the upper lobes, anterior segments of the lungs? A. Trendenlenburg - 30 degrees B. Supine position C. Prone position D. Trendelenburg - 15 degrees

The respiratory therapist notices a patient in the intensive care unit has a blood pressure of 110/80 mm Hg by arterial line and a blood pressure 120/85 when taken by sphygmomanometer with a cuff on the right arm. The therapist should A. replace the art line B. document the pressure taken by cuff C. document the pressure by arterial line D. replace the blood pressure cuff

The respiratory therapist reads a patient's medical record and notes a unilateral wheeze on the left is documented. Which of the following may be associated with this finding? A. bronchoconstriction B. bronchial carcinoma C. asthma D. vocal cord paralysis

Which of the following ABG results would the respiratory therapist expect to see for a patient who is experiencing an acute on chronic episode with known COPD? A. pH 7.33 PaCO2 55 mm Hg PaO2 52 mm Hg HCO3- 30 mEq/L B. pH 7.48 PaCO2 50 mm Hg PaO2 51 mm Hg HCO3- 34 mEq/L C. pH 7.28 PaCO2 62 mm Hg PaO2 49 mm Hg HCO3- 33 mEq/L D. pH 7.51 PaCO2 35 mm Hg PaO2 60 mm Hg HCO3- 29 mEq/L

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

Which of the following methods would be most helpful to a patient weaning from mechanical ventilation who has a documented restrictive pulmonary defect and has been having difficulty in recent weaning attempts? A. pressure control ventilation B. pressure support C. permissive hypercapnia D. T-piece trials of 24 hour periods several times a week

Which of the following parameters could be used to calculate tidal volume? A. PECO2 and VD/VT B. minute ventilation and respiratory rate C. PetCO2 and alveolar ventilation D. minute ventilation and alveolar ventilation

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

Which of the following would NOT increase if inspiratory flow is increased on a time-cycled ventilator and pressure is not limited? A. Tidal volume B. Total rate C. Expiratory time D. Inspiratory pressure

While performing a test discharge of a metered dose inhaler (MDI) prior to administering to a patient, the respiratory therapist is unable to visually confirm the discharge of any particles or aerosol. The therapist should A. Administer the dose to the patient B. Discard the canister, obtain a new MDI C. Shake the canister and administer the dose to the patient D. Utilize a chamber and administer the dose to the patient

While performing oxygen rounds, the respiratory therapist visits a patient who is ordered to receive 5 L/min by nasal cannula with a bubble humidifier. The therapist finds the oxygen flow meter is reading 0 L/min, even though the knob is not in the off position, and there is no flow to the patient. Which of the following may cause this? A. low water level in the humidifier B. clogged down-tube C. loose humidifier bottle D. large hole in the cannula

The head of 41-gestational week infant has just been delivered through the birth canal. The respiratory therapist notices meconium staining about the infant's face. Which of the following actions should the therapist recommend next A. begin chest compressions B. provide vigorous manual resuscitation C. perform deep tracheal suctioning D. place the infant on mechanical ventilation

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

A patient is receiving volume-controlled ventilation in the Assist/control mode at the following settings Mandatory rate 16 VT 550 mL FIO2 0.6 PEEP 22 cm H2O Recent arterial blood gases show pH 7.35 PaCO2 44 torr PaO2 68 torr HCO3- 26 mEq/L BE 0 mEq/L In response to the blood gas, PEEP is increased from 22 to 25 cm H2O. Immediately following the increase, cardiac index drops from 2.8 to 1.9. The therapist should now A. Perform an optimal PEEP study B. Increase FIO2 to 0.70 C. Decrease PEEP to 22 cm H2O D. Increase FIO2 to 1.0

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 expiratory time B. decrease inspiratory flow rate C. increase inspiratory flow rate D. increase I:E ratio

A patient receiving volume-controlled ventilation is coughing uncontrollably. The high-pressure alarm is sounding continuously. The respiratory therapist should first A. sedate the patient B. suction the patient C. provide the patient with manual ventilatory support D. silence the ventilator alarm, calm the patient's anxiety

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

A pulmonary rehabilitation patient is being monitored for compliance to a smoking cessation program. Which of the following values would be most helpful to evaluate? A. SPO2 B. PaO2 C. multiple wave-length spectrophotometry D. metHb

A radiological report is placed in the medical record that describes the results of a chest radiograph. The report indicates a batwing pattern. This finding is consistent with A. pneumonia B. atelectasis C. pulmonary edema D. pleural effusion

A respiratory therapist is initiating mechanical ventilation at the following settings and preferences: Mode Assist/control Mandatory rate 20 VT 500 mL FIO2 0.5 PEEP 5 cm H2O I:E 1:2 Which of following is the minimum inspiratory flow setting? A. 80 L/min B. 65 L/min C. 40 L/min D. 28 L/min

After analyzing arterial blood on a patient with a history of arterial blood gas analysis, the respiratory therapist concludes the results are not possible. They are very different than the patient's historical blood gas results. Quality control records show no evidence of any trends, shifts, or out-of-control situations in the last month. The therapist should A. Inform the physician of the suspect blood gas B. Ask the medical director for direction in this situation C. Repeat the analysis with the same blood sample and same analyzer D. Perform a two-point calibration on the analyzers

The respiratory therapist analyzes the oxygen percentage coming from the end of the aerosol tubing on a large-volume, nebulizer. The analysis shows a higher oxygen percentage than the set FIO2 on the air-entrainment device. Which of the following could be the reason for this disparity? A. depleted reservoir B. clogged down tube in the nebulizer C. kinked aerosol tubing D. leak in the aerosol tubing

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

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

Which of the following may be done to increase the effectiveness of gas distribution for a patient with ARDS who is receiving volume-controlled ventilation in the assist-control mode? A. Switch to SIMV mode B. Administer surfactant C. Use pressure-controlled ventilation D. Decrease the I:E ratio

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

Which part of a pulmonary function testing machine is being evaluated when performing quality control with a 3-liter syringe? A. internal electronic components B. mouthpiece and circuit C. pnemotachometer D. body box

While instructing a patient on the use of a volume-type incentive spirometer, the therapist observes the patient exhaling forcefully in the spirometer, but no volume is registering on the spirometer. The therapist should A. encourage the patient to exhale more forcefully B. switch to a flow-type incentive spirometer C. instruct the patient to inhale through the device D. obtain a new volume-type spirometer

A burn trauma patient who is also suspect for carbon monoxide poisoning is receiving oxygen therapy by a nonrebreathing mask. The respiratory therapist observes that the reservoir bag collapses completely with each inspiration. The therapist should A. remove the one-way valve in the reservoir B. continue current therapy as this is normal C. obtain a larger reservoir D. increase flow to the reservoir bag

While performing overnight CPAP/Bi-level titration on a patient previously diagnosed with obstructive sleep apnea, the respiratory therapist reviews the patient's medical record and notes an AHI of 65, observed during diagnostic polysomnography. Currently, the patient is receiving nasal mask CPAP at 9 cm H2O. The corresponding AHI is 22. The therapist should conclude that

CPAP pressure in insufficient

A 12-year-old patient diagnosed with bronchiectasis is receiving postural drainage and percussion to drain the basal segments of the right lung. While draining with the head of the bed down 30 degrees, the patient begins to exhibit signs of distress including frequent PVCs and a decrease in oxygen saturation. After discontinuing the therapy, the respiratory therapist should recommend A. Provide percussion with the bed flat B. Provide percussion with the head of bed up in semi-fowlers position C. Placing head of bed down only 15 degrees D. Administering therapy with an external percussive device (Vest)

A 38-year-old male patient presents to the emergency room with difficulty swallowing and double vision. He reports a history of Myasthenia Gravis at a prior time, but was never ventilator-dependent. He now has the following clinical data: Vital Capacity Tidal volume MIP 0.9 L 350 mL -22 cm H2O What should the respiratory therapist recommend? A. Atropine B. NRB mask C. manual ventilation D. Tensilon challenge

A 5-year-old child is brought to the emergency room (ER) with a fever and difficulty breathing. The patient is drooling but is making no vocal sounds. Which of the following procedures should the respiratory therapist recommend? A. bronchoscopy B. CBC C. inspection of the pharyngeal area with a tongue depressor D. lateral neck radiograph

A patient receiving heliox therapy at 80% / 20% mixture by nonrebreathing mask has a total flow of 18 L/min to the mask. The oxygen flow meter that is adapted to fit on the heliox tank is indicating a flow rate of 10 L/min. The therapist would best explain the difference to the physician by saying A. The heliox mixture has greater viscosity B. The oxygen flow meter is not compensated for back pressure C. The helium expands once delivered into the ambient pressure environment D. Helium is less dense and therefore reads a lower flow by an oxygen flow meter

A patient receiving oxygen therapy at home complains the oxygen concentrator is not working and that the flow feels insufficient. The respiratory therapist should A. instruct the patient to check the flow with a calibration tube B. tell the patient to call the manufacturer C. tell the patient everything is normal D. instruct the patient use back-up E cylinders until the concentrator can be examined

A patient receiving volume-controlled ventilation who was admitted 3 days prior for drug overdose is beginning to awake from a barbiturate-induced coma. There is no history of pulmonary disease in the patient's medical record. As the patient becomes alert, the respiratory therapist should recommend A. sedate the patient with Ativan B. perform pulmonary function testing C. interview the patient for family medical history of drug abuse D. begin following the ventilator weaning protocol

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 tidal volume to 700 cc B. decrease tidal volume to 400 cc C. increase PEEP to 10 cm H2O D. increase mandatory rate to 14

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

A patient, who is on a 3-chamber chest-tube drainage system, is receiving volume controlled ventilation in the assist/control mode. The low return volume alarm begins to sound. Which of the following should the respiratory therapist troubleshoot to determine the cause of the alarm? A. secretions in the airway B. excess condensate in the circuit C. loose circuit connection D. bubbling in the water seal chamber

A respiratory therapist has achieved the following weaning parameters on a post-operative patient who experienced a total knee replacement. The SpO2 is 97% on 35% oxygen. Spont VT 480 mL VC 1600 mL VE 7.0 L MIP -4 cm H2O The next best action would be to A. reduce FIO2 to 0.30 B. return to full mechanical ventilation C. evaluate the MEF D. check the pressure manometer for leaks

A respiratory therapist notes endotracheal suctioning is ineffective as the patient's secretions have become thick and tenacious. The patient is intubated with an 8.0 mm endotracheal tube and is being suctioned at a pressure of 100 mm Hg with a 10 Fr closed system suction catheter. Which of the following modifications in therapy would be most beneficial to the patient? A. Have the patient orally consume water B. Diurese the patient C. Increase suction pressure to 110 mm Hg D. Use a 12 Fr suction catheter

A victim of a multiple trauma motorcycle accident is receiving mechanical ventilation and has chest tubes inserted in the right lung. The respiratory therapist notices gentle bubbling in the water-seal bottle and a small amount of fluid dripping into the fluid collection bottle. The following data is also available: Mode Assist/control Mandatory rate 18 Total rate 18 VT (set) 550 mL VT(exhaled) 534 mL Peak pressure 28 cm H2O Plateau pressure 18 cm H2O The therapist should A. suction the patient B. clamp the chest tube(s) near the patient C. troubleshoot the chest tube drainage system D. continue current therapy

After confirming the blood gas analyzer is "in control", the respiratory supervisor introduces arterial blood from a patient breathing room air and obtains the following results: pH 7.39 PaCO2 41 torr PaO2 210 torr HCO3- 24 mEq/L BE -2 mEq/L Which of the following should the respiratory therapist investigate? A. Fluid level of the reference electrode B. Membrane integrity of the Severinghaus electrode C. Membrane integrity of the Sanz electrode D. Function of the Clark electrode

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. maternal history of barbiturate abuse B. pulmonary immaturity C. hormone imbalance D. problem with bilirubin level

At patient in pulseless ventricular tachycardia is receiving chest compressions while being orally intubated. Immediately after ET tube insertion, the respiratory therapist checks breath sounds and notices vesicular sounds bilaterally. The therapist should next do which of the following: A. remove the ET tube and attempt nasal intubation B. withdraw the ET tube by 2 cm, observe chest rise C. advance the ET tube and auscultate the chest D. recommend a chest radiograph

The respiratory therapist should gather which of the following equipment in preparation for the administration of heliox therapy? A. non-rebreathing mask B. air/oxygen blender C. air flow meter D. face tent

The correct answer is : A Explanation : Helium-oxygen therapy requires a non-rebreathing mask for delivery.

During the weaning process of a 70 year-old patient, the respiratory therapist notes the following ventilator settings and clinical information: Mode SIMV Mandatory rate 8 Total rate 28 VT 500 mL VT(spont) 220 mL FIO2 0.4 PEEP 5 cm H2O The respiratory therapist should do which of the following? A. increase rate B. increase set VT C. discontinue PEEP D. add pressure support

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

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 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. decrease manual ventilation rate B. administer Verapamil C. increase manual ventilation rate D. sodium bicarbonate administration

The respiratory therapist is determining the proper size of an oropharyngeal airway on a patient who is orally intubated. Which of the following methods will be helpful in properly estimating the appropriate size of the airway? A. determine the patient's ideal body weight in kilograms B. examine the distance between the earlobe and nasal septum C. determine the age and sex of the patient D. examine the distance between the angle of the jaw and tip of the chin

The respiratory therapist is performing a preoperational test of a ventilator. The therapist notices the return volume is 200 mL less than the set tidal volume. The therapist should A. tag the ventilator as non-functional and isolate it from functional equipment B. notify the medical director and seek advice C. accept the results and place the ventilator into service D. check for a leak in the circuit or the circuit's connections

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

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

While performing a routine ventilator a check on a patient with a balloon-tipped flow-directed pulmonary artery catheter in place, the respiratory therapist notices the inflection points on the waveform indicate the tip of the pulmonary artery catheter is improperly placed in the right ventricle. To correct this problem, the therapist should recommend A. recording the pulmonary artery pressure as shown on the waveform B. removing the catheter and inserting a new one C. twisting the catheter until pulmonary artery pressures are observed D. inflating the balloon and advancing the catheter

Which of the following is most appropriate for handling biohazardous material?

Discard by using red bags and containers marked biohazard.

a. examine the ventilator circuit for proper connections

During a preoperational test of the ventilator with a test lung, the respiratory therapist notes a return tidal volume of 600 cc. Ventilator settings are: Mode: Assist/control FiO2: 0.50 Mandatory rate: 10 VT: 750 mL What action should the therapist take? a. examine the ventilator circuit for proper connections b. obtain a larger test lung c. increase the set tidal volume to 900 mL d. obtain a smaller test lung

a. begin CPR

During the administration of an IPPB treatment, the patient becomes unresponsive and develops the ECG rhythm as shown below. Which of the following is the best initial action? a. begin CPR b. connect a pacemaker c. arterial blood gas analysis d. defibrillate at 50 joules

d. change the fuel cell

During the preoperational test of the ventilator, the respiratory therapist notices the galvanic analyzer on the ventilator is reading erroneously low. Which of the following can the respiratory therapist do to correct the problem? a. replace the analyzer batteries b. replace the electrolyte solution in the analyzer c. tag the ventilator as non-functional and avoid placing it in service d. change the fuel cell

b. Ballard

Which of the following should be used to determine the gestational age of a neonate? a. lung compliance b. Ballard c. APGAR d. request the information from the mother

d. inspiratory muscle strength

Evaluating MIP (maximum inspiratory pressure) is most useful in evaluating which of the following? a. presence of a restrictive pulmonary defect b. effectiveness of cough c. presence of obstructive pulmonary defect d. inspiratory muscle strength

a. autoPEEP

For a patient receiving volume-controlled ventilation in the assist/control mode, the starting of the inhalation cycle before the expiratory flow rate returns to zero would result in which of the following? a. autoPEEP b. atelectasis c. alveolar collapse d. decreased FRC

b. cystic fibrosis

For which of the following conditions is chest wall oscillation therapy most beneficial? a. ARDS b. cystic fibrosis c. drug overdose d. Guillain-Barre syndrome

a. cancerous mass in the lung

For which of the following is the respiratory therapist observing if obtaining a series of oblique chest radiographs? a. cancerous mass in the lung b. pneumonia c. pneumothorax d. pleural effusion

b. administer 2 units of blood

Four hours after a quadruple coronary artery bypass graft, a patient's blood pressure is 90/50 mmHg and the patient is ashen in color. The following data is also available: PAP: 10 mmHg PCWP: 5 mmHg CVP: 1 mmHg The patient could benefit most from which of the following? a. adminster normal saline, IV b. administer 2 units of blood c. an echocardiogram d. Lasix (furosemide)

Hemoximetry can be used to determine which of the following levels?

c. CVP

Hypovolemia would first be manifested in which of the following values? a. PCWP b. PAP c. CVP d. PVR

a. airway is too long

Immediately after inserting a nasal pharyngeal airway, the patient begins to cough uncontrollably. Which of the following is the most likely cause? a. airway is too long b. airway diameter is too large c. too much water-soluble lubricant was used d. patient has significant sputum in the upper airway

c. report to the hospital or call an ambulance

In response to an Asthma action plan, the patient has attempted to contact their physician after determining peak flow measurement is less than 50% of the patient's usual baseline value. The physician is not responding to the call. According to NAEP guidelines, the patient should NEXT a. take a short-term bronchodilator and contact a different physician b. take a short-term bronchodilator, check peak flow in 1 hour c. report to the hospital or call an ambulance d. take a corticosteroid inhaler and check again in 20 minutes

a. report the problem to the supervisor

In spite of repeated attempts, a respiratory therapist is unable to obtain successful quality control values on a blood gas analyzer. The therapist should a. report the problem to the supervisor b. continue running quality control samples c. inform the medical director d. place the machine in service but monitor closely

A COPD patient who is receiving 1 L/min by nasal cannula becomes short of breath after ambulating to the bathroom and back. The patient indicates she is having difficulty catching her breath more than usual. Her respiratory rate is 22/min. The respiratory therapist should do which of the following to help the patient return to her normal breathing status?

Increase oxygen flow rate to 3 lpm.

Which of the following electrolyte values is not within range? Na+ 135 mEq/L HCO3- 23 mEq/L K+ 5.5 mEq/L Cl- 101 mEq/L

K+

c. cardiac index

L/min/m2 is the unit of measure for a. stroke volume b. cardiac output c. cardiac index d. systemic vascular resistance

A patient has congestive heart failure and fluid overload. Which of the following agents will help to decrease the pre-load pressure of the right atrium in the heart?

Lasix (furosemide)

d. cardiac output and wedge pressure

Left heart failure would be manifested in which of the following values? a. MAP and SVR b. CVP and mPAP c. mPAP and wedge pressure d. cardiac output and wedge pressure

A patient is about to go to surgery for nasal reconstruction and will be orally intubated for the procedure. The respiratory therapist determines that the patient is likely to be very difficult to intubate based on an anatomical assessment of the upper oropharynx. Maximum intubation difficulty would be associated with a(n)

Mallampati classification of 4.

A 32-year old, 73-kg (161-lb), 178-cm (5 ft, 10 in) male patient is receiving VC ventilatory support on the following settings with the following ABG results: Mode SIMV VT 400 mL(f) 12/min PEEP 5 cm H2O FIO2 0.45 ABGs pH 7.29 PaCO2 50 mm HgPaO2 81 torr HCO3- 24 mEq/L BE -5 mEq/L The respiratory therapist should make which of the following observations about the patient's condition?

Minute ventilation is too low.

A patient who has chest tubes in place for the treatment of a pneumothorax does not breathe deeply despite active coaching by the respiratory therapist. The patient indicates he is unable to do so. The therapist should assess

Pain Level

A gram-positive organism is identified in the blood of patient who has bacterial pneumonia and who is penicillin-resistant. Which of the following antimicrobials would be most suitable for treatment?

Oxacillin

A physician suspects a patient is transitioning into ARDS. Which of the following calculations and or data would be helpful in evaluating the patient for this suspicion?

PF ratio and oxygen index

The patient has a PetCO2 that has been decreasing over the last several hours while PaCO2 roughly remains unchanged. Vd/Vt has been climbing and is currently at 38%. Which of the following can be concluded?

Physiological dead space is increasing.

d. Run 2 only

Quality control material has published values for pH of 7.20, PO2 of 65 mmHg. Documentation indicates the range of pH is 0.5% and is 3% for PO2. Machine results are as follows: Run 1: pH 7.19, PO2 64 Run 2: pH 7.10, PO2 69 Run 3: pH 7.21, PO2 65 Which quality control run(s) indicate the machine is out of control? a. Run 1 and 2 b. Run 2 and 3 c. Run 3 only d. Run 2 only

During endotracheal suctioning of a patient with a closed-system suction catheter (BallardÒ), the respiratory therapist observes the following ECG rhythm on the monitor. The therapist could do which of the following to prevent the rhythm in the future?

Reduce applied suction duration.

Which of the following pulmonary function tests would be most helpful in determining the presence of restrictive lung disease?

SVC

a. chest radiograph

Which of the following should the respiratory therapist use to determine the effectiveness of hyperinflation therapy of a patient who is post operative for a partial lobectomy and who has atelectasis? a. chest radiograph b. FEF 25-75 c. FEF 200-1200 d. DLCO measurements

c. proximal to the tip

The balloon on a balloon-tipped, flow-directed pulmonary artery catheter may be found a. mid-catheter b. distal to the tip c. proximal to the tip d. proximal to the transducer

An external air compressor is being used to provide pressure to a transport ventilator. The respiratory therapist notices a frayed electrical cord on the compressor. Which of the following should be done?

The compressor should be removed from service.

A patient presents to the emergency room with clear lung sounds, but a high-pitched noise is present during inspiration in the upper airway. This finding is most closely associated with A. stridor. B. bronchospasm. C. wheezing. D. a fixed upper airway obstruction.

The correct answer is : A Explanation : A high-pitched noise in the upper airway is also known as stridor. Stridor is related to inflammation in the upper airways resulting in a narrowing passageway for air movement. In some cases this is life-threatening.

Arterial blood gases on a patient in the emergency department are as follows: pH 7.29 PaCO2 51 mmHg PaO2 70 mmHg HCO3- 25 mEq/L BE +4 mEq/L Which of the following represents an accurate interpretation of these results? A. uncompensated respiratory acidosis with mild hypoxemia B. compensated metabolic alkalosis C. uncompensated metabolic acidosis with moderate hypoxemia D. ketoacidosis with hypoxemia

The correct answer is : A Explanation : A look at the CO2 reveals an elevation. When we glance at the pH we see that there is no compensation, thus making the problem acute uncompensated respiratory acidosis. Additionally, we see the patient is mildly hypoxic. This, mild hypoxemia and respiratory acidosis is the correct interpretation for this patient.

A patient is receiving non-invasive positive pressure ventilation with an IPAP of 20 and an EPAP of 10 cm H2O. Which of the following changes would remedy the patient's snoring while asleep? A. increase EPAP B. decrease IPAP C. decrease EPAP D. increase IPAP

The correct answer is : A Explanation : A patient who has signs of obstructive sleep apnea, such as snoring, would benefit most from increased expiratory pressure. This continuous pressure combats obstruction caused by relaxation of upper airway tissues.

Which if the following is appropriate regarding suctioning? A. Increase suction duration within limits for thick secretions B. use a suctioning catheter diameter size less than 5/6th of the ETT diameter C. apply intermittent suctioning during withdrawal of the catheter D. ventilator patients should be suctioned every two hours

The correct answer is : A Explanation : A suction catheter should not exceed 1/2 the internal diameter of an artificial airway. Suctioning should be done as needed and not on a routine schedule for mechanically ventilated patients. It is appropriate to increase the suction duration to manage thick tenacious secretions. It is also appropriate to decrease the suction duration for a patient who is experiencing serious side effects related to suctioning.

Which of the following assessment criteria all relate to APGAR scores? A. grimace, pulse, appearance, color B. respiratory rate, breath sounds, heart auscultation, cough C. SpO2, grunting, nasal flaring, retractions D. cord blood gas, glucose, coombs test, billirubin

The correct answer is : A Explanation : APGAR (appearance, pulse, grimace, activity, and respiratory effort) is done on every newborn after 1-minute and after 5-minutes of life.

In response to an Asthma action plan, the patient has attempted to contact their physician after determining peak flow measurement is less than 50% of the patient's usual baseline value. The physician is not responding to the call. According to NAEP guidelines, the patient should NEXT A. report to the hospital or call an ambulance B. take a corticosteroid inhaler and check again in 20 minutes C. take a short-term bronchodilator, check peak flow in 1 hour D. take a short-term bronchodilator and contact a different physician

The correct answer is : A Explanation : According the national asthma guidelines, a self monitored peak flow of 50% of baseline is an indication to contact one's physician. However, if one's physician is not available, the patient should report to the hospital or to the emergency room or call an ambulance.

For which of the following responses to therapy should a respiratory therapist discontinue aerosolized albuterol? A. bleeding gums B. heart rate increases by 10 beats per minute C. patient reports no change in dyspnea D. poor cooperation by a 2-year-old patient

The correct answer is : A Explanation : Bleeding from the mouth, nose, or gums is a rare but serious symptom of an allergic response to albuterol.

A 36-week gestational age infant delivered 2 hours prior shows signs of ventilatory distress including grunting. In preparation for oxygen administration at 40% by oxygen hood, the therapist should utilize which of the following devices? A. aerosol heater B. isolette C. bubble humidifier D. heat-moisture exchanger

The correct answer is : A Explanation : Because maintaining adequate body temperature in an infant is paramount, inspired gases should be heated and humidified. This can best be accomplished through the use of an aerosol heater.

During morning ventilator rounds, the respiratory therapist observes the following results of an arterial blood gas done 1 hour prior with the patient receiving volume-controlled ventilation. pH 7.53 PaCO2 39 torr PaO2 85 torr HCO3- 19 mEq/L BE +8 mEq/L FIO2 0.45 SaO2 97% The respiratory therapist should suspect an error in recording which of the following values? A. HCO3- B. pH C. BE D. PaCO2

The correct answer is : A Explanation : Because the arterial blood gas results show a PaCO2 of 39 mmHg but the pH shows alkalosis, the problem must be metabolic rather than respiratory. This would mean that the bicarbonate must be very elevated. However, when we look at the bicarbonate it is nearly normal at 26 mEq/L. This would suggest an error in the recording of the HCO3-.

A respiratory therapist desires to modify the therapy of a patient who is receiving 2.5 mg of Albuterol via mouthpiece every 2 hours via small volume nebulizer because the patient has experienced cardiac palpitations and a headache. What is the appropriate modification in this scenario? A. Discontinue therapy. B. Change to 1.25 mg Proventil. C. Reduce the frequency. D. Reduce the dosage.

The correct answer is : A Explanation : Because the patient has not tolerated the therapy, the respiratory therapist should discontinue it and notify the ordering physician. A note about the patient's tolerance should also be made in the medical record.

Which of the following should be prevented with the proper application of cricoid pressure during manual bag/mask ventilation prior to intubation? A. gastric insufflation B. tachycardia C. pneumothorax D. right mainstem intubation

The correct answer is : A Explanation : By applying proper cricoid pressure, the rigid rings of the trachea are indirectly pressed down over the esophagus, which blocks air from entering the stomach during mask ventilation, and further prevents gastric contents from entering the oropharynx.

Which of the following equations would determine cardiac index? A. (stroke volume x heart rate ) / BSA B. C.O. x ejection fraction C. stroke volume x heart rate D. C.O. / stroke volume

The correct answer is : A Explanation : Cardiac index can be determined by taking the cardiac output and dividing it by the body surface area. In these equations cardiac output divided by body surface area is not offered. However if you look closely stroke volume times heart rate is another way of calculating cardiac output therefore stroke volume multiplied by the heart rate divided by the body surface area will achieve cardiac index.

A bronchoscope has been used on a patient with a staphylococcus infection. To properly sterilize the equipment, perform a A. 15 minute soak in 13-day-old Cidex B. steam autoclave C. 1 hour soak in 30-day-old Sonacide D. 3 minute soak in one-day-old Sonacide

The correct answer is : A Explanation : Cidex, or alkaline glutaraldehyde, is most commonly used for bronchoscopy sterilization. A 10-hour soak is best, but all bacteria will be destroyed within 10 min. In this example, the primary concern is Staphylococcus, a bacteria. Alkaline glutaraldehyde must be changed no later than every 14 days.

After 15 seconds following birth, a neonate presents with vigorous crying and a strong cough. Obvious secretions and amniotic fluids are present from the airway and stomach. The baby has peripheral cyanosis. You would FIRST A. suction the mouth. B. check the heart rate. C. suction the nose. D. provide blow by oxygen.

The correct answer is : A Explanation : Clearing the oropahrynx or mouth of a newborn is a first step to prevent the baby from aspirating the secretions. Following the suctioning of the mouth, one should also gently suction the nose.

Which of the following tests would be most helpful at diagnosing a patient with cystic fibrosis? A. sweat chloride test B. pulmonary function studies C. calorimetry D. metabolic studies

The correct answer is : A Explanation : Cystic fibrosis is primarily diagnosed with a simple test called a sweat chloride test.

The following arterial blood gas values are reported for a patient with emphysema receiving 3 L/min nasal cannula: Day 1 Day 2 Day 3 Day 4 pH 7.39 7.35 7.31 7.27 PaCO2 (torr) 55 57 59 61 PaO2 (torr) 55 60 65 70 What is the appropriate action? A. reduce O2 to 2 L/min B. calibrate the blood gas analyzer C. place on venture mask at 30% D. maintain current therapy

The correct answer is : A Explanation : Days 3 and 4 show that the patient's PO2 is increasing toward a normal range but that CO2 is climbing above the normal level for the patient. This is best manifested starting on day three with a low pH. This data suggests that the patient is receiving too much oxygen. Oxygen should be reduced to 2 L/min.

Two days prior an 85 kg (187-lb), 168-cm (5-ft 6-in) female patient was placed on mechanical ventilation for acute respiratory failure secondary to pulmonary hypertension. She has the following data after a one-hour spontaneous breathing trial at an FIO2 of 0.40. pH 7.35 PaCO2 45 torr PaO2 75 torr HCO3- 24 mEq/L Respiratory Rate 34 VT 375 ml What should the respiratory therapist do FIRST A. Place the patient on PCV B. Discontinue mechanical ventilation C. Increase FIO2 to 0.50 D. Extubate and provide continuous Albuterol therapy

The correct answer is : A Explanation : In this case we are asked to assess whether or not a patient is successfully weaning during a trial period. The blood gases are generally acceptable along with tidal volume, however, the respiratory rate is too high and the patient has failed the trial. Therefore, the only option that returns the patient to mechanical ventilation is to place the patient on PCV. The therapist may be uncomfortable with this mode of ventilation, but it is the best choice because it addresses ventilation, the first of the vital functions of life.

A patient with CHF has the following input/output history Yesterday Today IN 2800 mL 2300 mL OUT 1200 mL 1100 mL This data is most consistent with A. hypervolemia B. decreased CVP C. increased left end-diastolic pressure D. hypovolemia

The correct answer is : A Explanation : In this problem it is obvious over the course of two days that the patient is taking in more fluid than he is putting out. This must mean the patient is retaining fluid and is therefore hypervolemic.

Which of the following weaning parameters would NOT be useful in determining whether the patient is ready for cessation of mechanical ventilation for a 75-kg (165-lb) male patient? A. MVV of 75 L in 15 seconds B. Vital capacity of 650 mL C. Spontaneous tidal volume of 375 mL D. PaCO2 increase of 8 torr during weaning trial

The correct answer is : A Explanation : MVV, or maximum voluntary ventilation is a test completed during a complete pulmonary function evaluation. It is not a part of weaning parameters assessed on mechanically ventilated patients. It is also a test that should be completed on patients who are otherwise healthy and in their best condition, not a critically ill patient receiving mechanical ventilation. The other tests are appropriate to assess when deciding to terminate mechanical ventilation.

During the assessment of a 3-year-old child, the respiratory therapist auscultates wheezing over the right lung field with normal breath sounds heard over the left. This finding is most consistent with A. foreign body aspiration B. croup C. unilateral bronchoconstriction D. diaphragmatic hernia

The correct answer is : A Explanation : Normally, bronchial constriction results in bilateral wheezing. The presence of wheezing on only one side of the lungs is most often related to foreign body aspiration.

In preparation for a patient who will be receiving oxygen by nasal cannula at 2 L/min at home, the respiratory therapist should recommend which of the following devices for primary oxygen delivery? A. molecular sieve device B. bank and manifold of H tanks C. 3-5 E cylinders D. bulk liquid oxygen conversion system

The correct answer is : A 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.

What would the respiratory therapist exclude in an education plan for a patient going home after abdominal surgery? A. peak-flow monitoring B. incentive spirometry C. incision splinting D. effective cough technique

The correct answer is : A Explanation : Peak-flow monitoring is for asthma patients, not post-operative care.

Predicted Observed TLC (liters) 4.90 3.30 FRC (liters) 2.55 1.80 SVC (liters) 3.30 1.90 FEV1 (liters) 2.10 1.90 FEF50 (liters/sec) 3.80 3.70 Which of the following represents the most appropriate interpretation of the preceding spirometry results? A. kyphoscoliosis B. normal C. chronic bronchitis D. emphysema

The correct answer is : A Explanation : Pulmonary function data indicates normal flows, which means the patient is not obstructive. Flows however, are diminished significantly as shown by a decreased SVC. This means the patient has a restrictive lung defect. To find the correct answer, we must look for that disease which is restrictive. Of those offered, only kyphoscoliosis is restrictive.

A 28-week gestational age infant is receiving ventilatory support by a high frequency oscillation ventilator (HFOV) after being administered surfactant to treat severe IRDS. Heart rate is 150/min and blood pressure is within normal limits. Arterial blood gas results on high frequency ventilation are as follows: pH 7.25 PaCO2 65 torr PaO2 62 torr HCO3- 27 mEq/L BE + 1 mEq/L The respiratory therapist should recommend A. increasing oscillatory amplitude B. decreasing expiratory pressure C. increasing FIO2 D. decreasing driving pressure

The correct answer is : A Explanation : The arterial blood gas on this patient shows hypoventilation but adequate oxygenation. To correct this, the oscillatory amplitude should be increased on the high-frequency ventilator. Oscillatory amplitude is related to tidal volume.

A patient has an Hb level of 6.0 g/dL and the following blood gas results: pH 7.55 PaCO2 27 mmHg PaO2 110 mmHg HCO3- 24 mEq/L BE 0 mEq/L Which of the following is an accurate statement? A. hyperventilation secondary to hypoxemia is present B. hyperoxemia is present C. patient has respiratory acidosis D. metabolic alkalosis is present

The correct answer is : A Explanation : The first thing we see on this patient is that the hemoglobin is low. When a patient's hemoglobin is low they suffer from hypoxemia regardless of their PaO2. In this case the patient's PaO2 is high. They are also over ventilating as a result of the hypoxemia that is present due to the low hemoglobin. The best interpretation of this condition is hyperventilation secondary to (caused by) hypoxemia.

A patient is being paralyzed and intubated in preparation to receive positive pressure ventilation with a volume-cycled ventilator in the control mode. Which of the following alarm settings is most important? A. low PEEP alarm B. high-pressure alarm C. low minute ventilation alarm D. low return-volume alarm

The correct answer is : A Explanation : This is a difficult question. When a patient is intubated after being paralyzed, they do not have the ability to signal or perform any kind of physical manifestation should they accidentally become disconnected from the ventilator. Thus, a ventilator alarm is paramount. The most sensitive alarm that would signify an accidental disconnection is the low PEEP alarm. On some ventilators this is called the disconnect alarm. Keep in mind, this alarm is more sensitive than the low pressure or low-volume alarms. In other words, the low PEEP alarm responds faster than any other alarm when a disconnection has occured.

After a motor vehicle accident causing blunt trauma to the chest, a male patient in the emergency room has air beneath the skin about the chest, neck and face. What would the respiratory therapist expect to auscultate in the affected areas? A. Dry crackles throughout B. Moist crackles upon expiration C. Moist crackles throughout D. Dry end inspiratory crackles

The correct answer is : A Explanation : This patient is experiencing subcutaneous emphysema secondary to chest trauma. The most common sign associated with subcutaneous emphysema is dry crackles upon auscultation. Moist crackles are associated with pulmonary edema or secretions in the airways. Dry end inspiratory crackles are associated with atelectasis.

A respiratory therapy supervisor is responsible for making suggestions in the initial development of a smoking cessation program. Which of the following would be part of an effective smoking cessation program? A. nicotine replacement therapy B. daily completion of an asthma action plan C. removing pulmonary irritants from the house D. daily COHb analysis

The correct answer is : A 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.

A respiratory therapist notes the word cachectic used in the medical documentation to describe a patient. This is most consistent with A. obesity B. a wasted appearance C. obtunded D. non-attentiveness

The correct answer is : B Explanation : The word "cachectic" refers to a wasted appearance, skinny, and poor skin turgor. A person with AIDS or pulmonary tuberculosis may demonstrate this.

A patient presents to the emergency room with shortness of breath and severe nasal/sinus congestion. SPO2 on air is 86%. She is placed on a nasal cannula at 4 L/min but complains that she cannot breathe through her nose. The therapist should A. change to a 35% air-entrainment mask B. change to 100% cool aerosol mask C. increase to 6 L/min nasal cannula D. change to a 40% venture mask

The correct answer is : A Explanation : When a patient's nose is occluded with secretions or for any other reason a nasal cannula may not be appropriate. Switching to a mask will allow gases to be delivered by mouth. The FIO2 coming from a nasal cannula is approximately 3 to 4% per liter. Thus, a 35% Venturi mask most closely approximates the FIO2 of a nasal cannula running at 4 L/min.

A patient receiving oxygen by nasal cannula at 5 L/min complains of dryness of the nasal passages. The respiratory therapist notices the patient is using a bubble humidifier and that the reservoir is one quarter full. The respiratory therapist should help the patient by A. Adding sterile water to the reservoir B. Applying a petroleum based ointment to the patient's nares C. Switching to a Venturi mask D. Utilizing a heated cascade humidifier

The correct answer is : A Explanation : When receiving flows greater than 1-2 liters per minute by nasal cannula, patients have a tendency to experience a drying of the nasal mucosal tissues. To combat thi,s humidification of the delivered gas by a bubble humidifier is appropriate. In this case, the patient's humidifier reservoir is nearly empty. As the bubble humidifier loses water its effectiveness decreases significantly because there is less distance from the bubbles to travel from the bottom of the humidifier to the top water level. Ensuring an adequate level of sterile water in the reservoir is important.

What is the maximum negative pressure that should be used to suction a 4-year-old patient who is intubated with a 5.0 mm endotracheal tube? A. -100 mm Hg B. - 80 mm Hg C. -110 mm Hg D. -120 mm Hg

The correct answer is : A Explanation : When suctioning, use the following indicated "gauge" pressures: _x000D_ Adult: 100-120 mm Hg (negative), Pediatric: 80-100 mm Hg (negative), Infant: 60-80 mm Hg (negative)

In order for a patient with a fenestrated tracheostomy tube to feel the least amount of airway resistance while breathing spontaneously, what should the respiratory therapist recommend? A. deflate cuff, remove inner cannula, cap tube B. deflate cuff, remove inner cannula, remove cap C. inflate cuff, insert inner cannula, remove cap D. inflate cuff, remove inner cannula, cap tube

The correct answer is : B Explanation : A fenestrated tracheostomy tube has an inner cannula with a hole to facilitate talking and weaning. It also has an inner cannula for resuscitation, or mechanical ventilation. The cuff is like that of an endotracheal tube, low-pressure, high-volume. And finally, a cap is used to close the tube for speech therapy. When the cap is used, the inner cannula should be removed and the cuff should be deflated.

A 30-week gestational age infant is experiencing respiratory distress within an hour after delivery. A chest radiograph shows bilateral radiolucency with a ground glass appearance. Which of the following would be most beneficial in the care of the patient? A. Atropine B. Survanta (beracant) C. Aminophylline D. Albuterol sulfate

The correct answer is : B Explanation : A ground glass appearance on an infant's x-ray is indicative of lung immaturity. This may be treated with surfactant therapy. Of the options listed, only Survanta is a surfactant agent.

Which of the following clinical data can be obtained from a patient who is comatose? A. dyspnea level B. oxygenation status C. subjective information D. vital capacity

The correct answer is : B Explanation : A patient who is comatose is unable to comply with verbal commands. Of the options offered, the only data that requires compliance to a verbal command is "vital capacity".

A 49-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. Which of the following should be recommended first? A. arterial blood gas analysis B. 100% oxygen by cool aerosol C. 10 L/min partial-rebreathing mask D. COHb analysis

The correct answer is : B Explanation : A patient who was found in a garage with a vehicle running should be suspected for carbon monoxide poisoning. The treatment for carbon monoxide poisoning is maximum FIO2. This could be accomplished by use of a 100% cool aerosol.

Which of the following diagnostic procedures should the respiratory therapist recommend for a patient who presents in the emergency department (ED) with shallow, irregular respirations and paradoxical chest movement on the right side? A. bedside pulmonary function studies B. portable chest radiogram C. vital capacity (VC) and maximum inspiratory pressure (MIP) measurement D. maximum voluntary ventilation

The correct answer is : B Explanation : A patient with paradoxical chest movement is most likely suffering from fractured ribs. The source of the paradoxical movement may be confirmed by a chest radiograph.

A patient is in the intensive care unit receiving volume-controlled ventilation and is hemodynamically unstable. A new balloon-tipped, flow-directed, pulmonary artery catheter has been placed. The pulmonary artery waveform on the monitor is rising and falling with inflection points at 25 mmHg and 8 mmHg. Which of the following can the respiratory therapist conclude about the positioning of the pulmonary artery catheter? A. the catheter should be withdrawn B. the catheter is properly positioned C. the balloon should be deflated D. the catheter should be advanced

The correct answer is : B Explanation : A pulmonary artery catheter should be placed so that the distal end rests in the pulmonary artery. When monitoring the pressure in the pulmonary artery, we may look at mean pressures or the data may be in the form of a systolic and diastolic pressure. In this case, the systolic pressure of 25 mmHg is given and the diastolic pressure is 8 mmHg. This indicates that the pulmonary artery catheter is properly placed.

In preparation for an arterial puncture in the right radial artery, the respiratory therapist performs a modified Allen's test. When the ulnar artery is released, color returns to the hand in 35 seconds. The therapist should A. perform the puncture in the right radial artery B. perform an Allen's test on the left ulnar and radial arteries C. perform a brachial artery puncture D. perform a femoral artery puncture

The correct answer is : B Explanation : An Allen's test is an assessment for collateral blood flow in to the hand in preparation for a radial arterial puncture. The presence of bilateral blood flow into the hand reduces risk of the arterial puncture because there is another source of blood if the radial artery is damaged. The procedure occurs by occluding both the radial and ulnar artery and allowing the hand to blanche or the blood to leave the hand. When the ulnar artery is released the amount of time required to not color in the hands is observed. Blood must return in under seconds. A duration of 35 seconds is too long in indicates poor blood flow through the ulnar artery. This would suggest an alternative site should be considered.

While coaching a patient on the use of a volume-type incentive spirometer, the respiratory therapist notices the patient is exhaling forcefully into the mouthpiece and that there is no rise of the indicator (no volume is achieved). The therapist will provide which of the following instructions? A. "perform an inspiratory capacity maneuver" B. "inhale as deeply as possible" C. "exhale more forcefully" D. "breathe in and out rapidly"

The correct answer is : B Explanation : An incentive spirometer is a device that measures the inspiratory capacity of a patient and therefore requires the patient to perform an inspiratory maneuver. In this case, the patient is found to be exhaling into the device rather than inhaling. Appropriate instruction should be provided to correct the problem.

A respiratory therapist notes during a ventilator/patient check that the RAW is lower than in previous assessments. One explanation for this change is a reduced A. waveform. B. flowrate. C. fever. D. I:E.

The correct answer is : B Explanation : As flow rate increases airway resistance also increases due to the turbulence of air movement. Therefore, reductions in flow rate will likewise reduce airway resistance.

A known COPD patient presents to the emergency room with extreme shortness of breath and copious amounts of thick, yellow sputum produced over the past three days. Respiratory rate is 32/min. ABGs on 1 L/min nasal cannula are: pH 7.45 PaCO2 47 torr PaO2 49 torr HCO3- 33 mEq/L BE +4.1 mEq/L The proper interpretation for the arterial blood gas is A. compensated metabolic alkalosis B. compensated respiratory acidosis C. the blood gas analysis is in error D. compensated respiratory alkalosis

The correct answer is : B Explanation : At first, the respiratory therapist may believe that the patient has experienced alkalosis because the pH is on the high-end of the normal range. However, with a closer review you will see that the patient has a very high HCO3-, is known to have COPD, and is likely experiencing an acute on chronic episode. This is further confirmed with a very low PaO2 of 47 torr. In fact, the low oxygen status is causing a much higher than normal minute ventilation due to air hunger. This is the cause of the pH being in the high-end of the range. The patient's normal blood gas values probably show a pH on the low side of the range, a high PaCO2, with a high HCO3-.

A patient is receiving continuous oxygen by transtracheal catheter with a flow rate of 1 L/min. The patient complains that he is not getting enough air. Which of the following is most appropriate? A. place the patient on a nasal cannula at 1 L/min B. place the patient on a nasal cannula at 2 L/min C. remove the catheter D. flush the catheter with saline

The correct answer is : B Explanation : Before troubleshooting the transtracheal oxygen catheter is appropriate to switch the patient to a more reliable oxygen source. When switching from a transtracheal oxygen catheter to a nasal cannula, the flowrate should be doubled. This will approximate the FIO2 achieved by the transtracheal catheter.

During positive-pressure mask ventilation on a newborn, cricoid pressure may be used to A. check for a pulse. B. limit gas entry into the stomach. C. prevent aspiration of meconium D. decrease the neonate's heart rate.

The correct answer is : B Explanation : By applying proper cricoid pressure, the rigid rings of the trachea are indirectly pressed down over the esophagus, which blocks air from entering the stomach during mask ventilation.

A patient is being monitored hemodynamically with a balloon-tipped, flow directed pulmonary artery catheter. The following hemodynamic data is available: PAP 22 mm Hg CVP 8 mm Hg PCWP 16 mm Hg C.O. 3.2 L Which of the following mostly likely represents the patient's condition? A. cor pulmonale B. mitral valve stenosis C. dehydration D. pulmonary hypertension

The correct answer is : B Explanation : CVP is high. PAP is also high. This indicates no problem in the right heart. PAP as high and pulmonary capillary wedge pressure is also high. This suggests no problem in the lungs. PCWP is high but cardiac output is low. This suggests there is a problem in the left heart. The only option that is associated with a left heart condition is mitral valve stenosis.

Which of the following pulmonary function test trails represents the best patient effort? Trial 1 Trial 2 Trial 3 FEV1 (L) 2.2 2.2 2.7 FVC (L) 2.7 2.7 2.3 IC (L) 2.4 1.9 2.1 FEF25-75% (L/sec) 1.8 1.3 1.3 A. Trial 2 B. Trial 3 C. Trial 1 D. set of trials do not meet ATS standards

The correct answer is : B Explanation : Determining the best patient effort in a pulmonary function test is done by adding the FEV1 and FVC. The trial with the highest sum is considered the "BEST TEST".

A respiratory therapist is assigned to monitor a mechanically ventilated male patient with the following settings and clinical data: Mode Pressure/control Mandatory Rate 20/min FIO2 0.75 PIP 30 cm H20 I:E ratio 2:1 PEEP 22 cm H20 pH 7.35 PaCO2 50 torr PaO2 60 torr Based on this data, which of the following conditions is most likely? A. Decreased QS/QT B. Acute Respiratory Distress Syndrome C. High A-aDO2 value D. Elevated oxygen index (OI)

The correct answer is : B Explanation : Due to the high FIO2 and PEEP associated with a low PaO2, ARDS is very likely. In such a case, A-aDO2 and oxygen index (OI) would likely be decreased. QS/QT would likely be increased.

A respiratory therapist has completed a pre-scheduled ventilator/patient check on a 65-year-old male patient. Set tidal volume is 600 mL. Returned volumes for mechanical breaths are 591 mL. There are no detectable leaks within the circuit. What should the therapist recommend? A. Obtain a chest radiograph. B. Continue current therapy and document the returned volume. C. Replace the ventilator. D. Increase the set VT to 825 mL.

The correct answer is : B Explanation : During volume-cycled mechanical ventilation, returned tidal volume varies from preset tidal volume. The allowable variance is 10%. A variation greater than 10% requires troubleshooting by the respiratory therapist.

A patient with a history of COPD is receiving mechanical ventilatory support in SIMV mode with a flow-triggering baseline flow of 18 L/min. During spontaneous expiration, the respiratory therapist notices the pressure manometer needle remains higher than the set PEEP level. The therapist should A. monitor the patient closely for 20 minutes B. decrease the baseline flow C. increase the level of PEEP D. obtain an arterial blood gas in 20 minutes

The correct answer is : B Explanation : For a patient who is using flow-triggering during mechanical ventilatory support, if the pressure manometer needle remains higher than the PEEP, the appropriate response is to decrease the baseline flow.

A respiratory therapist is setting up home oxygen by oxygen concentrator for a home care patient. Which of the following is the most appropriate safety consideration for the patient? A. poison control hotline phone number B. adequate electrical circuit load C. proper length of the oxygen tubing D. oxygen concentrator recalibration procedure

The correct answer is : B Explanation : Home care of a pulmonary patient has much to do with ensuring safety in the home. Electrical devices, such as oxygen concentrators, should be installed with care and with the patient's safety in mind. In this case, it is most important to ensure adequate electrical load for the oxygen concentrator.

A patient with status asthmaticus has been admitted to the intensive care unit from the emergency department (ED). Wheezing persists in spite of multiple treatments with beta sympathomimetic medications. To help alleviate bronchoconstriction, the respiratory therapist should suggest A. nasal CPAP B. prednisone C. aerosolized albuterol D. acetylcysteine

The correct answer is : B Explanation : In addition to beta sympathomimetic medication (short term bronchodilators) a patient with persistent wheezing may also benefit from steroids such as prednisone or methylprednisolone.

A patient following abdominal surgery has severe bilateral atelectasis in both bases. What would one expect to hear upon auscultation? A. diffuse inspiratory crackles B. end-inspiratory crackles C. pleural rub D. bronchial breath sounds

The correct answer is : B Explanation : Late inspiratory crackles, or end-inspiratory crackles are commonly auscultated with a patient experiencing atelectasis. Crackles are also known as rales.

A faint, discontinuous popping sound auscultated at the end of a deep breath in the posterior basal lung sections would indicate A. CHF B. atelectasis. C. meconium aspiration. D. ARDS

The correct answer is : B Explanation : Late inspiratory crackles, or end-inspiratory crackles are commonly auscultated with a patient experiencing atelectasis. Crackles are also known as rales. Crackles sound like discontinuous popping or "rice crispies" upon auscultation

Which of the following conditions could produce a central venous pressure of 9 torr, and a pulmonary artery pressure of 11 torr? A. excessive airway pressure B. Cor pulmonale C. hypervolemia D. mitral valve stenosis

The correct answer is : B Explanation : Normal CVP is approximately 4 or 5 mm Hg. Normal PAP is 14 mm Hg. Since the CVP is high and PAP is low, it tells us that the right heart is not functioning properly and blood cannot flow correctly through it. CVP is the pressure entering the right heart and PAP is the pressure leaving the right heart. Cor pulmonale is a right heart condition.

Which of the following is a determinant of Optimal PEEP level? A. VD/VT B. consistent cardiac output with increasing plateau pressures C. decreasing dynamic complianc D. RSBI

The correct answer is : B Explanation : Of the options offered, cardiac output relative to plateau pressures is used to determine optimal PEEP.

d. development of confusion or disorientation

Which of the following would be a sufficient reason to discontinue a spontaneous breathing trials a. respiratory rate increases from 18 to 26 b. heart rate increases from 78 to 92 bpm c. blood pressure increases from 110/80 to 118/88 mmHg d. development of confusion or disorientation

Which of the following patient conditions would CONTRAINDICATE the use of Trendelenburg's position? A. Independent lung ventilation B. Increased intracranial pressures C. Massive blood loss D. Lobectomy

The correct answer is : B Explanation : Placing the patient's head-of-bed down would be harmful to the patient, who has increased intracranial pressures. This could cause further increase which could result in herniation of the brainstem and permanent neurological damage.

A 3-year-old patient is demonstrating ventilatory difficulty with use of intercostal accessory muscles. The patient is febrile and is drooling. A softened inspiratory stridor is audible. Which of the following mostly likely represents the patient's condition? A. Asthma B. Acute epiglottitis C. Bacterial pneumonia D. Laryngotracheal bronchitis (croup)

The correct answer is : B Explanation : Softened inspiratory stridor in conjunction with drooling is associated with acute epiglottitis. Acute epiglottitis is a bacterial infection, which can cause febrile conditions.

A 6 year-old child is requiring frequent suctioning through a 5.0 mm endotracheal tube. Secretions are thick and copious and difficult to suction in spite of repeated instillation of normal saline prior to suction attempts. The suction catheter size is 6 Fr and suction pressure is set to -65 mm Hg. The respiratory therapist should do which of the following to improve the effectiveness of secretion removal? A. Instill atropine down the endotracheal tube B. Increase suction pressure C. Switch to a shorter catheter D. Use a 10 Fr suction catheter

The correct answer is : B Explanation : The appropriate suction pressure for an infant is between 60-80 mmHg. The patient is only receiving 65 mmHg of suction pressure and therefore has room for an increase in suction pressure. This will increase the effectiveness of secretion removal.

A patient has the following arterial blood gas results and ventilatory parameters: pH 7.08 PaCO2 27 mm Hg PaO2 101 mm Hg HCO3- 7 mEq/L BE -18 mEq/L RR 33 Which of the following blood tests would be indicated? A. INR B. glucose C. PTT D. Blood urea nitrogen (BUN)

The correct answer is : B Explanation : The blood glucose level should be evaluated in this case in order to determine the cause of the severe metabolic acidosis, which is likely to be diabetic ketoacidosis.

Quality control test results of a recently certified 3.0 Liter calibration syringe used in conjunction with a spirometer are as follows: Volume 1 3.10 L Volume 2 3.12 L Volume 3 3.15 L Which of the following is an accurate statement, according to ATS standards? A. The syringe is defective B. The spirometer is accurate C. The spirometer is inaccurate D. The spirometer lacks precision

The correct answer is : B Explanation : The spirometer is considered accurate if the results are no more than 3% above or 3% below than the 3 L calibration syringe. This means the accuracy range is 2.85 L -3.15 L. Because all values are within this range the spirometer is considered to be accurate.

The respiratory therapist records a patient's blood pressure to be 120/80 mmHg as measured by a sphygmomanometer. Simultaneously, the therapist notes the blood pressure measured by an indwelling radial artery catheter and transducer is reading 145/90 mm Hg. Which of the following could explain the difference in these results? A. the sphygmomanometer is likely in error B. the transducer is lower than the level to which it was originally zeroed and calibrated C. erratic movement of the arm with the arterial catheter D. the transducer is 8 inches or more above the level of the heart

The correct answer is : B Explanation : The transducer associated with an indwelling arterial catheter should be level with the heart in order to produce an accurate blood pressure reading. If the transducer is lower than the heart, increased blood pressure will be demonstrated on the monitor and the reported pressure will be erroneously high. If the transducer is above the level of the heart, the reported blood pressure on the monitor will be erroneously low, or less than the actual blood pressure of the patient.

A respiratory therapist notes the word cachectic used in the medical documentation to describe a patient. This is most consistent with A. obesity B. a wasted apperance C. obtunded D. non-attentiveness

The correct answer is : B Explanation : The word "cachectic" refers to a wasted appearance, skinny, and poor skin turgor. A person with AIDS or pulmonary tuberculosis may demonstrate this.

A female patient is intubated with a 7.0 mm endotracheal tube. The tube is noted to be positioned at 26 cm at the teeth. Breath sounds are not bilateral. Which of the following will best confirm placement of the artificial airway? A. chest rise B. chest radiograph C. breath sounds D. capnography

The correct answer is : B Explanation : There are several ways to assess proper endotracheal tube placement, such as auscultation of breathsounds, observance of symetric chest rise, or end-tidal CO2 evaluation. However, this scenario asks for confirmation of proper artificial airway placement, which is accomplished with a chest X-ray.

a. VD/VT ratio of 70%

Which of the following would be an indication to delay weaning a patient from mechanical ventilatory support? a. VD/VT ratio of 70% b. WBC of 8,000 cu mm c. A-aDO2 of 120 mmHg d. RSBI of 80

A patient with combined central and obstructive sleep apnea is being titrated for initial settings on Bi-Level therapy with oxygen bleed-in at 2 L/min. IPAP is 16 cmH2O and an EPAP is 8 cmH2O. Set back-up rate is 12/min. The following blood gas data with a spontaneous rate of 12/min is available: pH 7.33 PaCO2 48 mm Hg PaO2 80 mm Hg HCO3- 24 mEq/L BE 0 mEq/L Which of the following changes is most appropriate? A. decrease EPAP to 6 cmH2O B. increase IPAP to 18 cm H2O C. increase backup rate to 14/min D. increase IPAP and EPAP by 2 cm H2O

The correct answer is : B Explanation : This patient has elevated CO2, indicating under ventilation, but adequate oxygenation. Ventilation is increased by increasing the distance between the inspiratory and expiratory pressures. In this case simply raising IPAP alone is sufficient.

A respiratory therapist should open the airway by using the jaw-thrust maneuver for a patient experiencing A. a difficult intubation requiring application of cricoid pressure B. a serious motor vehicle accident C. vomiting D. a carotid massage

The correct answer is : B Explanation : Trauma caused by motor vehicle accidents may result in injury to the spinal cord, or vertebrae. Additional movement or manipulation of the neck or upper back may result in additional damage, which could result in permanent paralysis. The jaw-thrust maneuver will prevent further damage to the spine.

Arterial Venous pH 7.40 7.38 PCO2 40 torr 42 torr PO2 85 torr 48 torr HCO3- 24 mEq/L 24 mEq/L BE 0 mEq/L 0 mEq/L SAT 96% 80% Hb 14 g/dL 14 g/dL A patient receiving mechanical ventilator support in the intensive care unit has the follow blood gas results: The respiratory therapist should record which of the following C(a-v)O2 values in the patient's medical record? A. 6.2 vol% B. 3.1 vol% C. 1.6 vol% D. 5.1 vol%

The correct answer is : B Explanation : To answer this question, one must complete two calculations. First, CaO2 and CvO2 must be determined. Once CvO2 is subtracted from CaO2, 3.1 vol% is the closest answer.

A patient is receiving mechanical ventilator support with an adult VC ventilator. The following data is available: pH 7.41 PB 747 torr PaCO2 40 torr PaO2 70 torr HCO3- 24 mEq/L BE +0 mEq/L FIO2 0.60 Mode Assist/control Rate 14 VT 550 mL Pressure (peak) 24 cm H2O PEEP 5 cm H2O The respiratory therapist should report which of the following values as an accurate A-aDO2? A. 350 torr B. 300 torr C. 225 torr D. 490 torr

The correct answer is : B Explanation : To determine the alveolar-arterial oxygen difference or gradient, one must first calculate the alveolar oxygen tension by using the alveolar air equation or by a shortcut. To determine PAO2, first take the oxygen percentage and multiply it by 7. 60% x 7 = 420. Next, subtract the CO2 + 10. 420 - 50 = 370 mmHg. Finally, if you subtract the PaO2 you get 300 mmHg, which represents the A-aDO2.

d. bronchoscopy

Which of the following would be most beneficial in resolving microatelectasis? a. chest tubes b. percutaneous ventilation c. thoracentesis d. bronchoscopy

The following data is available for a 62-year old patient with arterial sclerosis. MAP 93 torr CVP 3 torr mPAP 18 torr PCWP 8 torr Q.T. 5.0 L/min PEEP 5 cm H2O C.I. 2.5 L/min/m2 The physician asks the therapist to determine systemic vascular resistance and record the findings in the patient's medical record. The therapist should record which of the following values? A. 160 dynes B. 1440 dynes C. 1200 dynes D. 1600 dynes

The correct answer is : B Explanation : To obtain a systemic vascular resistance (SVR) value, CVP should be subtracted from MAP. (93-3) = 90. Then, the result should be divided by cardiac output. In this case, cardiac index should be multiplied by 2 to estimate cardiac output. This gives us a cardiac output of 4 L. (90/5 = 18). Finally, we must multiply that result by 80 to obtain the measurement unit of dynes. SVR = 18 x 80 = 1440 dynes.

d. C(a-v)O2

Which of the following would be most helpful at identifying optimal PEEP? a. A-aDO2 b. VD/VT c. CVP d. C(a-v)O2

A 40-week gestational age neonate is receiving time-cycled, pressure-limited ventilation with an I-time of 0.4 seconds, PIP 28 cm H2O, RR of 25/min, FIO2 0.45 and PEEP 5 cm H2O. As the flowrate is increased, what will happen to the I:E ratio? A. Decrease I-time, Increase E-time B. No change C. Decrease D. Increase

The correct answer is : B Explanation : Unlike volume-cycled mechanical ventilation, changing the flow rate will not change inspiratory or expiratory time. However, changing the flow rate will change the delivered tidal volume. Tidal volume is affected by peak inspiratory pressure, flow rate, and inspiratory time.

For which of the following developments should the therapist monitor carefully for several hours after a patient self-extubates? A. friction rub B. stridor C. hyperventilation D. wheezing

The correct answer is : B Explanation : When a patient inadvertently or purposefully removes an endotracheal tube, he or she has not removed the air from the ET tube cuff. While pulling the tube out, it is possible for the inflated cuff to injure or inflame the upper airway. This could result in stridor.

d. COHb

Which of the following would be most helpful in determining if a patient regularly smokes tobacco products? a. end-tidal carbon dioxide b. pulse oximetry c. DLCO d. COHb

A one-minute APGAR assessment reveals a score of three. What is the appropriate response by the respiratory therapist? A. provide positive pressure ventilation with a flow-inflating resuscitator B. warm the infant and provide tactile stimulation C. start chest compressions and positive pressure ventilation D. provide blow-by oxygen

The correct answer is : C Explanation : APGAR scores are calculated 1 and 5 minutes after birth. A score of less than 4 indicates that CPR is required.

A pulmonary rehabilitation patient is being monitored for compliance to a smoking cessation program. Which of the following values would be most helpful to evaluate? A. metHb B. SPO2 C. COHb D. PaO2

The correct answer is : C Explanation : A patient on a smoking cessation program may be monitored for compliance by periodically assessing the COHb. If COHb remains elevated or increases, the patient is likely not compliant with the program.

Which phase of the nitrogen elimination (SBN2) test should the therapist primarily look at to find a mixture of deadspace and alveolar gas? A. Phase III B. Phase IV C. Phase II D. Phase I

The correct answer is : C Explanation : A single breath nitrogen elimination test (SBN2) I is useful in determining the evenness of gas distribution in the lungs. The results come in four phases as the patient exhales a single breath. Phase I is the exhalation of pure deadspace gas. Phase II consists of some deadspace and some alveolar gas. Phase III consists of pure alveolar gas and is the phase that indicates the evenness of distribution. Phase IV is called "closing volume".

A respiratory therapist has been paged to the neonatal intensive care unit to assess an infant who is 38 weeks of gestation, delivered 3 hours prior. Which of the following would be appropriate to include in the assessment? A. oxygen index B. R/Q value C. Record of APGAR, at 1 and 5 minutes D. symptoms

The correct answer is : C Explanation : An infant is incapable of communicating problems such as shortness-of-breath and pain. This type of information is considered to be subjective and is also referred to as "symptoms". APGAR scores can be very helpful in directing the further care of the patient. Oxygen index is generally used in complex oxygenation cases and is not really appropriate at this stage in the case.

c. epinephrine

While assisting a physician during a bronchoscopy procedure, the therapist notices bright red blood in the specimen tube. The therapist should prepare which of the following NEXT? a. Heparin b. atropine c. epinephrine d. cold normal saline

A 4-year-old male weighing 27-kg (60-lbs) is receiving volume-cycled mechanical ventilation with a microprocessor ventilator using an adult circuit and a cuffed size 5.0-mm ET tube. Tubing compliance and airway resistance was measured and delivered tidal volumes are corrected. An arterial blood gas reveals the need for an increase in VE of 1.6 L/min. What is the optimal way to accomplish this? A. subtract 10 ml deadspace B. change to a pediatric circuit C. increase respiratory rate D. replace ET tube with a 4.5 uncuffed tube

The correct answer is : C Explanation : An increase in VE, or minute ventilation, may be done by increasing tidal volume or increasing respiratory rate. Of the options offered, increasing respiratory rate is the most appropriate. The other options will not result in an increase in minute ventilation.

b. disconnected thermistor line

While monitoring a patient receiving mechanical ventilation, the respiratory therapist notices the low-pressure and low exhaled volume alarms are sounding. Which of the following could be the cause? a. kinked endotracheal tube b. disconnected thermistor line c. excess water in the inspiratory limb of the circuit d. herniated endotracheal tube cuff

What is the humidity deficit for patient who is intubated if the relative humidity of the inspired gas is 25%? A. 44 mg/L B. 11 mg/L C. 33 mg/L D. 22 mg/L

The correct answer is : C Explanation : Any time you are asked "what is the humidity deficit", the answer has to be in milligrams. When the gas is humidified at 100% the number of milligrams in a liter of gas is 44. The word "deficit" means how much is missing to make the relative humidity 100%. So if the relative humidity is 25%, there is only 11 mg of water per liter of gas. That would mean if you take 44 and subtract 11, the humidity deficit is 33 mg/L of gas.

A respiratory therapist is asked whether patient instructions were effective for a patient being sent home with supplemental oxygen. How would this best be accomplished? A. Assure that the home health technician will repeat the instructions. B. Call the patient in one week to see if there are any complications. C. Ask the patient to repeat the instructions back to the therapist. D. Assure the patient signs the medical record for receipt of instructions.

The correct answer is : C Explanation : By having the patient repeat the instruction back, one can assure that the instructions are understood. Avoid closed-ended questions when determining whether a patient understands what they are to do.

A homebound oxygen-dependent patient receives 2 L/min oxygen by molecular sieve device. An electrical storm has resulted in the loss of electricity. She has 2 full E-cylinders. How many hours will her oxygen last? A. 6 B. 8 C. 10 D. 12

The correct answer is : C Explanation : Duration per E cylinder tank = 2200 x 0.28 = 616 L/ 616 L / 2 L/min = 308 minutes. 308 minutes / 60 = 5.1 hours per tank. 2 tanks will last about 10.2 hours, or 10 hours.

c. epinpherine

While performing a biopsy of a tissue extracted from a patient's right mainstem bronchus with a bronchoscope, the physician reports sudden bleeding from the site. Which of the following should the respiratory therapist have ready to instill? a. atropine sulfate b. racemic epinephrine c. epinpherine d. normal saline

A physician requests the presence of a respiratory therapist for an intubation to deliver Exosurf to a newborn. Which of the following clinical finding is most likely? A. Normal radiolucency on chest radiograph B. esophageal atresia C. L/S ratio less than 2:1 D. hypopharyngeal swelling

The correct answer is : C Explanation : Exosurf, a brand of surfactant, is indicated for infant respiratory distress syndrome (IRDS). A newborn suffering from IRDS would not respond very well to oxygen, would likely have a problematic L/S ratio due to prematurity, and have a high respiratory rate. X-ray would reveal a honeycomb or ground glass pattern.

A physician is about to perform a bronchoscopy for the purpose of tissue extraction and analysis to rule out carcinoma. The patient is receiving heparin therapy and the physician is concerned about bleeding. Which of the following should the therapist have ready in case of bleeding inside the airway? A. Atropine sulfate B. Alcohol in a 10 cc syringe C. Epinephrine D. 5.0 mL low molecular weight heparin

The correct answer is : C Explanation : For a patient who is receiving anticoagulant therapy, a bronchoscopy procedure can become quite risky. The risk relates to the inability to stop bleeding in the bronchial tree should it occur. Preventative actions prior to the procedure include the preparation of epinephrine and access to a Fogarty catheter. Epinephrine, when applied to a bleeding site, can stop bleeding. The Fogarty catheter can be used as a tamponade the bleeding site.

Immediately following the extubation of an adult who was orally intubated for the past 2 weeks, the respiratory therapist hears moderate stridor. The therapist should recommend A. Immediately intubate the patient B. Delivery aerosol therapy with cool mist C. Administer racemic epinephrine D. Send to surgery

The correct answer is : C Explanation : Moderate stridor, caused by inflammation in the upper airway, may be treated with racemic epinephrine. Mild stridor may be treated with the racemic epinephrine and/or cool aerosol. Marked or severe stridor is treated by reestablishment of an artificial airway.

A patient is ordered to be placed on a high frequency jet ventilator in response to a bronchopleural fistula. Which of the following ventilator parameters can the respiratory therapist expect to manipulate when setting up the patient on the ventilator? A. tidal volume B. plateau pressure C. I:E D. jet orifice

The correct answer is : C Explanation : For a patient with a broncopleural fistula, keeping ventilatory pressures at a minimum is most appropriate. One alternative is to avoid traditional positive airway pressure and use high-frequency jet ventilation. These ventilators have different controls than traditional volume-controlled ventilators. Specifically, tidal volume is not a contol found on the machine. Of the options listed, PEEP, I:E, and frequency are controls that may be found on a high-frequency jet ventilator.

Immediately following oral endotracheal extubation the patient should first be A. receive hydration B. suctioning C. directed to cough D. trained on PEP therapy

The correct answer is : C Explanation : Immediately following extubation the patient should be first instructed to cough. If effective this is the quickest method to remove secretions immediately from the upper airway. Suctioning is appropriate if the patient is unable to cough. Hydration is time-consuming and while important will not help to immediately remove secretions in the upper airway. PEP therapy is intended to mobilize secretions from the lower airways which is not the most immediate concern following extubation.

A respiratory therapist is called to the room of a mechanically ventilated patient with a size 8.0 mm endotracheal tube. The low volume and low PEEP alarms are sounding. The respiratory therapist is able to see only 1.5 inches of the end of the endotracheal tube, which is located at the lips at the 22 cm marking. What should the therapist recommend? A. Withdraw the tube 2 cm. B. Add air to the cuff. C. Check for a leak. D. Silence the alarm and troubleshoot.

The correct answer is : C Explanation : In this example, it appears that the endotracheal tube has been cut and is therefore only showing 1.5 inches. However more importantly is the centimeter marking at the lips, which is 22 cm. The only reasonable option is to check for a leak.

End inspiratory crackles are heard upon auscultation of a post operative hip patient with no known pulmonary history. The patient is febrile. These signs are indicative of A. dehydration. B. subcutaneous emphysema. C. atelectasis. D. hypovolemia.

The correct answer is : C Explanation : Late inspiratory crackles, or end-inspiratory crackles are commonly auscultated with a patient experiencing atelectasis. Crackles are also known as rales. Atelectasis is the presence of fully or partially collapsed alveoli.

Which of the following is NOT part of the suction procedure of an orally intubated patient receiving volume-controlled ventilation in the assist/control mode? A. hyper-oxygenate prior to suctioning B. hyperventilate the patient through the ventilator C. switch to SIMV mode D. utilize sterile technique

The correct answer is : C Explanation : Normal suctioning procedure includes hyper oxygenation and hyperventilation of the patient prior to suctioning. A sterile technique is also used. Switching to an SIMV mode is not helpful.

While assisting the physician with a thoracentesis procedure, the patient suddenly becomes short of breath. Respiratory rate has increased to 32/min, heart rate is 120/min, and oxygen saturation had dropped to 86%. The respiratory therapist should FIRST do which of the following? A. obtain a chest radiograph B. perform tracheal palpation C. place the patient on a non-rebreathing mask D. insert chest tube on the side of the thoracentesis

The correct answer is : C Explanation : One of the risks associated with the thoracentesis procedure is accidental puncture of the lung. When this happens, a pneumothorax may occur. In response to this the most appropriate option offered is to place the patient on a non-rebreathing mask which is close to 100% oxygen.

b. add air to the cuff

While performing minimum occluding volume technique on an 80-kg (176-lb) male with an 8.0-mm tube, the therapist auscultates a high-pitched sound over the neck at the top of each mechanical breath. The therapist should a. record results and monitor the patient b. add air to the cuff c. remove air from the cuff d. obtain a new ET tube

A local college basketball team collapsed during a pre-game warm up after leaving a newly-constructed dressing room with an improperly-vented furnace. Multiple wavelength spectrophotometer readings suggest CO poisoning. To confirm this a respiratory therapist would evaluate A. Arterial blood gases B. hyperbaric chamber tolerance C. COHb D. MetHb

The correct answer is : C Explanation : The key word in the question here is to "confirm" carbon monoxide poisoning. This is done with a co-oximeter. The result is called a COHb (carboxyhemoglobin) level. One might be tempted to choose arterial blood gas, which may or may not include COHb. For this reason COHb is the best answer.

A newborn is experiencing nasal flaring, declining oxygen saturation values, tachypnea, and diminished breath sounds in the left lung following a meconium delivery. One possible cause of these findings is A. BPD. B. TTN. C. pneumothorax. D. IRDS.

The correct answer is : C Explanation : The patient is showing obvious signs of respiratory insufficiency with nasal flaring, low oxygenation, and tachypnea. Because we also have localized diminished breathsounds upon auscultation, along with a recent history of meconium, we must suspect a pneumothorax. Meconium creates a ball-valve effect when in the lung, creating air-trapping during ventilation that may result in a pneumothorax.

A patient in the cardiac intensive care unit has pitting peripheral edema rated at +2. What other laboratory data would be helpful to assess to further understand the nature of the problem? A. serum electrolytes B. PD50 C. creatinine and BUN D. arterial blood gases

The correct answer is : C Explanation : The presence of pitting edema is a fluid shifting problem that is related to the kidney and sometimes the heart. Any kind of fluid shifting problem can be evaluated further by looking at the creatinine and BUN. Of these tests, creatinine is considered more accurate. But both will supply the same kind of information.

A 70-kg (154-lb) COPD patient who was started on mechanical ventilation due to a severe pulmonary infection has the following weaning parameters & clinical data three days after initiation of mechanical ventilation: MIP -25 cmH20 Spont VT 360 mL RR 27 WBC 8,000 per cu mm Hb 16 gm/dL Based on the calculated RSBI, the respiratory therapist should recommend A. extubating and providing Bi-level ventilation via mask. B. changing to Pressure/control. C. discontinuing mechanical ventilation. D. returning to full mechanical ventilation.

The correct answer is : C Explanation : The underlying problem of pulmonary infection seems to be resolved as the WBC is 8,000 per cu mm. The rapid shallow breathing index, RR/VT (L) is 75, well below the threshold of 106. Therefore, the best option is to discontinue mechanical ventilation.

While transporting at patient from the emergency department (ED) to the intensive care unit (ICU), the respiratory therapist suspects the oral endotracheal tube has changed position. The quickest way to assess the ET tube position would be to A. obtain a chest radiograph B. visualize diaphragmatic excursion C. auscultate breath sounds D. analyze end-tidal CO2

The correct answer is : C Explanation : There are many ways to determine the location or position of the ET tube. The question is asking for the quickest way. Of the options offered, auscultation of breath sounds would provide the most immediate pertinent data. If an option such as examination of equal and bilateral chest rise were offered, that option would be even better because it is visual in nature and therefore quicker.

a. low gas pressure in tanks

While transporting a patient on a fixed-wing aircraft, the therapist notices the actual respiratory rate of the transport ventilator is less than the set rate and is gradually decreasing. Which of the following is the likely cause? a. low gas pressure in tanks b. effects of altitude on the ventilator c. effects of pressure associated with the curvature of the earth d. defective ventilator

An 83 kg (183 lb) male, postoperative abdominal surgery, is receiving mechanical ventilatory support on the following settings: FIO2 0.40 Mode SIMV Mandatory rate 14 Total rate 15 Tidal volume (VT) 550 mL Inspiratory flow 50 L/min Corresponding blood gases show: pH 7.25 PaCO2 55 torr PaO2 69 torr HCO3- 26 mEq/L BE +1 mEq/L Which of the following should the respiratory therapist increase? A. inspiratory flow B. FIO2 C. mandatory rate D. tidal volume

The correct answer is : C Explanation : This patient is hyperventilating. Because the patient is receiving mechanical ventilatory support, the first thing that should be checked is the appropriateness of the ventilator settings, especially the tidal volume. If the set tidal volume is found outside the range it should be corrected first prior to any other change. In this case, the set tidal volume is appropriate for the patient's height and weight and therefore an increase in mandatory rate is most appropriate to blow off excess CO2.

A patient receiving mechanical ventilatory support has the following capnographic waveform obtained from an infrared device. Which of the following is most consistent with this data? A. hypoventilation B. defective infrared sensor C. deadspace disease D. condensate on the infrared sensor

The correct answer is : C Explanation : This saw-tooth pattern seen on the capnograph is associated with dead space disease. Notice the low end-tidal CO2 and the rapid rate.

The following arterial blood gas results are recorded for a patient during cardiopulmonary resuscitation: pH 7.10 PaCO2 46 torr PaO2 208 torr HCO3- 12 mEq/L FIO2 1.0 On the basis of these values and the following ECG waveform, the respiratory therapist should recommend A. decrease FIO2 B. administer sodium nitroprusside C. sodium bicarbonate administration D. increase manual ventilation rate

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 bicarb (HCO3-) is appropriate.

A postoperative patient receiving mechanical ventilatory support is waking from sedation. Ventilatory settings and arterial blood gases are as follows: Mode Assist/control Mandatory rate 14 Total rate 16 Tidal volume 450 mL FIO2 0.30 PEEP 5 cm H2O pH 7.41 PaCO2 39 torr PaO2 65 torr HCO3- 23 mEq/L BE -1 mEq/L In order to begin weaning, the respiratory therapist should recommend which of the following methods? A. decrease mandatory rate B. switch to bi-level ventilation C. SIMV with pressure support D. CPAP

The correct answer is : C Explanation : This postoperative patient is awaking from sedation while on a mechanical ventilator. Normally, when a patient awakens from surgery, they may be removed from mechanical ventilatory support very quickly. However, in this case, the patient's PaO2 still shows hypoxemia. Weaning with pressure support is appropriate.

Which of the following actions would most likely resolve a high-pressure alarm on a volume-cycled adult ventilator? A. add air to the ET tube cuff B. decrease heater temperature setting C. suction the patient D. tighten the patient-ventilator interface connection

The correct answer is : C Explanation : To determine the answer to this question one must first look at the cause of the high pressure alarm on the ventilator. The need to add air to the ET tube cuff would result in a low-pressure alarm. The need to tighten the patient ventilator interface connection would presumably be caused by a leak and would result in a low-pressure alarm. The heater temperature should have no effect. Therefore, suctioning the patient is the only solution that is an appropriate response to the high-pressure ventilator alarm

What radiographic findings are associated with active, untreated tuberculosis? A. Butterfly or batwing pattern in the lower lobes B. A single cavitation in one of the lower lobes C. Upper lobe cavitations D. Varying sized masses found in both upper lobes

The correct answer is : C Explanation : Upper lobe cavitations are associated with tuberculosis. The cavitations are larger and singular. These single cavitations are rarely if ever seen in the lower lobes. Butterfly or batwing patterns are associated with pulmonary edema. Varying sized masses are associated with cancer.

A 45-year old male is receiving mechanical ventilation on the following settings: Mode Assist/control Mandatory rate 16 Tidal volume 550 mL FIO2 0.60 Pressure limit 60 cm H2O PEEP 8 cm H2O I:E 1:1.5 The patient is developing autoPEEP. The respiratory therapist should do which of the following? A. Decrease PEEP to 5 cm H2O B. Discontinue PEEP C. Increase inspiratory flow rate D. Set PEEP to match the Auto PEEP value

The correct answer is : C Explanation : When a patient is developing auto PEEP, the solution is to either decrease mandatory rate or increase expiratory time. Because decreasing mandatory rate will likely negatively affect ventilation, the most appropriate action is to manipulate the I:E ratio. To lengthen expiratory time, inspiratory flow rate should be increased.

A patient receiving supplemental oxygen at home with a molecular sieve device reports appropriate flow coming from her cannula, but does not believe she is receiving enough oxygen. The therapist should advise the patient to A. change out the oxygen tubing. B. increase the flowrate by 1 L/min. C. change to E-cylinder oxygen and evaluate. D. call 911.

The correct answer is : C Explanation : When a patient reports difficulty getting air or oxygen through one oxygen delivery device, before troubleshooting, the most appropriate first action is to ensure adequate ventilation by changing to a different, reliable device. In this case switching to an E cylinder is most appropriate while the oxygen concentrator is assessed.

What type of procedure is the suctioning of blood-tinged secretions from a patient with an artificial airway? A. universal B. clean C. benign D. sterile

The correct answer is : D Explanation : All suctioning of a patient's airway is done with sterile technique, regardless of the type of secretions removed.

Which of the following defibrillator settings is appropriate for treating a patient with ventricular tachycardia? A. synchronize to the R wave B. synchronize to the T wave C. synchronization set to OFF D. synchronize to the P wave

The correct answer is : C Explanation : When using a defibrillator, one setting that must be adjusted is the synchronization. When defibrillating a patient who has ventricular tachycardia, the synchronization must be set to OFF. Only when cardioversion is being done should the synchronization be set to ON or ACTIVE.

Which of the following is the best reason for reducing the high-pressure alarm limit for a patient who is receiving volume-cycled mechanical ventilation? A. decreased respiratory rate B. increased cough frequency C. increased lung compliance D. decreased patient alarm tolerance

The correct answer is : C Explanation : With increased lung compliance, peak pressures will diminish with constant delivered tidal volumes. Therefore, the therapist should adjust the peak pressures downward in order to remain 10-15 cm H20 above the baseline peak pressures.

What effect does decreasing the I:E ratio through pursed lips have for a spontaneously breathing asthmatic patient? A. decreases oxygen consumption B. increases FRC C. increases IC D. decreases air trapping

The correct answer is : D Explanation : A patient with active asthma suffers from the inability to exhale gas from the lung. This results in air-trapping. A solution is pursed-lips breathing, along with an extension of expiratory time. One may also decrease I-time or increase E-time to resolve air-trapping created by asthma.

A patient has been diagnosed with central sleep apnea. Which of the following would be helpful and most appropriate in the further treatment of the patient? A. full nocturnal ventilatory support B. weight loss C. surgical remove of soft tissue D. bi-level therapy with a rate

The correct answer is : D Explanation : A patient with central sleep apnea either needs mechanical ventilatory support or medication that stimulates ventilation. Dopram is such a medication. Mechanical ventilatory support can be achieved with bilevel therapy in conjunction with a rate.

A patient's radiological image is reported to have hyperlucency with diffuse dry crackles auscultated throughout the chest. These findings are most closely associated with A. Pneumonia B. Atelectasis C. pulmonary edema D. subcutaneous emphysema

The correct answer is : D Explanation : Auscultated dry crackles is the main sign of subcutaneous emphysema in the scenario. Increased radiolucency in the lung is also an indication that extra air exists in the chest, even though it is on the outside of the lung. Pulmonary edema would show fluffy infiltrates. Pneumonia is more localized and is associated with a reduced radiolucency.

The wick humidifier is A. unable to accomplish 100% of the body's humidification requirements. B. not indicated for thick secretions. C. designed for cool aerosol only. D. optimal for use on a pediatric patient at home with a tracheostomy.

The correct answer is : D Explanation : A wick humidifier is electronically powered and can provide sufficient heat and humidification for any patient including pediatric patients with a tracheostomy at home.

Which of the following units is associated with cardiac index? A. dynes/sec/cm2 B. L/min C. L/min/m3 D. L/min/m2

The correct answer is : D Explanation : Cardiac index is cardiac output divided by body surface area. Or if BSA is unknown, the cardiac index is estimated by dividing cardiac output by two. The unit of measure is L/min/m2.

The respiratory therapist is preparing for defibrillation of a patient with ventricular tachycardia. A pulse is not palpable. Prior to handing the physician the paddles, the therapist will ensure which of the following? A. the machine is set to 50 joules B. the machine is set to 480 joules C. synchronization is active D. synchronization is deactivated

The correct answer is : D Explanation : Defibrillation is the treatment for ventricular tachycardia without a pulse. When performing this type of defibrillation the synchronization of the machine must be deactivated. Cardioversion is performed with the synchronization active but defibrillation the synchronization must be deactivated.

A morbidly obese female patient with a large neck circumference is trached with a 7.5 mm tracheostomy tube. The tube frequently becomes dislodged with her cough. What should be done to resolve the problem? A. Increase to a size 8.0 mm tracheostomy tube. B. Tie the tracheostomy tube securely. C. Increase to a size 10.0 mm tracheostomy tube. D. Replace the tube with a longer tube.

The correct answer is : D Explanation : Due to the increased neck circumference of a morbidly obese patient, special tracheostomy tubes that have long proximal extensions allow for the increased distance from the interior tracheal wall to the opening of the stoma at the skin.

A physician performing bronchoscopy does NOT need the ability to provide which of the following down the multi-lumen ports? A. lidocaine B. epinephrine C. saline D. albuterol

The correct answer is : D Explanation : During bronchoscopy, lidocaine, saline, or epinephrine may be instilled down the scope itself. Gauze may be used during the procedure to wipe the scope clean when withdrawn, but gauze is never placed into the lung.

Heel sticks are performed on the lateral area of a newborn's foot in order to A. reduce the pain for the patient. B. acquire better capillary blood flow. C. facilitate the procedure for the practitioner. D. prevent future ambulation problems.

The correct answer is : D Explanation : Heel sticks should not be performed on a neonate in an area of the foot that they will walk on in the future as they grow. Damage to this area of the foot can result in difficulty with future ambulation. Therefore, heel sticks are performed on the lateral area of the bottom of a newborn's foot.

An 85 kg (187 lb) postoperative hernia repair patient is receiving mechanical ventilatory support on the following settings: Mode SIMV Mandatory rate 12 Total rate 16 FIO2 0.40 Tidal volume (VT) 475 mL Inspiratory flow 50 L/min Corresponding blood gases show: pH 7.25 PaCO2 55 torr PaO2 69 torr HCO3- 26 mEq/L BE +1 mEq/L Which of the following should the respiratory therapist increase? A. FIO2 B. inspiratory flow C. mandatory rate D. tidal volume

The correct answer is : D Explanation : In addition to this patient being acidodic from hypoventilation, the set tidal volume is too low for the patient's height and weight. When the patient's height is not given we must assume that the reported weight is the patient's ideal body weight. This patient weighs 85-kg which means the minimum tidal volume is 510 mL. When CO2 must be corrected by this amount, an increase in rate is indicated. However, because set tidal volume is erroneously low, this should be corrected first.

A routine screening blood gas performed on an asymptomatic patient prior to surgery shows the following: pH 7.38 PaCO2 42 mm Hg PaO2 80 mm Hg HCO3- 26 mEq/L SaO2 96% COHb 24% What should the respiratory therapist do? A. Place the patient on a NRB mask B. Report the findings and emphasize that the patient is likely a smoker C. Evaluate saturation using a single wave-length spectrophotometer D. Run quality control material and evaluate the accuracy of the Co-oximeter

The correct answer is : D Explanation : In this case the patient is presented as asymptomatic. A patient with a carboxyhemoglobin level of 24% would feel dyspnea and present with tachypnea. Therefore, the respiratory therapist should evaluate the accuracy of the laboratory results, specifically the carboxyhemoglobin (COHb). When checking accuracy of lab results, one would use quality control measures.

A patient has a pulmonary artery catheter in place. The following data is obtained: PAP 10 torr CVP 1 torr PCWP 4 torr C.I. 1.8 L/min/m2 Which of the following is an accurate interpretation of this data? A. increased pulmonary vascular resistance B. increased left-sided preload C. hypervolemia D. decreased right atrial filling pressure

The correct answer is : D Explanation : In this problem all the hemodynamic values are low. This is indicative of hypovolemia. However, that is not the question. Of the options given, the only one that is true is that there is decreased right atrial filling pressure. Those specific words are nothing more than a way to say the patient has low CVP. The terminology is interchangeable.

A male postoperative patient has physician orders to receive SMI therapy. His preoperative inspiratory capacity was 2200 mL. The respiratory will set which of the following as an initial goal? A. 2200 mL B. 500 mL C. 3100 mL D. 1100 mL

The correct answer is : D Explanation : Initial goal for incentive spirometry (SMI therapy) after surgery should be about one half of the inspiratory capacity achieved prior to surgery. If the patient is unable to achieve this goal, the goal should be set just above the patient's ability to achieve.

Which of the following would result from excessive PEEP? A. reduced pulmonary vascular resistance (PVR) B. increased auto PEEP C. reduced alveolar oxygen tension D. reduced cardiac index

The correct answer is : D Explanation : Of the options offered, PEEP will most likely cause a reduction in venous return which will cause a reduction in cardiac output and therefore, cardiac index.

A chest radiograph that has been overexposed could result in which of the following? A. blunting of the costophrenic angles B. absence of bone density C. appearance of a pneumothorax D. pronounced vascular markings

The correct answer is : D Explanation : Pronounced vascular markings are associated with COPD and overexposure of a chest x-ray.

Pulmozyme is best used for A. COPD patients with airway inflammation B. tuberculosis patients with blood-tinged secretions C. asthma patients refractory to sympathomimetic bronchodilators D. cystic fibrosis patients with a FVC of at least 40% predicted

The correct answer is : D Explanation : Pulmozyme is helpful at helping patients with cystic fibrosis mobilize and expectorate secretions. However, to be effective the patient must be able to at least produce an FVC of 40% of predicted.

A patient with asthma is receiving bi-level therapy to decrease work of breathing. Current settings and blood gas results are: IPAP 20 cm H2O EPAP 10 cm H2O FIO2 0.35 pH 7.35 PaCO2 45 torr PaO2 70 torr HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should make which of the following changes? A. decrease both IPAP and EPAP B. increase EPAP C. decrease EPAP D. increase IPAP and EPAP

The correct answer is : D Explanation : The arterial blood gas shows the patient is hypoxic but ventilation appears to be adequate. When we want to correct oxygenation we must look to the expiratory positive airway pressure. We must be careful here, however, because raising EPAP by itself will also inadvertently lower ventilation by decreasing the distance between the expiratory pressure and the inspiratory pressure. Thus, when we raised EPAP by a specific amount we must raise IPAP by that same amount if we do not wish to decrease ventilation.

a. administer Survanta

The respiratory therapist is caring for a 28-week-old gestational age infant currently receiving mechanical ventilatory support on the following settings: PIP: 30 cmH2O FIO2: 0.70 PEEP: 5 cmH2O Mandatory rate: 40 A chest radiograph shows bilateral haziness. Arterial blood gas analysis shows pH 7.22 / PaCO2 67 / PaO2 44 / HCO3 27 / BE +1 The most appropriate recommendation would be to a. administer Survanta b. increase PIP c. increase FIO2 d. decrease mandatory rate

A patient with asthma receiving volume-controlled mechanical ventilation has the following arterial blood results on the settings below: Mode SIMV Mandatory rate 18 VT 600 mL FIO2 0.40 PEEP (set) 5 cm H2O Total PEEP 8 cm H2O I:E 1:2 pH 7.32 PaCO2 48 torr PaO2 70 torr HCO3- 26 mEq/L BE +2 mEq/L Which of the following should be decreased? A. flow B. PEEP C. FIO2 D. I:E

The correct answer is : D Explanation : This patient is developing autoPEEP as manifested by a total PEEP that is higher than the set mechanical PEEP. This is caused from insufficient expiratory time and is remedied by shortening inspiratory time, which is also termed as a decrease in I:E ratio. A decrease in flow would result in less expiratory time and an increase in autoPEEP.

A bedside PFT is completed on a patient who is being evaluated for effects and progress of Myasthenia Gravis. Reproducible results are: FVC FEV1 SVC Trial 1 (L) 2.0 1.1 2.1 Trial 2 (L) 2.1 1.0 2.2 Trial 3 (L) 2.1 1.2 2.2 Trial 4 (L) 2.1 1.0 2.2 Which is the best trial? A. 4 B. 1 C. 2 D. 3

The correct answer is : D Explanation : To determine the best test, multiple FVC maneuvers should be done. Attempts should not differ by more than 5%. The highest sum of FEV1 + FVC is considered the "best test". In this case FVC 2.1 + Fev1 1.2 = 3.3

A large-volume aerosol used as a direct gas source for an infant oxygen hood is associated with which of the following complications? A. low moisture B. unstable temperature C. unstable FIO2 D. hearing damage

The correct answer is : D Explanation : Use of a large-volume nebulizer with an oxygen hood can sometimes be of concern because of the sound the nebulizer may transmit to the oxygen hood. When this happens hearing damage may be caused and/or the infant may become restless. The most appropriate adjustment is to utilize an oxygen-air blender and set the large-volume nebulizer at 100% in order to avoid entraining air, which will help reduce sound.

A patient is receiving heliox therapy at 60%/40% mixture by nonrebreathing mask. The oxygen flow meter is set to 10 L/min. The patient has minute ventilation of 12 L/min. What is the total flow of the heliox gas mixture to the patient? A. 16 L/min B. 22 L/min C. 2 L/min D. 14 L/min

The correct answer is : D Explanation : When a helium-oxygen gas mixture is run through an oxygen flow meter, the indicated flow on the flow meter is less than the actual total flow of gas. This is because helium is less dense than oxygen. Therefore, each helium-oxygen mixture percentage has a correction factor. For a 60%/40% mixture, the correction factor is 1.4. In other words, the indicated oxygen flow of 10 L/min is multiplied by the correction factor of 1.4 to get a total gas flow of 14 L/min.

a. manual dexterity

The respiratory therapist should evaluate which of the following to develop a teaching plan for a patient who will be using a small volume nebulizer at home? a. manual dexterity b. highest grade level achieved in school c. spousal support d. English speaking proficiency

A patient with a history of status asthmaticus is admitted to the emergency room (ER) for the treatment of acute bronchoconstriction. After two treatments with aerosolized Albuterol, the patient demonstrates no relief. Peak flow measurements are unchanged. The respiratory therapist should recommend which of the following? A. switch to corticosteroid administration B. administer cromolyn sodium (Intal) C. repeat the Albuterol treatment, then reassess D. administer ipratropium bromide (Atrovent)

The correct answer is : D 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 respiratory therapist is transporting a patient in a fixed-wing aircraft. Prior to the flight the patient was stable, but since arriving at altitude, the patient is exhibiting cyanosis, shortness of breath, and anxiety. Which of the following could explain this change? A. increased barometric pressure B. altitude sickness C. decreased FIO2 D. decreased PAO2

The correct answer is : D Explanation : When patients experience an increase in altitude, hypoxemia may occur due to the decrease in barometric pressure. This decrease in pressure first and foremost decreases the oxygen tension in the alveoli or the PAO2.

While performing endotracheal suctioning on a cystic fibrosis patient who is intubated and receiving VC SIMV ventilatory support, the respiratory therapist discovers that the suction has immediately stopped. Which of the following is the most likely cause?

The suction canister is full.

An adult male is receiving volume-controlled ventilation and is on SIMV mode with a mandatory rate of 12/min, tidal volume of 550 mL, FIO2 of 0.60, and a PEEP of 10 cm H2O. Flow triggering is in use at 16 L/min baseline flow. During spontaneous expiration, the pressure remains higher than the set level of PEEP. The respiratory therapist should A. increase PEEP B. discontinue flow triggering C. perform an optimal PEEP study D. reduce the baseline flow of the flow triggering mechanism

The correct answer is : D Explanation : When the baseline flow of the flow triggering mechanism is excessive, the result will be that the pressure needle does not return to the baseline PEEP level at the end of each exhalation. This should be remedied by reducing the baseline flow.

A respiratory therapist is repeating pulmonary function testing on a patient who had initial pulmonary function testing 6 months ago. With the first FVC attempt, the therapist notices the patient was only able to accomplish an FEV1.0 sec of 50% of predicted. Six months prior, the patient was able to reliably accomplish 85% of predicted. The therapist should A. reject the results as they have not met ATS standards B. change the helium analyzer C. report the significant decline as exacerbation of COPD D. repeat the effort, encourage the patient to increase effort

The correct answer is : D Explanation : When the pulmonary status of the patient degrades, it happens slowly. It is not likely that a patient's forced vital capacity would drop from 85% of predicted to 50% of predicted within six months. It is more likely that variation of patient effort is being observed. The patient should be instructed to reattempt the maneuver and apply greater effort.

c. take rescue medication, check flows in one hour

The respiratory therapist working in a clinic receives a call from a patient who has asthma and is only able to achieve 75% of their normal baseline peak flow measurement. The therapist should advise the patient to a. call their doctor immediately b. check flows again in one hour, call if less than 50% of expected c. take rescue medication, check flows in one hour d. take rescue medication every 15 minutes for 2 hours, recheck flows

A patient who maintains a fenestrated tracheostomy tube would like to speak. Immediately after configuring the tracheostomy tube for speech, the patient is unable to ventilate. Which of the following is most likely?

The cuff is inflated.

d. sodium bicarbonate administration

The following arterial blood gas results are recorded for a patient during cardiopulmonary resuscitation: pH 7.10 / PaCO2 46 / PaO2 208 / HCO3 12 / FiO2 1.0 On the basis of these values and the following ECG waveform, the respiratory therapist should recommend a. administer sodium nitroprusside b. increase manual ventilation rate c. decrease FiO2 d. sodium bicarbonate administration

c. decreasing pulmonary compliance

The following data is available for a patient receiving volume-controlled mechanical ventilation: 6am --> 9am Ppeak: 20 --> 32 Pplat: 13 --> 25 Set VT: 0.6 --> 0.6 PEEP: 5 --> 5 Which of the following is most consistent with these data? a. bronchoconstriction b. kyphoscoloiosis c. decreasing pulmonary compliance d. increasing dynamic airway resistance

a. emphysema

The following flow volume loop is obtained from a 59-year-old farmer who works in a granary. Which of the following could represent the patient's diagnosis? a. emphysema b. asthma c. chronic bronchitis d. pulmonary fibrosis

c. poor patient effort

The following pulmonary function data is obtained from a 32-year-old male with a history of pulmonary fibrosis: SVC: 62% of predicted FVC: 69% of predicted FEV1.0: 80% of predicted FEF25-75: 79% of predicted FEV200-1200: 82% of predicted DLCO: 91% of predicted The respiratory therapist should interpret this data as a. severe restrictive disease b. moderate diffusion impairment c. poor patient effort d. mild obstructive defect

c. pulmonary emphysema

The following pulmonary function data is obtained from a 72-year-old male: SVC: 81% of predicted FVC: 79% of predicted FEV1/FEV: 70% FEF25-75: 69% of predicted FEF200-1200: 63% of predicted DLCO: 16% The respiratory therapist should interpret this data as a. asthma b. sarcoidosis c. pulmonary emphysema d. severe diffusion impariment

d. decrease inspiratory time

The physician orders a change in I:E ratio from 1:2 to 1:4 for a COPD patient receiving volume-cycled mechanical ventilation. Which of the following accommodates the physician's request if the mandatory rate is not changed? a. increase the inspiratory time b. decrease the inspiratory flow rate c. decrease expiratory time d. decrease inspiratory time

c. basic spirometry

To determine potential post-operative risk of a patient preparing for surgery, the respiratory therapist should recommend which of the following tests? a. cardiac stress test b. pulmonary stress test c. basic spirometry d. pulmonary diffusion studies

Which of the following is a cardiac enzyme that can be used to detect the presence of a recent myocardial infarction?

Troponin

A respiratory therapist auscultates expiratory wheezing on a patient with COPD who has a 75 pack-year history of smoking. The therapist should recommend

Unit dose of Albuterol by small volume nebulizer.

A respiratory therapist is communicating with a 4-year-old patient to determine the level of pain currently being experienced by the patient. Which of the following methods would be most effective?

Use the Wong-Baker faces and ask the child to point to correct level

Despite repeated efforts to verbally coach a patient to cough and expectorate upper airway secretions as manifested by the presence of rhonchi, the patient is unable or unwilling to following commands. The respiratory therapist decides to perform NT suctioning. Which of the following is the most important consideration when performing NT suctioning?

Utilize ample water-soluble lubricant and be gentle.

A patient is in the intensive care unit following a motor vehicle accident. The respiratory therapist notices cyanosis from the waist up. Additional data shows: ABG pH 7.38 PaCO2 42 torr PaO2 78 torr HCO3- 24 mEq/L BE 0 mEq/L PetCO2 18% Hb 12 gm/dL CBC 9,000 cu mm Which of the following should the therapist recommend?

V/Q scan

d. TLC - FRC

Which of following calculations will determine inspiratory capacity (IC)? a. IRV - TLC - RV b. ERV + VT + IRV c. TLC - VT - ERV d. TLC - FRC

a. radiologist reports the ET tube is 1 inch above the carina

Which of the follow data, if observed, would indicate proper positioning of an oral endotracheal tube? a. radiologist reports the ET tube is 1 inch above the carina b. end of ET tube 2 cm below the aortic knob c. end of ET tube is 6 cm above the carina d. poor left chest symmetry

c. ET tube markings at the lips

Which of the following can be examined to initially determine the approximate position of the oral endotracheal tube? a. chest radiograph b. lateral neck radiograph c. ET tube markings at the lips d. diaphragmatic excursion

d. stroke volume

Which of the following data is needed to calculate cardiac output? a. VO2 b. QS/QT c. A-aDO2 d. stroke volume

d. magnetic resonance imaging (ME)

Which of the following diagnostic procedures should the respiratory therapist recommend to more clearly identify what looks like a mass in the upper right lung field? a. PA chest radiograph b. transesophagus echocardiogram (TE) c. AP chest radiograph d. magnetic resonance imaging (ME)

a. pulmonary capillary wedge pressure

Which of the following hemodynamic values is associated with the function of the left heart? a. pulmonary capillary wedge pressure b. systemic vascular resistance c. mean pulmonary artery pressure d. central venous pressure

c. increased CVP, decreased PAP

Which of the following is most indicative of right heart failure? a. increased PAP, decreased cardiac output b. increased PAP, decreased PCWP c. increased CVP, decreased PAP d. decreased CVP, decreased PAP

c. BP and FIO2

Which of the following is needed to calculate alveolar oxygen tension? a. VD/VT, PAO2 b. QS/QT, deadspace c. BP and FIO2 d. PetCO2 and PaO2

d. Anectine (succinylcholine chloride)

Which of the following medications is shown to have sufficient affect when facial muscle twitching is observed? a. Halcion b. Curare (d-turbo curare) c. Romazicon d. Anectine (succinylcholine chloride)

c. ARDS

Which of the following patients or conditions would benefit most from pressure control ventilation? a. COPD b. myasthenia gravis c. ARDS d. pneumonia

a. 25/8 mmHg

Which of the following pressures is most consistent with a normal pulmonary artery pressure (PAP)? a. 25/8 mmHg b. 12/8 mmHg c. 120/80 mmHg d. 25/4 mmHg

a. diligent hand washing

Which of the following represents the most effective method of preventing nosocomial infections in a hospital setting? a. diligent hand washing b. use of sterile gloves c. use of N-95 respirators d. use of alcohol wipes on equipment

d. auscultate breath sounds

While transporting at patient from the emergency department (ED) to the intensive care unit (ICU), the respiratory therapist suspects the oral endotracheal tube has changed position. The quickest way to assess the ET tube position would be to a. analyze end-tidal CO2 b. obtain a chest x-ray c. visualize diaphragmatic excursion d. auscultate breath sounds

While assisting in the performance of a cardiac stress test, the respiratory therapist notes the following in the medical record after increasing the tension on a stationary bicycle: before increase in workload after increase in workload HR 110/min 130/min BP 132/90 mm Hg 152/92 mm Hg SpO2 97% 95% The respiratory therapist should anticipate

a further increase in workload

A patient who is receiving mechanical ventilation has the following ventilatory data: 2 pm 2 am 2 pm 2 am VT (mL) 650 650 650 650 PEEP (cm H2O) 7 7 7 7 Pressure (plat) 28 30 32 36 SpO2 (%) 97 95 94 94 If no changes are made on the ventilator, which of the following alarms could be expected if this trend continues?

a high-pressure

Which of the following is an example of an advanced directive?

a living will

While purposefully kinking a bubble-humidified nasal cannula momentarily while in use on a patient receiving oxygen at 2 L/min, the respiratory therapist notices no audible response from the system. Which of the following could be the cause?

a loose reservoir

A 6-minute walk test is used to evaluate

a patient's physical stamina and aerobic endurance.

A patient receiving high-frequency mechanical ventilation has the following ABGs: PH 7.51 PaCO2 30 tor rPaO2 82 torr HCO3- 23 mEq/L Which of the following should be recommended?

a reduction in oscillatory amplitude

A 24-year-old Caucasian male has suffered a spontaneous pneumothorax on the right side. Upon inspection, which of the following would most likely be observed?

accessory muscle use

While performing routine chest physiotherapy on a patient, the respiratory therapist observes a sudden change in the patient's condition. A quick assessment reveals: HR 62/min RR 20/min, shallow SpO2 87% and falling on 4 L/min NC BP 80/55 mm Hg The therapist should immediately

activate the rapid response team

A patient who has been orally intubated, for a surgical procedure, demonstrates moderate stridor immediately after extubation. Prior to surgery, the anesthesiologist determined the patient's Mallampati classification to be 3. The respiratory therapist should recommend

administering aerosolized racemic epinephrine.

A patient in the intensive care unit (ICU) is receiving mechanical ventilation following a massive heart attack where injury and infarction were sustained. The following data is available: Mode VC, SIMV FIO2 0.50VT 500 mLf 14/minPEEP 5 cm H2O PCWP 12 mm HgCVP 8 mm HgmPAP 20 mm HgC.O. 7.9 L/min ABG pH 7.36PaCO2 49 mm HgPaO2 82 mm HgHCO3- 25 mEq/LBE +1 mEq/L The respiratory therapist should recommend

administration of a loop diuretic.

A sputum gram stain report indicates the presence of a gram-positive organism (diplococcus) in the sputum. The following data is available: WBC 28,000 cu mm Hb 14.5 g/dL RBC 4.6 g/dL HCT 42% Which of the following medication would be most appropriate?

amoxicillin

A patient is suspected of being a chronic CO2 retainer. A blood gas analysis reveals a PaO2 of 64 torr and a PCO2 of 65 torr. What additional data may be used to determine if the patient is a chronic CO2 retainer?

arterial blood pH

The build-up of positive end-expiratory pressures in the lungs as a result of insufficient time to exhale is known as

autoPEEP

The legal guardian of a patient with asthma calls into the clinic and reports that her child is in the red zone on the asthma action plan and asks for direction. The respiratory therapist should instruct the guardian to

call 911 for an ambulance.

A patient in the intensive care unit (ICU) is suspected for pulmonary embolism. Which of the following exams would help investigate for this suspicion?

capnography

Which of the following chest radiographic findings would most likely be observed on a patient who has a long-standing condition of congestive heart failure, secondary to obesity?

cardiomegaly

A patient in the neurological intensive care unit (NICU) is dependent on mechanical ventilation following evidence of significant brain-stem herniation. A cerebral brain perfusion study shows large areas without perfusion. An EEG shows virtually no brain activity. Ventilator settings and ABGs are as follows: FIO2 1.0 VT 450 mL Rate(set) 18/min Rate(total) 18/minMode VC A/C PEEP 0 cm H2O pH 7.42 PaCO2 39 torr PaO2 92 torr HCO3- 24 mEq/L BE 0 mEq/L Which of the following should be recommend by the respiratory therapist?

cessation of mechanical ventilation.

The following volume-pressure graphic is observed on a patient who is receiving VC A/C ventilation. The respiratory therapist should

change the scale volume axis of the graph

Which of the following emergency airway clearance techniques should be used on a female who is 7 months pregnant and who has complete airway obstruction by aspirated food?

chest thrusts

A local flu epidemic has flooded the area's emergency services with more patient's than can be handled by local facilities. All emergency services in the area are at or above capacity. Which of the follow would be an appropriate strategy for a respiratory therapist to suggest in an ER when additional patients are expected to arrive while the ER is at capacity?

cohorting of patients

Prior to performing pulmonary function testing on a several patients, a respiratory therapist is conducting quality control on the pneumotachometer. After injecting a 3.0 L syringe through the pneumotachometer, the therapist notes a measurement of 2.86 L. Based on this result the therapist should

commence testing on patients.

A patient develops rhonchi during postural drainage and percussion. SpO2 drops to 92% during a related coughing episode. After bringing the patient's head-of-bed up to allow for recuperation, the therapist should recommend

continuance of therapy as ordered.

A patient admitted with confirmed myasthenia gravis has a spontaneous VT of 350 mL and a VC of 1.9 L. Which of the following should be recommended?

continued monitoring of VC, VT, and MIP

A patient has been receiving mechanical ventilatory support for one week, following a pulmonary contusion. The physician would like to consider weaning. Current ventilator settings and other data reveal: Mode SIMV f 4/min VT(set) 500 mL PEEP 5 cm H2O FIO2 0.40 VC 1.8 L VT (spont) 525 mL MIP -38 cm H2O The patient follows commands intermittently and, at times, seems somewhat disoriented to time, person, and place. The respiratory therapist should recommend

continuing mechanical ventilatory support.

A 68-year-old near drowning victim is triggering a high-pressure alarm on a VC ventilator. The following ventilatory data is available: 8 pm 8 am 8 pm 8 am VT (mL) 550 550 550 550 PEEP (cm H2O) 5 5 5 5 Px (plat) (cm H2O) 18 23 27 32 Px (peak) (cm H2O) 28 33 37 42 SpO2 (%) 98 96 94 93 For which of the following reasons has the high-pressure alarm most likely been triggered?

decreased static compliance

A 75-kg (165-lb) patient in the intensive care unit (ICU) has gradually experienced a decrease in pulmonary compliance. Consequently, the ordering physician has ordered a change in mechanical ventilation settings from volume-controlled to pressure-controlled with the following settings: PIP 35 cm H2O PEEP 5 cm H2O FIO2 0.60 Rate 20/min Return VT 760 mL SpO2 0.91HR 110/min The respiratory therapist should recommend

decreasing PIP

The high return-volume alarm is sounding on a 68-kg (150 lb) IBW patient who is receiving PC ventilation in the SIMV mode. Current settings and ventilatory data are: PIP 35 cm H2O PEEP 5 cm H2O FIO2 0.50 Rate 18/min I:E ratio 1:2.4 Return VT 768 mL SPO2 0.99 The respiratory therapists should recommend

decreasing PIP

A patient in the emergency room (ER) has multiple fractured ribs bilaterally after a motor vehicle accident. ABGs show pH 7.51 PaCO2 29 torr PaO2 102 torr HCO3- 24 mEq/L BE +3 mEq/L FIO2 0.21 The respiratory therapist should

determine the level of pain.

While performing endotracheal suctioning on a patient in the intensive care unit (ICU), the respiratory therapist notices the following ECG wave form on the monitor: The therapist should immediately:

discontinue suctioning, provide 100% oxygen.

A patient with congestive heart failure is transferred to the intensive care unit (ICU) following an exacerbation resulting in acute pulmonary edema. A pulmonary artery catheter is placed. The following data is reported: mPAP 22 mm Hg CVP 9 mm Hg PCWP 12 mm Hg C.I. 4.2 L/min/m2 BP 122/88 mm Hg HR 110/min The respiratory therapist should recommend

diuresis

A patient's chest radiograph shows consolidation in the right middle and lower lobes. What additional finding is likely?

dull to percussion over the affected areas

A patient's medical record indicates the physician recently documented auscultation of a cardiac murmur. For which of the following possible examination results should the respiratory therapist search in the record?

echocardiogram

When auscultating the heart of a newborn, delivered by C-section at 34 weeks-of-gestation, the respiratory therapist observes a murmur. What follow-up exam should be ordered?

echocardiography

An air-oxygen blender is being used to provide 40% oxygen to a newborn. Suddenly the blender begins to emit a high-pitched sound. The respiratory therapist should

ensure the blender is adequately attached to 50 psi source gas.

To best assure that the blood pressure reading from an in-dwelling arterial catheter is accurate, the respiratory therapist should

ensure the transducer is level with the heart

Which of the following would be most helpful at impeding and/or stopping bleeding occurring within the mainstem bronchus caused by tissue extraction with a bronchoscope?

epinephrine

Which of the following could be a cause of a low-pressure ventilator alarm A. improved pulmonary compliance B. kinked ET tube C. increased airway resistance D. ARDS

he correct answer is : A Explanation : The solution here is to look for choices that could result in a low pressure or low volume alarm. If someone has improved pulmonary compliance, this could result in lower pressures, thus triggering a low-pressure alarm. Significantly reduced airway resistance would also cause a low-pressure alarm if the low-pressure alarm was set too high or too close to the previous pulmonary pressures. A disconnected ventilator circuit and a deflated ET tube cuff would also result in a low-pressure alarm. Thus, all answers are correct.

Which of the following circumstances, if occurring during a cardiopulmonary exercise test, would indicate that the test should be halted?

heart rate does not increase with an increase in workload

A patient is brought to the emergency department (ED) with respiratory distress. The patient has a single-bore tracheostomy tube in place, which was replaced three weeks prior. The patient reports recently coughing up tan, thick secretions through the tube. The medical record from the transferring facility indicates the patient breathes ambient air without supplemental oxygen. Currently, the patient is receiving oxygen by trach collar and a high-flow air entrainment device set at 40%. The respiratory therapist should recommend

heated humidity.

A patient who requires continuous mechanical ventilatory support is suspected for having a perforation in the lung tissue of the left lower base. A chest radiograph confirms this suspicion. Which form of ventilatory support would minimize the chance of further perforation?

high-frequency jet ventilation (HFJV)

Which of the following should be ordered for a post-surgical patient who has a history of contracting pneumonia following invasive surgery?

hyperinflation therapy

A patient has returned to the sleep clinic after using nasal mask CPAP for 2 days. The patient complains of a small amount of continuous air escaping from a hole in the plastic mask. The respiratory therapist should instruct the patient to

ignore the escaping air because it is built into the mask.

A patient in the emergency department (ED) is breathing spontaneously after inhalation of kerosene. The following physiologic data is available: ABG pH 7.31 PaCO2 49 torr PaO2 74 torr HCO3- 23 mEq/L BE -2 mEq/L HR 110/min SpO2 92% The patient is lethargic but responds appropriately to commands. The respiratory therapist should recommend

implementing non-invasive ventilation.

A respiratory therapist has intubated an adult patient who is receiving mechanical ventilation. The therapist intends to adjust ET tube cuff pressure using he minimal leak technique. The first step is to

inject enough air to create a seal

A respiratory therapist is observing a patient in the intensive care unit (ICU) during an exacerbation of congestive heart failure. The doctor orders close monitoring of the hemodynamic status of the patient. The therapist should recommend

insertion of a pulmonary artery catheter.

While receiving ventilatory support by a non-invasive ventilator, a patient vomits into the full inflatable mask. Although not known, it is believed that the patient may have aspirated. The following arterial blood gases are determined 20 minutes after the event while receiving ventilatory support on IPAP 25 cm H2O, EPAP 5 cm H2O: ABGs pH 7.38 PaCO2 42 torr PaO2 81 torr HCO3- 24 mEq/L BE +1 mEq/L The respiratory therapist should

institute invasive mechanical ventilation.

During a preoperative test of a mechanical ventilator, the respiratory therapist notices the ventilator is not delivering sufficient tidal volume to the test lung compared to the set tidal volume. The following settings are being used: Mandatory rate 20/min VT 800 mLI:E 1:2FIO2 0.30PEEP 5 cm H2OFlow 40 L/min Which of the following is most likely the cause of the problem?

insufficient flow

A patient with COPD, receiving mechanical ventilation, is undergoing early extubation to non-invasive ventilation. Immediately following extubation, the patient is placed on bi-level ventilation with settings IPAP 20 cm H2O, EPAP 5 cm H2O. Thirty minutes later, the patient begins to exhibit moderate inspiratory stridor that advances to a marked condition. The respiratory therapist should

intubate the patient

A patient has undergone a laryngectomy two days prior and currently has a laryngectomy tube in place. In the past hour, the patient has begun to demonstrate marked ventilatory difficulty. An arterial blood gas analysis shows ventilatory failure. In preparation for mechanical ventilation, the respiratory therapist should

intubate the patient though the laryngectomy tube.

A physician suspects a patient has a pleural effusion. What should the respiratory therapist recommend to further investigate the suspicion?

lateral decubitus radiograph

An adolescent patient is brought to the emergency room (ER) in a state of panic and respiratory distress. Peak flow measurement is attempted but the patient is unable to perform the maneuver. The patient is only capable of speaking in one-word sentences. The respiratory therapist should consider the situation to be

life threatening.

A patient in the neurological intensive care unit (NICU) is being monitored for intracranial pressure (ICP). The average pressure over the last several hours is 15 mm Hg. In the last few minutes, ICP has risen to 25 mm Hg. This is most likely due to

over-stimulation of the patient.

A home-care plan is being created for a COPD patient who will be discharged home. Which of the following would be most helpful in assessing a patient's ability to conduct activities of daily living (ADLS) relative to the oxygen needs of the patient?

oxygen titration with exercise

A patient is brought to the emergency room (ER) after being retrieved from a motor vehicle accident where he was the driver. The respiratory therapist notices paradoxical chest movement on the right side, a deviated trachea to the left, and the presence of tachypnea. Which of the following should the therapist suspect?

pneumothorax

A patient reports to the emergency room (ER) following an accident while playing football. Paramedics on the scene report a sudden on-set of tachypnea. The following chest radiograph is taken. What is the most likely diagnosis?

pneumothorax

A patient has the following pulmonary function test results: SVC 4.2 L FVC 4.3 L Fev1 3.1 L Fev1/FVC% 72% DLCO 22 mL/CO/min/mm Hg The respiratory therapist should conclude

poor patient effort on the SVC.

For a patient receiving mechanical ventilation, with which of the following is plateau pressure most closely associated?

pulmonary static compliance

A patient is receiving aerosolized Xopenex 1.25 mg every 4 hours. The respiratory therapist notices that the patient's heart rate jumps from 92 to 108 during the last two treatments. The respiratory therapist should recommend

reducing the Xopenex dose to 0.63 mg.

A patient with a fenestrated tracheostomy tube in place is experiencing marked respiratory distress. While attempting to suction the airway with a sterile catheter, the respiratory therapist notices an obstruction in the tube. The therapist should immediately

remove the inner cannula

While ventilating a patient with a VC ventilator, the respiratory therapist notices that the ventilator is not delivering the set tidal volume. The therapist should

remove the ventilator from service, perform preoperative test.

A respiratory therapist notices the fluid collection chamber on a disposable chest tube drainage system is full. The respiratory therapist should

replace the entire apparatus.

The mother of a patient with asthma calls into the clinic to get advice regarding her child's ventilatory difficulty. She reports the child is breathing fast and deeply and is having trouble talking between breaths despite the delivery of 3 doses of albuterol. She also indicates she has a call in the child's doctor but has not yet received a return call. The respiratory therapist should recommend

reporting to the emergency room immediately.

A 6-ft, 2-in (188-cm) Caucasian male has inexplicably become tachypneic. Tracheal deviation to the left is noted. A chest radiograph confirms a pneumothorax and chest tube placement is ordered. The respiratory therapist should recommend placement of chest tubes in the

right side, 2nd interspace, mid-clavicular line.

A patient has the following 12-lead ECG tracing after being found emaciated, hypothermic, and unconscious in an abandoned building. The ECG shows flattened 'T' waves. The respiratory therapist should suggest checking which of the following, based on the ECG tracing?

serum electrolyte levels

Which of the following could cause a false exhaled CO2 reading on a capnograph placed in a ventilator circuit?

soiled infrared detector

If a patient is prescribed Vancomycin, which of the following is most likely?

sputum culture shows gram negative organisms

A 14-year-old, 66-kg (145-lb) female patient with a history of asthma is in the emergency room (ER) in response to an exacerbation of asthmatic symptoms over the last 2 hours. While en route the patient received 2 small volume nebulizer treatments with 0.5 mL albuterol. Paramedics report no appreciable responses to the bronchodilator. The respiratory therapist should recommend

starting continuous albuterol therapy at 10 mg/hr.

Following surgery, a patient is slow to emerge from sedation and requires continued ventilatory support through an 8.0-mm ET tube. The patient will be transferred to the intensive care unit overnight for close observation. The respiratory therapist notices sputum in the HME device attached to the end of the ET tube. The therapist should

switch to heated humidification.

An adult patient experiences an adverse cardiac and blood pressure reaction to 0.25 mL Albuterol when administered by small volume nebulizer. The respiratory therapist should

switch to unit dose Atrovent (ipratropium bromide).

A patient suspected of ARDS is receiving VC mechanical ventilation and has the following ventilatory data: VT 650 mL Mode A/CFIO2 0.60PEEP 12 cm H2OPx(peak) 52 cm H2OPx(plat) 36 cm H2OSpO2 88%OI 32 The respiratory therapist should consider

switching to PC ventilation

Extensive testing has proven no brain activity in a patient who is completely ventilator-dependent. The family decides to discontinue life support. The physician orders extubation and implementation of non-invasive ventilation. For what purpose is NIV being used in this case?

to provide comfort to the patient and family

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