TMC (LJU Version 10)

A respiratory therapist reviews the medical record of a patient and notes the HbCO is 10%. This data was collected 1 hour prior and the patient is asymptomatic. From these results, the respiratory therapist can conclude the patient most likely A. is a heavy smoker B. attempted to commit suicide C. has pulmonary fibrosis D. has an exhaust leak into the cabin of the vehicle

The correct answer is : A Explanation : And HbCO of 10% is much higher than normal and indicates the patient likely smokes tobacco.

Which of the following is a significant indicator of negative effects from positive pressure ventilation? A. decrease urine output B. drying of pulmonary secretions C. increased alveolar distention D. increase in physiological deadspace

The correct answer is : A Explanation : Excessive pressures from positive pressure ventilation will first and foremost cause decreased venous return. Of the options offered the next most significant response is decreased urine output.

Immediately after oral intubation of an apneic patient, the respiratory therapist begins manual ventilation with a bag-valve assembly. The patient is simultaneously connected to an end-tidal carbon dioxide monitor. Which of the following should the respiratory therapist expect to observe when looking at the capnographic waveform? A. first a rise, then a fall in CO2 B. stair-step shifts in the CO2 tracing C. steady CO2 reading D. fall in CO2 followed by a subtle rise

The correct answer is : A Explanation : Initial ventilation attempts after a patient has been apneic will show reduced end-tidal CO2 followed by a steady rise as ventilation is provided. Ultimately, as ventilation continues the end-tidal CO2 will begin to decrease.

A patient is receiving volume-controlled ventilation. Which of the following blood gas results is a clear indication for an increase in minute ventilation? A. pH 7.25, PaCO2 55 torr, PaO2 51 torr B. pH 7.35, PaCO2 60 torr, PaO2 65 torr C. pH 7.55, PaCO2 26 torr, Pao2 88 torr D. pH 7.50, PaCO2 30 torr, PaO2 82 torr

The correct answer is : A Explanation : The need to increase minute ventilation can be determined by examining arterial CO2. In this question, two options have an elevated PaCO2, indicating a need to increase ventilation. However one of these options shows a corrected pH, suggesting that the elevated CO2 is normal for that patient. Therefore, the correct answer is the blood gas results that show elevated CO2 with an uncompensated pH. This is called uncompensated respiratory acidosis.

A patient undergoing pulmonary function testing in a body box has an airway resistance (Raw) of 2.7 cm H2O/L/sec. The respiratory therapist should provide which of the following interpretations? A. Guillain-Barre Syndrome B. asthma C. restrictive pulmonary disease D. normal results

The correct answer is : B Explanation : An airway resistance of 2.7 cmH2O/L/sec is considered high. Elevated airway resistance is associated with asthma.

A respiratory therapist has provided Albuterol treatments via SVN to a patient in the emergency room for shortness of breath. The patient now has bleeding gums and epistaxis. What should the physician check? A. sinus X-ray B. allergic response to Albuterol C. arterial blood gas D. prothrombin time

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

Which of the following is used to evaluate a patient for fluid imbalance? A. minute ventilation B. pitting edema C. P50 D. cerebral perfusion pressure

The correct answer is : B Explanation : Fluid imbalance may result in pitting edema, changes in sensorium, and altered capillary refill time. Minute ventilation, P50, and CPP is not helpful.

Predicted Observed TLC (liters) 4.50 4.30 FRC (liters) 2.45 2.30 SVC (liters) 3.30 3.10 FEV1 (liters) 2.15 1.65 FEF50 (liters/sec) 4.00 3.09 Which of the following represents the most appropriate interpretation of the preceding spirometry results? A. pulmonary fibrosis B. cystic fibrosis C. scoliosis D. tracheomalacia

The correct answer is : B Explanation : Pulmonary function values show low flows as shown by an FEV1 which is less than 80% of predicted. This means the patient is obstructive. Volumes are normal as shown by the slow vital capacity, and indicates the patient is not restrictive. We must pick the option that is an obstructive disease. In this case, only cystic fibrosis is obstructive.

A home care patient with a tracheostomy tube uses an electrically-powered ventilator during sleeping hours. Recent nocturnal oximetry results reveal moderate hypoxemia while asleep on the ventilator. What should the respiratory therapist recommend? A. Provide a tracheostomy collar with FIO2 0.40 heated aerosol. B. Provide oxygen bleed-in by molecular sieve device. C. Increase the set respiratory rate by 2/min. D. Perform complete polysomnography.

The correct answer is : B Explanation : The best device for home oxygen therapy is a molecular sieve device, commonly known as an oxygen concentrator. This device is powered with electricity, which makes it appropriate for home use.

A patient is experiencing shortness of breath. The radiological AP view of the chest shows a blunt costophrenic angle in the left lower lobe. This would indicate A. atelectasis. B. pneumonia. C. pleural effusion. D. pulmonary embolus.

The correct answer is : C Explanation : A chest X-ray reveals a pleural effusion if we see descriptors such as "blunt or obliterated costophrenic angles", or "concave superior interface".

A patient in the emergency room, who is breathing rapidly and deeply, is receiving heated aerosol by mask and large-volume nebulizer with FIO2 set at 1.0 and the flow set at 15 L/min. The therapist notices the aerosol disappears completely with each breath. Pulse oximetry shows an oxygen saturation of 88%. The therapist should recommend A. switch to a non-rebreathing mask at the same flow B. increase flow to 20 L/min C. a tandem aerosol device D. decrease FIO2 to 0.6

The correct answer is : C Explanation : A large volume nebulizer set at 60% with a flow of 15 L/min is producing a total gas flow of 15 L/min. Because this patient is breathing rapidly and deeply and is hypoxic, it is likely that the total flow is not meeting the inspiratory demands of the patient. Because the flow of the large-volume nebulizer may not be increased significantly due to back pressure the solution for this case is to add another tandem large-volume nebulizer device, producing a total gas flow of 30 L/min.

A patient in the emergency room has been diagnosed with status asthmaticus. She has received IV steroids, MDI steroids, bronchodilators and antibiotics. Which medication should be discontinued first once the patient becomes stable? A. MDI steroids B. bronchodilators C. IV steroids D. antibiotics

The correct answer is : C Explanation : A patient with status asthmaticus would benefit from IV steroids such as methylprednisolone. Of the medications given IV steroids should be discontinued first.

A bronchoscopy is used to diagnose A. atelectasis. B. emphysema C. malignant processes. D. idiopathic chronic bronchitis

The correct answer is : C Explanation : Bronchoscopy is used to diagnose foreign body obstructions, active bleeding causes, pathogenic involvement (to identify organisms) and cancerous or malignant processes or areas. It may help decrease atelectasis if immobilized mucous plugs are blocking a portion of the lung from expanding, but it does not serve in the diagnosis of atelectasis.

A patient presents in the emergency department (ED) with shallow, irregular respirations. Which of the following diagnostic procedures would best help rule out a pleural effusion? A. ventilation/perfusion (V/Q scan) B. pulmonary angiogram C. series of oblique chest radiographs D. PA chest radiograph

The correct answer is : C Explanation : Pleural effusions may be diagnosed through obtaining a lateral decubitus x-ray or by obtaining a series of x-rays from oblique angles and different positions.

A respiratory therapist changes from a normal adult ventilator circuit to a heated-wire circuit. Arterial blood gases are as follows: pH 7.31 PaCO2 48 torr PaO2 81 torr HCO3- 24 mEq/L BE 0 mEq/L Which of the following changes is most indicated? A. revert to the normal non-heated wire circuit B. increase inspiratory flow rate C. remove 50-100 mL of deadspace between the wye and patient D. add 100 mL of deadspace at the patient-ventilator interface

The correct answer is : C Explanation : When arterial carbon dioxide is high, there are three options. Respiratory rate may be increased, tidal volume may be increased, or deadspace may be removed. Of the options offered removing deadspace is the best option and is the only option that will reduce carbon dioxide. What also makes this appropriate is the fact that CO2 is off target by a very small amount, making a change in deadspace appropriate.

A patient is receiving mechanical ventilation in the pressure-control mode. End-tidal CO2 is being monitored. The following tracing is available on the monitor in real-time. Which of the following interpretations is most consistent with this tracing? A. hyperventilation B. hypoventilation C. poor alveolar recruitment D. normal ventilation

The correct answer is : D Explanation : An end-tidal CO2 of 40 mmHg correlates with an arterial CO2 level of about 40 mmHg, which is normal.

During a routine check of a patient on mechanical ventilation, the respiratory therapist palpates less chest rise on the left compared to the right during inspiration. The therapist should first do which of the following? A. Advance the endotracheal tube and recheck chest rise B. Prepare for needle decompression in the left chest C. Check the integrity of the ET tube cuff D. Auscultate breath sounds bilaterally for equal air movement

The correct answer is : D Explanation : Asymmetrical chest movement, or chest rise during mechanical ventilation, is an indication that the endotracheal tube may be improperly placed. The first, more immediate action that should be taken is to further assess the problem by auscultating the chest. If breath sounds are absent on one side, it is appropriate to withdraw the endotracheal tube until breath sounds can be heard bilaterally. After doing so, a chest x-ray should be ordered to confirm proper placement of the endotracheal tube.

What radiographic finding would be most likely associated with a patient who is experiencing active tuberculosis? A. Atelectasis in the upper lobes B. Cavitation in a lower lobe C. Mass in the left middle lobe D. Pleural cavitation in the upper lobes

The correct answer is : D Explanation : Cavitations in the upper lobes are generally associated with tuberculosis, and an X-ray with this finding should assure the respiratory therapist of the diagnosis. Plate-like or patchy infiltrates on X-ray are seen with atelectasis. A mass, which is solid, (opposite of a cavitation) is often associated with cancer.

Which of the following sounds assessed by a respiratory therapist is potentially the most serious if heard on a pediatric patient in the emergency room? A. barking cough, otherwise clear B. rhonchi clearing with cough C. high-pitched continuous on exhalation over the larynx D. high-pitched continuous during inhalation over the larynx

The correct answer is : D Explanation : High-pitched continuous sounds in the upper airway, also known as stridor, may be life-threatening.

An end-expiratory chest radiograph is best used to assess for which of the following? A. pulmonary vascular disease B. overall pulmonary aeration C. diaphragmatic hernia D. small pneumothorax

The correct answer is : D Explanation : Normally, we prefer to observe a chest x-ray at full inhalation. However, an end-expiratory chest radiograph is helpful at identifying a small pneumothorax.

The following ECG waveform is noted on the monitor while performing endotracheal suctioning using a 12 Fr catheter at a wall suction pressure of 110 mmHg. Which of the following is the mostly likely cause? A. vagal nerve stimulation B. oxygen toxicity C. hypokalemia D. arterial hypoxemia

The correct answer is : D Explanation : Premature ventricular contractions (PVCs) can be caused by suctioning. Suctioning causes alveolar oxygen tensions to fall thus causing arterial hypoxemia. Vagal nerve stimulation also occurs but this is not associated with PVCs.

An adult is receiving NT suctioning and experiences a decrease in SpO2 from 98% to 80% during the procedure. The respiratory should A. check for breathing. B. manually ventilate with bag/mask. C. provide 100% oxygen. D. stop the suction procedure.

The correct answer is : D Explanation : The respiratory therapist should immediately stop suctioning if any signs of distress are present cardiac, desaturation, or otherwise).

A patient is receiving bronchodilator therapy with the following results: Pre-treatment Mid-treatment Resp rate 14 15 Heart rate 90 120 The therapist should do which of the following? A. continue treatment and monitor closely B. instruct the patient to take smaller breaths C. continue treatment, notify the physician D. terminate the treatment and notify the physician

The correct answer is : D Explanation : This patient demonstrates an excessive change in heart rate during the bronchodilator therapy. Any change greater than 20 above baseline is considered a significant reaction to the bronchodilator medication. This is a direct indication to stop the therapy and to modify it by either decreasing dosage, switching to a different medication, or changing the modality altogether.

How many portable oxygen E cylinders will be required for a 12-hour car trip with a flow rate of 2 L/min? A. 4 B. 5 C. 2 D. 3

The correct answer is : D Explanation : To answer this question you must know that the tank factor for an E cylinder is 0.28. A full E cylinder is 2200 PSI. Therefore 2200x0.28 is equal to 616 L. 616 divided by two is equal to 308 min. A 12 hour car trip is 720 min. Therefore the patient will need three E cylinders of oxygen to go on a 12 hour trip.

Excessive bubbling is noted in the water seal chamber of a chest tube drainage system. Which of the following could be the cause? A. leak in the drainage tubing coming from the patient B. water seal fluid level is too high C. wall pressure is too low D. water seal fluid level is too low

The correct answer is : A Explanation : A leak in the drainage tubing coming from a patient's chest will cause the entrainment of additional air into the system which will show up as excessive bubbling in the water-seal compartment. Normally gentle bubbling should be observed. When excessive bubbling is present, a leak most likely exists somewhere between the waterseal compartment and the patient's lung tissue and may be caused from a perforation or hole in the lung tissue.

The following pulmonary function test results are reported for a 60-year-old male patient who weighs 65-kg (143-lb) and is 5-ft, 6-in (168 cm) tall. % of predicted Actual Value FVC 82 SVC 91 Fev1.0/FVC% 58% Fev1.0 62 FEF 200-1200 79 FEF25-75 60 DLCO 88 Based on this information the patient has A. mild obstructive defect B. mixed obstructive and restrictive defect C. moderate restrictive defect D. pulmonary emphysema

The correct answer is : A Explanation : A mild obstructive defect is suggested by a Fev1/FVC% of 58% and a Fev1 of 62% of predicted.

Which of the following would result in an increase in anatomical airway resistance? A. pulmonary secretions B. autoPEEP C. water build up in the ventilator circuit D. an undersized endotracheal tube

The correct answer is : A Explanation : Airway resistance is increased in the presence of pulmonary secretions and bronchoconstriction. The other examples listed are not anatomically related.

A radiographic image shows a right upper lobe cavitation. Which of the following conditions may be associated with this finding? A. Tuberculosis B. Cancer C. Foreign body aspiration D. Lung Mass

The correct answer is : A Explanation : Single cavitations in the upper lobes are associated with tuberculosis. A foreign body aspiration would be associated with an object, not a cavitation. Cancer or lung masses would also fill a space on X-ray instead of creating a cavitation.

A home care respiratory therapist is providing instruction on proper cleaning technique of a hand-held nebulizer. Which of the following should be included in the instruction? A. wash with warm, mild soapy water, air dry B. wash with acetic acid, dry with lint free towel C. soak in Cidex, rinse with acetic acid, air dry D. soak in alcohol, air dry

The correct answer is : A Explanation : Small volume nebulizer equipment should be washed with mild detergent in warm water, briefly soaked in a acetic acid solution (vinegar) and then air-dried.

A 62-year old male presents in the emergency department with the following arterial blood gas results while receiving supplemental oxygen by nasal cannula at 5 L/min. pH 7.53 PaCO2 28 torr PaO2 48 torr HCO3 - 22 mEq/L BE -2 mEq/L The respiratory therapist should conclude which of the following regarding the patient's condition? A. intrapulmonary shunting is occurring B. right-side heart failure is present C. increase in systemic vascular resistance D. metabolic alkalosis is present

The correct answer is : A Explanation : For a question like this, each option must be considered separately to determine if true or false. Only one of these options would be considered true. Examination of the pH and PCO2 shows a respiratory cause of the alkalosis. There is not enough data to indicate right heart failure or any changes in systemic vascular resistance. This leaves the option of intrapulmonary shunting. To determine if a patient is shunting, the FIO2 and PaO2 should be observed and compared. In this case, the patient is receiving 5 L/min by nasal cannula. On this setting PaO2 should be in excess of 100 mmHg. But, this patient is suffering from moderate hypoxemia. Even though the specific A-a gradient is unknown, it can still be assumed that pulmonary shunting is occurring.

The following clinical information is documented after you assess a home oxygen patient's SpO2 in the following situations. What is the appropriate oxygen treatment plan for home care for this patient? SpO2 #1: room air, resting: 91% SpO2 #2: moderate walk for 150 -ft on room air: 88% SpO2 #3: 1 L/min nasal cannula at rest: 96% SpO2 #4: moderate walk for 150 -ft on 1 L/min nasal cannula: 93% SpO2 #5: 2 L/min Nasal Cannula at rest: 97% SpO2 #6: fast walking for 250 -ft on 2 L/min nasal cannula: 94% A. 1 L/min while walking or exercising B. 1 L/min continuously C. discontinue supplemental oxygen D. 2 L/min continuously

The correct answer is : A Explanation : In order to provide sufficient oxygen for this patient to complete activities of daily living (ADLs), 1 L/min is required. A moderate walk is the highest reasonable activity. It is not necessary to oxygenate the patient at 2 L/min for a fast walk.

Which device is most appropriate to send to the central processing department for sterilization after use on an infectious patient? A. Battery-powered laryngoscope handle B. Infant ventilator C. Stylet D. Fiber optic laryngoscope blade

The correct answer is : A Explanation : In this example the laryngoscope handle is an electronic device and may be damaged with customary soaking in glutaraldehyde. A fiber-optic laryngoscope blade and a reusable stylet can both be soaked in a glutaraldehyde solution. An infant ventilator cannot be soaked or sent for sterilization. A ventilator is wiped down. The use of filters prevents contamination of the inner parts.

A patient is suspected to have a kidney disease process that causes fluid shifting. Which of the following would help evaluate this process? A. creatinine B. hemoglobin C. Theophylline level D. COHb

The correct answer is : A Explanation : Kidney disease often results in fluid shifting. When fluid shifting is present, as manifested through pitting edema or other clinical signs, the situation may be further evaluated by obtaining a creatinine level. Blood urea nitrogen (BUN) is another test that would be useful in further evaluating this condition, although not as accurate as creatinine.

The respiratory therapist observes an ECG wave form on a patient that is consistent with atrial tachycardia. The patient is complaining of chest pain, dizziness, and nausea. The respiratory therapist should recommend A. sychronized defibrillation B. unsynchronized defibrillation C. Atropine sulfate D. epinephrine

The correct answer is : A Explanation : Non-deadly arrhythmias, such as this one, may be addressed through cardioversion, also called synchronized defibrillation. Cardioversion is a form of defibrillation with low wattage and with the synchronization set to "active". This allows the shock to be sychronized to the R wave.

The laboratory results of a sputum culture and sensitivity have returned for a patient who has bilateral bacterial pneumonia. The culture reveals streptococcus, a gram-positive bacteria. The medical records indicates the patient is allergic to penicillin. Which of the following should the respiratory therapist recommend? A. Cephalexine (Keflex) B. Methacillin C. Nafcillin D. Amoxicillin

The correct answer is : A Explanation : Normally gram-positive bacteria may be killed by penicillin-type antibiotics. But, because the patient is allergic to penicillin, a suitable drug is cephalexine. Nafcillin and methacillin are suitable antibiotics when a patient is penicillin-resistant but not when they are allergic.

A patient is brought to the emergency room after ascending too quickly while scuba diving in the ocean. The patient is complaining of abdominal pain. The respiratory therapist should recommend A. hyperbaric chamber B. oxygen by non-rebreathing mask C. heliox therapy D. Bi-level therapy

The correct answer is : A Explanation : SCUBA divers who ascend too quickly are subject to a problem called "the bends". This is caused from dissolved nitrogen coming out of solution inside the blood when there is a significant reduction in pressure. For a patient with "the bends", the best treatment is to artificially increase the pressure of their environment. This is done with a hyperbaric chamber. Once the patient is at a deeper simulated pressure, the environmental pressure may be reduced slowly.

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. COHb B. drug toxicology screen C. pulse oximetry D. arterial blood gas analysis

The correct answer is : A Explanation : The circumstances surrounding this family suggest possible exposure to carbon monoxide. The most reliable way to assess carbon monoxide levels is to determine COHb. Pulse oximetry is not capable of measuring carbon monoxide attached to hemoglobin.

A chest radiograph indicates the presence of plate-like infiltrates. This finding is most closely associated with which of the following? A. atelectasis B. mycoplasma pneumonia C. mesothelioma D. CHF

The correct answer is : A Explanation : The radiological description of platelike infiltrates is most closely associated with atelectasis.

An adult female patient has severe airway resistance for which she is being treated with an 80/20 mixture of heliox via a NRM. The problem is improving but not yet resolved. ABGs are: pH 7.36 PaCO2 45 torr PaO2 67 torr HCO3- 6.2 mEq/L What should the respiratory therapist recommend? A. Change to 70/30 heliox mixture. B. Replace heliox with nasal cannula at 5 L/min. C. Change to 60/40 heliox mixture. D. Replace heliox with CPAP, FIO2 0.40.

The correct answer is : A Explanation : This is an oxygenation problem as seen by the PaO2 of 67 torr. Therefore more oxygen is required. A 70/30 heliox mixture would provide approximately 10% higher FI02.

A 70-kg (154-lb) patient is being weaned from mechanical ventilation. The initial T-piece trial data is reported below. The respiratory therapist should Before trial 30 minutes on T-piece VT (spont) 440 mL 390 mL MIP -32 cmH2O -30 cmH2O VC 2.5 L 2.5 L HR 82 110 RR 16 22 SpO2 (%) 92 89 A. return to mechanical ventilatory support B. extend current trial to 1 hour C. permanently discontinue mechanical ventilation D. administer Doxapram, IV

The correct answer is : A Explanation : This patient is obviously weaning from mechanical ventilation. T-Piece trials show the patient is doing well on most parameters but a closer look shows that the heart rate has increased more than 20 above baseline. This is an indication to discontinue weaning at this time.

On a time-cycled, pressure-limited ventilator, modifications to the ventilator settings occurred that resulted in an I:E of 1:6 becoming an I:E of 1:4. Which of the following is a possible setting change that could have produced this new I:E? A. an increase in I-Time B. development of autoPEEP C. Increase in PEEP D. Decrease in the flowrate

The correct answer is : A Explanation : Unlike volume-cycled mechanical ventilation, flow rate does not affect the I:E ratio in time-cycled mechanical ventilation. Only direct changes to the inspiratory time (I-Time) or to the total respiratory rate will affect the I:E ratio.

While transferring a ventilator-dependent patient from bed to gurney, the respiratory therapist notices sudden resistance when manually ventilating a patient through a standard tracheostomy tube. The therapist is unable to pass a suction catheter. The therapist should NEXT A. replace the tracheostomy tube. B. ensure adequate cuff inflation. C. provide ventilation by bag and mask. D. call for help.

The correct answer is : A Explanation : When a standard tracheostomy tube becomes clogged, the tracheostomy tube must be removed and replaced to ensure ventilation.

Which of the following benefits from continuous low-flow supplemental oxygen should be expressed to a patient with COPD who is participating in a pulmonary rehabilitation program? A. increase ability to perform ADLs B. reverse lung disease C. establish normal pulmonary function volumes D. return to normal life

The correct answer is : A Explanation : When performing any kind of pulmonary rehabilitation or home care with the patient, it is important for the practitioner to understand they cannot reverse lung disease or return the patient to normal life. Patients with lung disease will never return to normal life because their condition is not reversible. Therefore, the appropriate goals and intentions of rehabilitation and education is to increase their ability to perform activities of daily living, generally increase exercise tolerance, reduce the incidence of infection and hospitalization, and generally improve their quality of life from their point of view.

A 38-week gestational age infant delivered 4 hours prior shows signs of hypoxemia. In preparation for oxygen administration at 30% by oxygen hood, the therapist should utilize which of the following devices? A. blender B. heat-moisture exchanger C. high-flow hydrator D. bubble humidifier

The correct answer is : A Explanation : When using an oxygen hood, it is appropriate to premix gases by use of an oxygen-air blender. Use of a large-volume nebulizer at low FIO2 could cause excessive noise transmitted to an oxygen hood which could promote hearing damage and restlessness of the infant. For this reason use of blender is more appropriate.

A physician in the emergency department has asked that a patient be evaluated for pulmonary obstruction while in the emergency room. Which of the following tests should the therapist plan on performing? A. chest radiographic film at full expiration B. beside pulmonary function testing C. maximum inspiratory pressure D. pulmonary assessment by body box

The correct answer is : B Explanation : A patient in emergency room will be unable to perform complex pulmonary function testing. However, to determine if the patient is obstructive or restrictive, a bedside pulmonary function test is adequate. Pulmonary function testing such as DLCO, nitrogen washout, helium dilution, and airway resistance determined by body box would not be appropriate at bedside in the emergency room.

A patient is receiving oxygen by non-rebreathing mask at a flow of 10 L/min. Spontaneous tidal volume is 500 mL and spontaneous respiratory rate is 20 /min. What change should the therapist recommend? A. Ensure an adequate mask seal on the patient's face B. Increase flow to 14 L/min C. Order arterial blood gas analysis D. Increase flow until reservoir bag collapses completely with each breath

The correct answer is : B Explanation : A patient who is breathing a tidal volume of 600 mL at a rate of 20/min has a minute ventilation of 12 L. If the non-rebreathing mask is set at only 10 L/min, the total flow to the patient is insufficient. The flowrate should meet or exceed the inspiratory demand of the patient. Therefore, increasing to 14 L/min is most appropriate.

The respiratory therapist measures the functional residual capacity with a body box and determines the related value is 4.3 L. The FRC value is 3.4 L when determining via helium dilution method. Which of the following can explain the difference? A. hyperventilation secondary to panic in the body box B. significant amount of non-ventilated alveoli C. depleted helium analyzer D. inconsistent patient effort

The correct answer is : B Explanation : A patient with COPD has significant non-ventilated lung space. The measurement of total lung capacity, FRC, and RV done by helium dilution and nitrogen washout will likely be less accurate and show a smaller FRC compared to pulmonary function testing done by a body box. A body box can indirectly measure non-ventilated alveolar space.

A patient with asthma monitors their peak flow in the morning and documents that peak flow is 60% of his usual baseline. Based on the NAEP and the patient's asthma action plan, the patient should A. check peak flow again in 2 hours B. take a short-acting beta 2-agonist, continue to monitor peak flow C. contact their physician D. report to the hospital

The correct answer is : B Explanation : According to the national asthma guidelines, a patient who is self-monitoring peak flow and is only able to achieve 60% of baseline should first take a short-term bronchodilator (a short acting beta-II agonist), and continued to monitor peak flows.

Following a cardiac arrest and emergency intubation, breath sounds are bilaterally equal with manual ventilation on a male patient in the emergency room. Capnography shows an end-tidal CO2 of 5 mm Hg. What would the respiratory therapist expect to happen to the ETCO2 over the next few minutes with adequate ventilation provided? A. a sudden rise to normal B. gradually increase C. gradual decrease D. remain low

The correct answer is : B Explanation : After cardiac arrest, which includes ventilatory arrest, end-tidal CO2 will be very low because niether ventilation nor perfusion have been occurring, and there will be very little CO2 in the alveoli. As circulation and ventilation increase with manual ventilation, the CO2 should start to enter the lung, causing a gradual increase in exhaled CO2.

A radiographic image shows an upper lobe cavitation. Which of the following conditions is most closely associated with this finding? A. Asbestosis B. Tuberculosis C. Bronchiectasis D. Pneumonia

The correct answer is : B Explanation : Cavitations in the upper lobes are generally associated with tuberculosis. Bronchiectasis is a condition affecting the bronchioles or airways and is seen throughout the lung. Pneumonia is not a cavitation and can also be seen throughout the lung on X-ray. Asbestosis is seen throughout the lung with reduced lucency.

A patient in the emergency room complains of frequent vomiting over the last 24 hours. A 12-lead ECG shows a normal P-R interval and flattened T waves. Which of the following is the most likely explanation for the ECG waveform? A. first degree heart block B. hypokalemia C. congestive heart failure D. cardiac ischemia

The correct answer is : B Explanation : Fluid loss from a patient will likely change electrolyte status. An ECG that shows flattened T waves is associated with hypokalemia. This is the expected change that occurs to those patients who have fluid loss or whose electrolyte levels are not normal.

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 in place of the tidal volume control, which can be found on a volume-controlled ventilator? A. Injector line B. Drive pressure C. % expiratory time D. Rate

The correct answer is : B Explanation : High-frequency jet ventilators do not have a control to set tidal volume directly. Delivered volume is set indirectly through a control called drive pressure, sometimes called oscillatory amplitude.

A volume-cycled mechanically ventilated male patient intubated with a 6.5 mm endotracheal tube is on the following settings: Mode Assist/control Set rate 10 Tidal volume 600 mL Peak pressures are consistently exceeding 35 cm H20, with static compliance in the normal range. In order to correct the high peak pressures, the respiratory therapist would FIRST consider which of the following? A. Change to PCV. B. Replace the endotracheal tube with a larger size. C. Increase the flowrate. D. Suction the patient every 30 minutes.

The correct answer is : B Explanation : In this example the endotracheal tube at 6.5 mm is likely too small, creating increased airway resistance. This is resulting in high peak pressures. A larger diameter endotracheal tube should result in reduced peak pressures, making the ventilator more manageable.

A patient is receiving SIMV volume-cycled mechanical ventilation. A respiratory therapist is using slow, incremental reductions in the set respiratory rate for weaning. Which low alarm should the respiratory therapist place the most emphasis on? A. tidal volume B. minute ventilation C. pressure D. PEEP

The correct answer is : B Explanation : In this example we are tested about our knowledge to withdraw mechanical ventilation. While one may believe that low tidal volume could be the best answer, it is not as significant as the sum of several tidal volumes in a minute, or minute ventilation. While weaning, a patient may vary in VT, while maintaining an acceptable ventilatory drive. Pressures such as PEEP or low-pressure are not as critical for monitoring while weaning with slow incremental reductions of the mechanical rate.

A respiratory therapist is assisting in a cardiopulmonary stress testing of a patient. After several increases in workload by increasing the incline on the treadmill, heart rate is 120/min, blood pressure is 130/95 mmHg and O2 Sat is 97%. Increasing the treadmill further shows no further increase in these values, but the patient appears pale in color. The therapist should recommend A. decrease workload B. discontinue the test, document findings C. monitor the patient closely D. after two minutes, increase workload

The correct answer is : B Explanation : Increasing the workload by increasing the inclination of the treadmill should result in an increase in heart rate and blood pressure on a normal patient who has normal cardiac and blood pressure response. When workload is increased and there is no increase in heart rate or blood pressure, the patient has reached his or her maximum workload. The tests should be discontinued at this time and the previous level of workload should be recorded as the patient's maximum exercise ability

After removing 5 inches of mechanical deadspace on a ventilator circuit, what change would the respiratory therapist expect to see? A. Small reduction in PaCO2 with slight increase in MAP B. Small reduction in PaCO2 with no increase in MAP C. Unchanged MAP with slight increase in PaCO2 and PaO2 D. Increase in pH with a reduction in MAP

The correct answer is : B Explanation : Mechanical deadspace is the tubing on the patient side of the wye on a ventilator circuit. This includes the endotracheal tube. The deadspace reduces the efficiency of ventilation, which affects the PaCO2. Therefore, removing deadspace will reduce PaCO2. Increasing deadspace will increase PaCO2. Changes to mechanical deadspace do not affect the mean airway pressure in the chest.

A patient complaining of shortness of breath presents with severe hyperglycemia, marked hyperpnea, and normal oxygen levels. What should the respiratory therapist expect when analyzing an ABG? A. anemic hypoxemia B. metabolic acidosis C. respiratory failure D. compensated respiratory alkalosis

The correct answer is : B Explanation : Metabolic acidosis results in a significantly low pH, which causes an increased respiratory drive in order to attempt to normalize the pH. High glucose levels are often seen with metabolic acidosis. Oxygenation remains normal.

A patient receiving volume-controlled mechanical ventilation has the following values obtained from a pulmonary-artery catheter: PAP 24 mm Hg CVP 6 mm Hg PCWP 6 mm Hg C.I. 2.5 L/min/m2 Which of the following would be administered? A. 40% venturi mask B. nitric oxide C. balloon pump D. heliox

The correct answer is : B Explanation : Nitric oxide is used to treat pulmonary hypertension. By evaluating the hemodynamic values, particularly noting a high PAP and normal PCWP, it is evident that there is a problem in the lungs and likely hypertension. Nitric oxide therapy will help to lower pulmonary hypertension.

Results obtained from a multiple wave-length spectrophotometer are consistent with the results obtained from a Co-oximeter, but not with the blood gas analyzer. The respiratory therapist determines that the blood gas analyzer is inaccurate. How should this problem be corrected? A. Run QC only on the Co-oximeter B. Run a two-point calibration on the blood gas analyzer, followed by QC C. Accept the results that seem most consistent with the clinical scenario D. Run a two-point calibration on the Co-oximeter, followed by QC

The correct answer is : B Explanation : Once a respiratory therapist determines that an instrument is inaccurate, the machine should be either removed from service or calibrated. After calibration, quality control material should be utilized to confirm that the calibration efforts were successful and that the machine is now reading accurately.

The following data is obtained from the patient's ventilator flow sheet: 3 am 9 am 3 pm Peak pressure(cm H2O) 20 21 25 Plateau pressure (cm H2O) 14 14 20 VT (L) 0.5 0.5 0.5 PEEP (cm H2O) 5 5 10 Which of the following can be accurately stated? A. dynamic compliance is steady B. static compliance remains steady C. decreasing ventilation/perfusion mismatch D. decreasing shunt

The correct answer is : B Explanation : Static compliance is monitored by examining the plateau pressures over time. Observation of these data appear to suggest an increase in plateau pressures, which is associated with a decrease in pulmonary compliance. However, closer observation reveals that PEEP was increased by 5 cm H2O. Therefore, the increase in plateau pressures at 3 PM are caused by an increase in the PEEP setting and are not a result of changing static compliance. This data indicates static compliance is remaining steady.

A respiratory therapist is instructing a patient with chronic obstructive pulmonary disease on the proper method of taking a bronchodilator treatment with a small-volume jet nebulizer. Which of the following should be included in the instructions? A. breathe in quickly, blow out passively and relax between breaths B. breathe in slowly, pause at the top of each breath, blow out passively and relax C. take a slow deep breath in, pause, blow out with moderate forcefulness D. take deep breaths, hold for 10 seconds, blow out quickly

The correct answer is : B Explanation : The appropriate instruction for normal breathing and for taking an aerosol treatment is to breathe in slowly, pause at the top of each breath, and exhale passively, relaxing between breaths.

A patient with cystic fibrosis develops rhonchi after 5 minutes of PEP therapy at 20 cm H2O. The respiratory therapist should A. begin cool bland aerosol therapy B. continue the therapy C. discontinue treatment, report to findings to the physician D. switching to flutter therapy

The correct answer is : B Explanation : The development of rhonchi in response to PEP therapy is considered to be a good outcome for the therapy. The purpose of the therapy is to mobilize and promote expectoration of secretions. The development of rhonchi is an indication that secretions are moving from small and middle-sized airways to the larger size airways where they may be naturally expectorated or suctioned. The therapy should be continued because it is effective.

A post-operative patient is receiving positive-pressure ventilation with an IPPB while recovering from anesthesia. The mandatory rate is 10/min. Inspiratory pressure is set to 18 cm H2O. Gradually the rate increases to 16/min while the monometer needle is showing a significant negative deflection before inhalation begins. The pressure monometer no longer rises smoothly during inhalation. What should the respiratory therapist do? A. sedate the patient B. increase sensitivity C. decrease inspiratory flow rate D. wean the patient

The correct answer is : B Explanation : The gradual increase in respiratory rate indicates that the patient is waking up from anesthesia, as expected. The negative deflection before inhalation indicates that the machine sensitivity is too low-requiring the patient to work too hard to trigger inspiration. The manometer not rising smoothly indicates the flow rate is also too low. It is not appropriate to sedate the patient but rather allow him to wake up with more applicable settings.

A 72-kg (158-lb) patient is receiving volume-cycled mechanical ventilation on the following settings: Mode SIMV Rate 12 VT 550 ml FIO2 0.40 PEEP 10 cm H2O Which of the following alarm settings is most appropriate? A. low PEEP alarm of 2 cm H2O B. low VT alarm of 450 mL C. high VT alarm of 700 mL D. low VT alarm of 325 mL

The correct answer is : B Explanation : The low tidal volume alarm should be set at about 100 mL below the preset/returned tidal volume. Be prepared to lower the low VT alarm when the patient's lung compliance increases.

An adult male has had a unilateral wheeze, when auscultating the chest, for several months. Which of the following is the most likely cause? A. bronchoconstriction B. a cancerous mass in the pulmonary tree C. ARDS D. idiopathic pulmonary fibrosis

The correct answer is : B Explanation : The presence of a unilateral wheeze that has persisted for several months is not likely related to bronchoconstriction. When bronchoconstriction is present, wheezing is usually noted bilaterally. The unilateral wheeze, in conjunction with its persistence for several months, is most likely caused by a mass in the pulmonary tree. This mass may be cancerous or benign.

A written teaching plan for asthma patients using peak flow meters should include A. the unit of measure for the flow meter. B. the meaning of red, yellow and green zone results. C. avoidance of placing one's teeth around the mouthpiece. D. the importance of trending over baseline results.

The correct answer is : B Explanation : The respiratory therapist may determine that there is value in the three options that are incorrect in this scenario, but it is important to consider the best answer, which, in this case, is a thorough understanding of the color zones. Understanding the zones will help an asthma patient effectively manage their condition over time.

A patient is experiencing reduced tidal volumes on a volume-cycled ventilator. There is a gurgling sound coming from his mouth with each breath and the endotracheal tube marking is 19 cm at the lips. The respiratory therapist should A. replace the endotracheal tube. B. add air to the pilot balloon while auscultating over the neck. C. extubate the patient and provide manual ventilation. D. advance the endotracheal tube 5 cm.

The correct answer is : B Explanation : The scenario presents an airway managment problem including an air leak with an endotracheal tube. The cause is likely due to a lack of air in the cuff, but could be several other things, such as a hole in the cuff, or a misplaced tube. By first adding air to the cuff the respiratory therapist will either solve the problem, or further isolate the problem. For example, if a hole exists in the cuff, the leak will shortly return, and the therapist will know to replace the tube.

Which of the following would NOT be needed in preparation for a bronchoscopy? A. normal saline B. Magill forceps C. 10 cc syringe D. anesthetic

The correct answer is : B Explanation : There is no purpose for bringing Magill forcepts to assist with a bronchoscopy procedure. Magill forcepts are used primarily for nasal intubation.

A patient with ARDS receiving volume-controlled ventilation has the following arterial blood results on the settings below: Mode Assist/control Mandatory rate 14 VT 400 mL FIO2 0.70 PEEP 20 cm H2O pH 7.29 PaCO2 50 torr PaO2 69 torr HCO3- 23 mEq/L BE -1 mEq/L Which of the following changes is most appropriate? A. increase PEEP to 22 cmH2O B. increase rate to 16 C. add 100 mL deadspace D. increase FIO2 to 0.8

The correct answer is : B Explanation : This ARDS patient is both under ventilating and under oxygenating. Of these problems under ventilation should be addressed first. The most appropriate method of reducing CO2 that is offered among these options is an increase in rate. Adjusting PEEP or FIO2 will address oxygenation. Adding deadspace will cause a change in CO2 in the wrong direction (increase).

The following arterial blood gas results are obtained on a patient who has been on mechanical ventilation for 3 days. pH 7.55 PaCO2 40 torr PaO2 310 torr HCO3- 28 mEq/L BE -8 mEq/L FIO2 0.55 SaO2 98% Ventilator settings are: Mode Assist/control Mandatory rate 12 VT 550 mL FIO2 0.40 The respiratory therapist should evaluate the function of which of the following in the blood gas analyzer? A. Severinghaus electrode B. Clark electrode C. multi-wave length oximetery light D. Sanz electrode

The correct answer is : B Explanation : This blood gas reveals a problem. The PaO2 of 310 torr would be impossible with an FIO2 of only 40%. We know this from estimating the alveolar oxygen tension or doing the alveolar air equation. At 40% the maximum oxygen tension in the alveoli is about 230 torr. It is impossible for the arterial oxygen tension to be greater than the alveolar oxygen tension. Therefore, there is likely an error in the measurement of the PaO2. Of the options given, the Clark electrode is another name for the PO2 electrode.

A patient in the emergency room has the following arterial blood gas results: pH 7.18 PaCO2 30 mmHg PaO2 80 mmHg HCO3- 18 mEq/L BE -7 mEq/L SAT 94% This data is most typical of which of the following patient diagnoses? A. Flail chest B. diabetic ketoacidosis C. ARDS D. COPD

The correct answer is : B Explanation : This patient has a profound state acidosis as manifested by a low pH of 7.18. CO2 is low, which is associated with alkalosis. In this case the alkalosis is being caused by a profound decrease in HCO3-. This combination is associated with diabetic ketoacidosis.

During weaning from mechanical ventilation, a patient is on the following settings and has the following clinical data: Mode SIMV Mandatory rate 4 Total rate 32 VT (set) 450 mL VT (spont) 200 mL FIO2 0.40 PEEP 5 cm H2O PS 5 cm H2O pH 7.34 PaCO2 46 mm Hg PaO2 79 mm Hg HCO3- 25 mEq/L BE -1 mEq/L Which of the following can be increased to improve the patient's ventilation and decrease the work of breathing? A. VT B. pressure support C. FIO2 D. PEEP

The correct answer is : B Explanation : This patient is obviously weaning from mechanical ventilatory support. The SIMV mode, in addition to a low mandatory rate, are associated with weaning. The total rate of the patient however, is excessive and the spontaneous tidal volume is only 200 mL, which is far less than the 5 mL per kilogram needed to sustain life. To help this patient continue weaning, pressure support is most helpful. Pressure support helps the patient take larger spontaneous tidal volumes, which will promote a decrease in total rate and will ultimately result in a decrease in work of breathing.

A 38-year old male is receiving ventilatory support by a high frequency jet ventilator (HFJV). Heart rate is 120/min and blood pressure is within normal limits. Arterial blood gas results on high frequency ventilation are as follows: pH 7.26 PaCO2 64 torr PaO2 82 torr HCO3- 26 mEq/L BE 0 mEq/L The respiratory therapist should recommend A. switching to volume-controlled ventilation B. increasing frequency C. switching to pressure control ventilation D. increasing amplitude

The correct answer is : B Explanation : This patient, who is on a high-frequency ventilator, shows evidence of hypoventilation as manifested by high PaCO2. Oxygenation appears adequate. To correct the hyperventilation, the most appropriate action is to increase frequency. This is equivalent to increasing the mandatory rate.

The following data is available for a patient receiving volume-controlled mechanical ventilation: Mode Assist/control VT 500 mL Mandatory rate 16 FIO2 0.5 PEEP 5 cm H2O PIP 28 cm H2O PetCO2 28 torr pH 7.42 PaCO2 38 torr PaO2 98 torr PvO2 76 torr HCO3- 22 mEq/L BE -2 mEq/L SaO2 98% SvO2 78% Hb 15 g/dL The respiratory therapist should record which of the following values as an accurate CaO2? A. 5.0 vol% B. 19.4 vol% C. 25.1 vol% D. 15.2 vol%

The correct answer is : B Explanation : To determine the arterial oxygen content, the hemoglobin must be multiplied by the saturation and also multiplied times a factor of 1.34. In this case 15 x .98 x 1.34 is nearly 20 vol%. The closest answer is 19.4 vol%

A patient receiving mechanical ventilatory support via volume-controlled ventilation is experiencing a decrease in pulmonary compliance. Peak airway pressure has risen to 42 cm H2O in the previous week. Which of the following can the respiratory therapist do to improve gas exchange? A. Add PEEP B. Decrease inspiratory flow rate C. Increase mandatory rate D. Increase inspiratory flow rate

The correct answer is : B Explanation : To improve gas exchange, a patient benefits most from a slow and prolonged inspiratory phase. Providing volume slowly has a tendency to result in greater gas distribution throughout the lungs and results in improved gas exchange.

A homecare patient indicates that she is not getting enough air from her transtracheal oxygen catheter. The therapist should instruct the patient to A. remove the catheter. B. use a nasal cannula. C. increase the flow of oxygen to the catheter. D. flush the catheter with saline.

The correct answer is : B 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 a nasal cannula is most appropriate.

A patient is receiving bi-level therapy at the following settings: IPAP 15 cm H2O EPAP 5 cm H2O FIO2 0.5 Recent arterial blood gas results reveal hypoxemia. To compensate, the respiratory therapist increases the EPAP setting to 8 cm H2O. What other change should be made to ensure a consistent level of ventilatory support is maintained during spontaneous breaths? A. Add a back-up rate B. Increase IPAP to 18 cm H2O C. Decrease IPAP to 10 cm H2O D. Switch to full ventilatory support with a mandatory rate and a PEEP of 8 cm H2O

The correct answer is : B Explanation : When correcting hypoxemia with noninvasive positive pressure ventilation, EPAP should be increased. However, so as not to decrease ventilation inadvertently, the IPAP setting should be increased by the same amount in order to keep the distance between EPAP an IPAP unchanged.

Following extubation, after shoulder surgery, a 15-year-old male patient is experiencing 30-second periods of apnea. The respiratory therapist should A. provide SVN with normal saline 0.3% B. intubate the patient C. ventilate with a manual resuscitator D. place on 100% NRB mask

The correct answer is : C Explanation : 30-second periods of apnea indicate the need for immediate assistance with ventilation. Of the choices offered, only ventilation with a manual resuscitator meets this requirement. One may be tempted to choose to intubate the patient, but intubation does not automatically imply that mechanical ventilation will be provided. Intubation is for airway protection.

A patient admitted to the emergency room for chest pain is diaphoretic with cold extremities. These data are most consistent with which of the following A. pneumothroax B. pulmonary embolism C. myocardial infarction D. pulmonary tuberculosis

The correct answer is : C Explanation : Chest pain, diaphoresis, and cold extremities is associated with myocardial infarction. Other terminology that would describe this includes cold, wet, clammy skin. The next most appropriate action, although not asked in this question, would be to administer oxygen and to obtain an ECG.

The physician requests a recommendation for the delivery of surfactant therapy for a 32-week gestational neonate weighing 1800 grams with IRDS. The respiratory therapist should recommend which of the following? A. Provide one dose of Exosurf, turning the patient from side to side B. Provide 2 doses of Survanta using 2.5 mL/kg C. Intubate with a size 3.0mm endotracheal tube for the delivery of surfactant D. Review the APGAR scores prior to therapy

The correct answer is : C Explanation : APGAR scores would not be helpful for a premature neonate who needs surfactant. The options, which include Exosurf and Survanta, do not contain appropriate dosages or recommended delivery methods. Therefore, the only appropriate answer is to intubate with a properly sized endotracheal tube for an 1800 gram infant.

A COPD patient who receives 2 lpm continuous oxygen therapy by nasal cannula is exercising in conjunction with a monitored pulmonary rehabilitation program. The patient has begun breathing quickly and deeply. To ensure consistent arterial oxygenation, the respiratory therapist should A. decrease oxygen flow to 1 L/min B. use a partial rebreathing mask C. increase oxygen flow rate D. use a nonrebreathing mask

The correct answer is : C Explanation : Although COPD patients should rarely have more than 2 L/min. continuous oxygen, when they exercise and breathe more deeply, they inadvertently lower their FIO2, especially when on a nasal cannula. In such a case, it is appropriate to increase the flow rate temporarily for the duration of the exercise.

To calculate alveolar minute ventilation, the respiratory therapist should A. multiply the RR by the VT. B. measure with a metabolic cart study. C. subtract anatomical deadspace from the VT, then multiply by the RR. D. measure while the patient is receiving mechanical ventilation.

The correct answer is : C Explanation : Alveolar ventilation is calculated by subtracting the anatomical dead space from the tidal volume then multiplying by the respiratory rate. If the weight is known, the absolute value in pounds can be used to estimate anatomical deadspace. For example a patient weighing 130 pounds would have 130 mL of anatomical dead space. If weight is unknown, anatomical dead space should be estimated at 150 mL.

Prior to performing an arterial puncture, a modified Allen's test is performed on the patient's right radial artery. When the ulnar artery occlusion is released, a pink color returns in 3 seconds. Based on this result the respiratory therapist should A. perform a right brachial artery puncture B. perform a femoral artery puncture C. proceed with the puncture of the right radial artery D. perform an Allen's test on the left radial artery

The correct answer is : C Explanation : An Allen's test is performed to ensure there is collateral circulation prior to performing an arterial puncture. The presence of collateral circulation, blood flow through the radial and ulnar arteries, helps to lower the risk of the puncture. The procedure is done by occluding both the ulnar and radial arteries simultaneously. Once the hand becomes blanched (white and seemingly devoid of blood) the ulnar artery is released and the hand is observed to see if color returns in a timely manner. In this case, color returned in 3 seconds indicating good circulation through the ulnar artery. This is an indication that the puncture may occur safely in the radial artery.

A 50-year-old male presents in the emergency department (ED) complaining of frequent vomiting. Arterial blood gas results on room air show: pH 7.54 PaCO2 41 torr PaO2 96 torr HCO3- 30 mEq/L BE +6 mEq/L Which of the following would account for this blood gas anomaly? A. Cl- 110 mEq/L B. K+ 4.9 mEq/L C. K+ 3.4 mEq/L D. Hyperventilation

The correct answer is : C Explanation : Carbon dioxide in this blood gas shows adequate ventilation. However, a pH of 7.54 is an indication of alkalosis. Because the alkalosis cannot be attributed to an elevated CO2, it must be caused metabolically. Observation of the bicarb shows an elevation. Of the options offered the most likely cause of this elevation is the potassium of 3.4 mEq/L.

A patient is being sent home on a mechanical ventilator requiring oxygen bleed-in with the device. Which of the following should be recommended? A. E-Cylinders B. pulse-dose oxygen delivery C. oxygen concentrator D. liquid oxygen

The correct answer is : C Explanation : The best device for home oxygen therapy is a molecular sieve device, commonly known as an oxygen concentrator. This device is powered with electricity, which makes it appropriate for home use.

A morbidly obese patient who is trached with a fenestrated tracheostomy tube is experiencing frequent dislodging with minor movement or cough. What should the respiratory therapist suggest? A. Inflate the cuff. B. Tie or suture the trach into place more securely. C. Increase the length of the tracheostomy tube. D. Replace with a Bivona-type tracheostomy tube with a foam cuff.

The correct answer is : C 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.

An oxygen-dependent patient will be traveling for 24 hours. How many E- cylinder oxygen tanks will the patient require for the trip if the flow is 2 L/min? A. 2 B. 8 C. 5 D. 3

The correct answer is : C Explanation : Each tank duration = 2200 x 0.28 = 616 L. 616 L / 2 L/min = 308 minutes. 308 min / 60 = 5.1 hours. Each E cylinder will last about 5 hours. For a 24 hour trip, at least 5 tanks will be required.

Which of the following pulmonary function volume calculations may be used to determine functional residual capacity (FRC)? A. VC - ERV B. ERV-RV C. TLC - IC D. VT + ERV + RV

The correct answer is : C Explanation : FRC may be calculated in a variety of ways by adding and subtracting specific lung volumes. To answer this question, one must take each option and do the calculation to determine if the desired volume can be achieved. In this case, FRC may be calculated by subtracting inspiratory capacity (IC) from total lung capacity (TLC).

What is the typical frequency for Flovent MDI? A. PRN B. Q6 hours C. BID D. TID

The correct answer is : C Explanation : Flovent (fluticasone) is a corticosteroid used generally to prevent and relieve inflammation of airway walls. Inflammation is one of the components of asthma so corticosteroids are key in treatment. The frequency is twice per day or b.i.d.

An 8-year-old pediatric patient with a 6.0 mm endotracheal tube requiring endotracheal suctioning is experiencing bradycardia during the procedure. Suction pressure is set to -100 mm Hg. A respiratory therapist is suctioning for approximately 15 seconds using a 9 Fr catheter and is able to clear the airway effectively. To remedy the problem, the therapist should A. decrease the suction pressure. B. increase the pressure to -110 mm Hg and decrease duration to 5 seconds. C. decrease suction duration time. D. decrease catheter size.

The correct answer is : C Explanation : If suctioning is not adequate, correct the problem in this order: 1. check connections, change collection bottle if full 2. ensure suction pressure is in the right range 3. increase to the maximum size catheter within range 4. increase pressure within range 5. increase suction time

A patient complaining of shortness of breath with exercise has the following pre/post bronchodilator results. Which is the most meaningful indicator that a bronchodilator is effective? A. Patient reports the maneuver is easier after the bronchodilator B. 10% improvement in FEV1/FVC%. C. 15% improvement in FEV1 D. 9% improvement in FVC

The correct answer is : C Explanation : Improvement with bronchodilator therapy is considered significant if flows increase by 12% or more, or if FEV1 increases by at least 200 mL. In this example we see a 15% improvement in FEV1, well beyond the 12% threshold.

A respiratory therapist discontinues a small volume nebulizer started with mucomyst after 5 minutes due to a patient's poor tolerance of the therapy. SpO2 dropped from 95% to 86%, heart rate increased from 88 to 128 bpm. The patient returns to a normal condition shortly after the treatment is stopped. The next action would be to A. administer after adding a unit dose of Proventil. B. administer with 100% oxygen. C. document in the medical record and notify the physician. D. administer with a lower dose of mucomyst.

The correct answer is : C Explanation : In this example, the patient did not tolerate the therapy. Therefore, the respiratory therapist should discontinue therapy & notify the ordering physician. A note about the patient's tolerance should also be made in the medical record.

An oral pharyngeal airway is measured from the patient's jaw angle to the tip of the chin. After placement, the semi-conscious patient repeatedly pushes the airway out with his tongue. The therapist should A. secure the airway with tape. B. replace with a nasal endotracheal tube C. reinsert the oral airway. D. insert a larger airway.

The correct answer is : C Explanation : It is normal for a patient to reject an oral airway with their tongue. Reinserting the airway is most appropriate.

Which of the following test results would NOT be helpful in determining whether a patient should receive Bi-level therapy with supplemental oxygen? A. VE 9.0 L/min B. MIP -22 cm H2O C. MVV 50 L in 12 seconds D. pH 7.29

The correct answer is : C 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 very 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.

Pulmonary function is done on a 68-year old male with a 20-pack-year history of smoking. The following pulmonary function data is recorded: Percent of Pred Actual Fev1/FVC % 62% FEF200-1200 78% FEF25-75 60% SVC 85% FVC 83% DLCO 22 CO/min/mm Hg Which of the following most likely represents the patient's condition? A. sarcoidosis B. asbestosis C. chronic bronchitis D. emphysema

The correct answer is : C Explanation : Pulmonary function test data indicates the patient has an obstructed defect. This is manifest by a reduced FEV1/FVC%. Anything less than 75% is considered abnormal. The SVC is normal and therefore indicates the patient has no restrictive defect. So, we must pick an answer that is an obstructive disease. When we look at the answers we see there are two options - emphysema and chronic bronchitis. To know which one it is we must look back at the pulmonary function testing data and observe the DLCO. Only emphysema shows a poor DLCO. In this case the DLCO is greater than 20 CO/min/mmHg and is therefore normal. This means that emphysema can not be the correct option leaving only chronic bronchitis as the only possible correct choice.

While suctioning a patient through the inner cannula of a 7.0-mm fenestrated tracheostomy tube, the therapist observes the collected secretions show layers. With which of the following is this most consistent? A. COPD B. use of the antibiotic tetracycline C. bronchiectasis D. mycoplasma pneumonia

The correct answer is : C Explanation : Secretions that demonstrate differing layers of sputum is associated with bronchiectasis.

A respiratory therapist is called STAT to the general floor where a patient with a tracheal button in place is unable to breathe. The respiratory therapist should A. remove the cap and insert the inner cannula. B. remove the inner cannula and deflate the cuff. C. attempt to manually ventilate. D. remove the button and put a tracheostomy tube in through the stoma.

The correct answer is : C Explanation : The respiratory therapist should not confuse a tracheal button with a cap, which would be utilized with a fenestrated tracheostomy tube. A button is inserted into the stoma as a placeholder. Therefore, this patient should be treated as any other patient who cannot breathe by attempting to manually ventilate after opening the airway.

The following arterial blood gas values are reported for a patient who is weaning from mechanical ventilation. There is no notable change in the patient's condition. 0800 hrs 1000 hrs pH 7.42 7.38 PaCO2 37 torr 32 torr PaO2 80 torr 41 torr HCO3- 26 mEq/L 26 mEq/L FIO2 0.40 0.40 Based upon this data, the respiratory therapist should A. increase the FIO2 to 1.0. B. extubate the patient. C. repeat the arterial draw. D. increase the FIO2 to 0.50.

The correct answer is : C Explanation : The respiratory therapist should question all laboratory results to assure that they match the clinical scenario prior to reporting them. In this example, the patient's condition has not changed with the PaO2 of 41 torr. The sample might be a venous sample, and therefore should be redrawn.

A female patient weighing 150 lbs is receiving mechanical ventilation in the SIMV, volume-cycled mode. Set tidal volume is 500 mL. Returned volumes for mechanical breaths are 490 mL. The respiratory therapist should A. add air to the cuff. B. increase the set VT to 510 mL C. continue current therapy. D. check the circuit for leaks.

The correct answer is : C Explanation : The returned tidal volume will not always match the set tidal volume. In this example the loss of 10 mL per breath is not significant.

A 60-year-old female receiving oxygen therapy by a nonrebreathing mask has the follow arterial blood gas results: pH 7.47 PaCO2 32 torr PaO2 50 torr HCO3- 24 mEq/L BE 1 mEq/L The respiratory therapist should document which of the following conditions in the patient's medical record? A. intrapulmonary shunt secondary to hyperventilation B. idiopathic ventilatory failure C. refractory hypoxemia with mild hypocapnia D. compensated respiratory alkalosis

The correct answer is : C Explanation : This patient has profound hypoxemia in spite of maximum FIO2. This is known as refractory hypoxemia. Additionally, hypocapnia (reduced CO2) is present.

The following pulmonary function test results are reported for a 57-year-old male patient with a smoking history of 50-pack years. % of predicted Actual Value FVC 56 SVC 68 Fev1.0/FVC% 67% Fev1.0 62 FEF 200-1200 68 FEF25-75 68 DLCO 18 Based on this information the patient has A. asthma B. restrictive defect C. emphysema D. severe diffusion defect

The correct answer is : C Explanation : This patient is demonstrating an obstructive defect as shown by an Fev1/FVC of 67%, which is less than the 75% required to be normal. Additionally, DLCO is also less than 80% of predicted indicating mild diffusion impairment. These two conditions, together, are associated with pulmonary emphysema.

A patient with ARDS receiving volume-controlled ventilation has the following arterial blood results on the settings below: Mode Assist/control Mandatory rate 22 VT 350 mL FIO2 0.70 PEEP 22 cm H2O C.I. 2.2 L/min/m2 Heart rate 102 pH 7.35 PaCO2 45 torr PaO2 58 torr HCO3- 25 mEq/L BE +1 mEq/L Which of the following changes is most appropriate? A. decrease FIO2 to 0.6 B. increase FIO2 to 0.8 C. increase PEEP to 25 cm H2O D. decrease PEEP to 20 cm H2O

The correct answer is : C Explanation : This patient is hypoxic. To correct this problem either PEEP or FIO2 must be increased. Because the patient is already on 70% the next logical step is to increase PEEP. Hemodynamic data, namely a normal cardiac output, supports this change.

A patient who weighs 68 kg (150 lb) has a minute ventilation requirement of 14 L/min to maintain a PaCO2 of 38 torr. Which of the following can explain the ventilatory requirements? A. excessive caloric intake B. obstructive apnea C. increased dead space ventilation D. CNS depression

The correct answer is : C Explanation : This patient is requiring a very high minute ventilation to achieve a normal PaCO2. The most likely cause of this is increased dead space ventilation. Dead space ventilation is likely due to collapsed alveoli which results in lower lung space. This would cause the patient to breathe quickly and deeply in order to move significant amounts of air to achieve adequate ventilation.

A patient is receiving volume-controlled ventilation in the emergency department (ED). The following data is available: Mode Assist/control VT 500 mL Mandatory rate 14 FIO2 0.5 PEEP 5 cm H2O PetCO2 30 torr pH 7.39 PaCO2 40 torr PaO2 100 torr HCO3- 25 mEq/L BE +1 mEq/L The respiratory therapist should report which of the following as an accurate VD/VT ratio? A. 50% B. 75% C. 25% D. 15%

The correct answer is : C Explanation : VD/VT ratio calculation is (PaCO2-PetCO2)/PaCO2. In this case 40 -30 = 10. 10/40 = 25%

A patient with a fenestrated tracheostomy tube is in full cardiopulmonary arrest with a blood pressure of 40/10 mmHg, a respiratory rate of 2, and a pulse of 20/min. To provide manual ventilation the respiratory therapist should FIRST A. suction the patient B. inflate the cuff C. remove the tracheostomy cap D. remove the fenestrated tube and reintubate with a regular tracheostomy tube

The correct answer is : C Explanation : When a fenestrated tracheostomy is in a speaking configuration but requires positive pressure ventilation with a resuscitation bag or ventilator, the first step is to remove the tracheostomy. When transitioning from one configuration to the other, one must remember to always do the steps in a order that allows the patient to breathe freely during the change.

A therapist is unable to obtain a reading with a galvanic-type oxygen analyzer when attempting to measure oxygen percentage inside an infant oxygen hood while heated humidity is also applied. The therapist should? A. change the batteries B. discontinue heated humidity C. change the electrode D. change the electrolyte solution

The correct answer is : C Explanation : When a galvanic-type oxygen analyzer fails to produce a reading, it is likely a problem with the power source. These type of analyzers do not have batteries. The electrode is in essence a battery. So, the solution is to change the electrode. The electrode is also called the fuel cell.

While turning a patient for a V/Q scan, the therapist suspects the endotracheal tube changed position. Currently the ET tube markings are 19 at the lip line. The therapist should FIRST do which of the following to assess tube position? A. advance the ET tube by 2 cm B. obtain a chest radiograph C. observe chest rise D. withdraw the ET tube by 5 cm

The correct answer is : C Explanation : When trying to quickly determine the location of the endotracheal tube the action that must be taken first is that which is the quickest. Of the options offered, observing chest rise is the quickest.

The respiratory therapist obtains the following blood gas data on a patient breathing spontaneously on room air: pH 7.35 PaCO2 45 torr PaO2 50 torr HCO3- 27 mEq/L BE +2 mEq/L The therapist could accurately estimate the patient's SaO2 to be which of the following? A. 85% B. 90% C. 75% D. 80%

The correct answer is : D Explanation : A PaO2 of 50 mmHg most closely correlates with an oxygen saturation of about 80% on the oxygen dissociation curve.

A patient has a fenestrated tracheostomy tube configured to allow speech. In preparation for a positive pressure breathing treatment, the respiratory therapist should do which of the following? A. inflate the cuff, insert the inner cannula, remove the cap B. remove the cap, deflate the cuff and replace the inner cannula C. remove the inner cannula, deflate the cuff, place the cap D. remove the cap, inflate the cuff, insert the inner cannula

The correct answer is : D Explanation : A fenestrated tracheostomy tube has two potential configurations. The first configuration allows the patient to speak. The second configuration allows the patient to receive positive pressure ventilation. When transitioning from a speaking configuration to a positive pressure ventilation configuration, several things must be done in the right order to ensure the patient can breathe through the change. In this case, the first step is to remove the cap, then inflate the cuff, and finally, insert the inner cannula. Doing this in any different order could present a time where the patient is unable to breathe freely.

A 57-year-old cachectic male patient with known COPD is receiving oxygen by nasal cannula at 5 L/min. The patient is very drowsy with a respiratory rate of 8/min. Oxygen saturation is 100%. The therapist should A. place on a NRB mask. B. draw an arterial blood gas. C. obtain a CT scan. D. reduce supplemental oxygen delivery.

The correct answer is : D Explanation : A patient with COPD should not receive more than 1 to 2 L/min by nasal cannula or more than 28% oxygen. If excessive oxygen is administered the patient may experience a reduced ventilatory drive. Optimal oxygen saturation for a patient with COPD is between 92 and 94%.

A patient is found unconscious by a respiratory therapist. Pulse is palpated and found to be 38/min. An agonal breathing pattern is also noted. The therapist should immediately A. place the patient on a non-rebreathing mask at 15 L/min. B. administer epinephrine. C. perform oral endotracheal intubation. D. begin CPR

The correct answer is : D Explanation : A pulse of less than 40 per minute is an indication to begin cardiopulmonary resuscitation or BLS.

You are asked to instruct a patient being discharged home to use inhalers instead of small volume nebulizers. The patient is 8-years-old and was generally non-compliant with aerosol therapy during the hospitalization. Which of the following should NOT be included in the teaching plan? A. instructions for the parents/legal guardians B. MDI self-administration with a spacer C. order and timing of ordered medications D. MDI self-administration without a spacer

The correct answer is : D Explanation : A spacer is indicated for a patient this age in order to reduce the need to rely upon coordination with an MDI, along with improving medication particle delivery. Including the family and taking multiple medications in their proper order are necessary points for teaching.

With the addition of a spacer, the patient self-administering MDIs A. does not have to hold their breath after each maneuver. B. may take a smaller dose than ordered. C. should take a slower, deeper breath. D. does not have to closely correlate actuation and inhalation.

The correct answer is : D Explanation : An aerosol holding chamber, commonly known as a spacer, not only improves medication delivery when added to a metered-dose inhaler, but also reduces the significant amount of coordination required to properly self-administer an MDI.

A 7-year-old patient is receiving mechanical ventilation with a PB 840 volume ventilator with an adult circuit. The end-tidal CO2 monitor is indicating a PetCO2 of 56 mmHg. Which of the following is most appropriate? A. remove 50 mL of deadspace B. switch to a pediatric circuit C. add 50 mL of deadspace D. increase mandatory rate

The correct answer is : D Explanation : An end-tidal CO2 of 56 mmHg approximates an arterial CO2 of about 66 mm Hg. This is a definite indication of hypoventilation and would best be remedied by increasing minute ventilation. This may be done by increasing tidal volume or increasing rate. Adding dead space would increase end-tidal and arterial CO2 even further. Removing dead space, while a step in the right direction, isn't a sufficient response. Changing to a pediatric circuit is not helpful.

A male patient who weighs 72-kg (170-lb) and is 5-ft, 4-in tall is receiving mechanical ventilator support on the following settings with the following corresponding blood gas values: Mode SIMV Mandatory rate 14 VT 400 mL FIO2 0.50 PEEP 5 cmH2O pH 7.32 PaCO2 47 mm Hg PaO2 70 mm Hg HCO3- 25 mEq/L BE +1 mEq/L The respiratory therapist should recommend: A. increase PEEP to 8 cmH2O B. increase rate to 16 C. increase FIO2 to 0.6 D. increase tidal volume to 500 mL

The correct answer is : D Explanation : Arterial blood gases show mild hypoventilation and hypoxemia. Although increasing rate would correct ventilation, increasing tidal volume is most appropriate. Additionally, the CO2 is only off by a very small amount and a change in tidal volume is the better choice when making small changes in CO2 because it results in a smaller increase in mean airway pressure.

A patient in the intensive care unit is receiving mechanical ventilation on the following settings: Mode Assist/control VT 450 mL Mandatory rate 18 FIO2 0.6 PEEP 8 cm H2O Other clinical data includes: CVP 12 mm Hg PAP 15 mm Hg PCWP 8 mm Hg C.O. 4.8 L/min Which of the following most likely represents the patient's condition? A. congestive heart failure B. left-sided heart failure C. pulmonary embolus D. cor pulmonale

The correct answer is : D Explanation : CVP is high. PAP is normal. This indicates a problem in the right heart. PCWP is normal and cardiac output is normal. This data suggests that the left heart and the lungs are okay. In the options offered only cor pulmonale is a right heart condition. Congestive heart failure is associated with a left heart problem and pulmonary embolism with a lung problem.

Using the formula for calculation of cardiac index, how would a morbidly obese patient's C.I. compare to that of a person at ideal body weight? A. cardiac index would be unpredictable B. cardiac index would remained unchanged C. cardiac index would be higher D. cardiac index would be lower

The correct answer is : D Explanation : Cardiac index is determined by dividing cardiac output by body surface area. As body surface area is increased (from obesity) the cardiac index calculation will be less than a patient at ideal body weight.

An intubated patient has a size 7.5 mm endotracheal tube in place. Diffuse rhonchi are auscultated. A respiratory therapist is using a 12 Fr suction catheter set to a pressure of -100 cm H2O, attempting to suction for 15 seconds. Only scant secretions are suctioned, and breath sounds do not improve after the procedure. The respiratory therapist should increase the A. catheter size to an 18 Fr. B. catheter size to a 14 Fr. C. suction duration. D. suction pressure.

The correct answer is : D Explanation : If suctioning is not adequate, correct the problem in this order: 1. check connections, change collection bottle if full 2. ensure suction pressure is in the right range 3. increase to the maximum size catheter within range 4. increase pressure within range 5. increase suction time

A patient with myasthenia gravis presents to the clinic with a fever, suspected pneumonia secondary to an infiltrate seen on a chest radiograph, and the following ABG results: pH 7.33 PaCO2 47 torr PaO2 85 torr HCO3- 26 mEq/L FIO2 0.21 Based upon this information, the patient needs A. pulmonary function testing. B. oxygen at 2 L/min nasal cannula. C. intubation. D. antibiotic therapy.

The correct answer is : D Explanation : In this example, we see a problem with ventilation as the PaCO2 is 47 torr. However, there is no option that will resolve ventilation, therefore we must look to the scenario for other problems. There is an underlying problem of infection for which antibiotic therapy is indicated.

Evaluation of maximum expiratory pressure (MEP) is most useful in evaluating which of the following? A. fixed upper airway obstruction B. inspiratory muscle strength C. presence of restrictive defect D. forcefulness of cough

The correct answer is : D Explanation : Maxim expiratory pressure is an important measurement when determining how forcefully a patient can cough, though it can also be used to determine if the patient is able to sustain ventilation. However, MIP is more relevant when considering a patient's ability to sustain ventilation on his own.

Immediately following oral intubation, which of the following devices would be most helpful in determining if the ET tube is correctly positioned in the trachea? A. pulse oximetery B. SvO2 monitor C. transcutaneous CO2 monitor D. infrared CO2 detection device

The correct answer is : D Explanation : Of the devices listed, an infrared CO2 detection device may be used to determine if adequate CO2 is being exhaled from the ET tube during ventilation. If the endotracheal tube is inadvertently placed inside the esophagus end-tidal CO2 will read nearly 0, indicating a need to remove and reposition the endotracheal tube.

Under which of the following circumstances should a respiratory therapist consider stopping a PEP therapy treatment of a child? A. Cold B. Bronchitis C. Lingular lobe pneumonia D. Middle ear infection

The correct answer is : D Explanation : PEP therapy is contraindicated by sinusitis, epistaxis, and a middle ear infection.

A patient scheduled for abdominal surgery can be assessed for potential post-operative risk for complications by assessing which of the following? A. C(a-vDO2) B. alveolar oxygen tension on room air (FIO2 0.21) C. incentive spirometry with flow-type spirometer D. basic spirometry

The correct answer is : D Explanation : Potential postoperative risk may be assessed preoperatively through basic spirometry.

The therapist is observing the quality control results in order to determine the accuracy and precision of the blood gas analyzer. According to the documentation that came with the quality control material, pH is supposed to analyze at 7.40 with 0.5% upper and lower standard deviation. The PCO2 analyzer is supposed to measure 30 mmHg with 5% upper and lower standard deviation tolerance. Which of the following runs are consistent with an analyzer that is out-of-control? pH PCO2 (mm Hg) Run 1 7.37 25 Run 2 7.41 31 Run 3 7.34 29 A. 1 only B. 3 only C. 2 only D. 1 and 3

The correct answer is : D Explanation : Runs one and three, when calculated, exceed the pH or PCO2 limit and therefore are consistent with a blood gas analyzer that is out of control.

Which of the following can be done to increase the effectiveness of endotracheal suctioning? A. apply intermittent suction during removal of the catheter B. decrease suction catheter length C. use a coude-tipped catheter D. increase suction catheter size

The correct answer is : D Explanation : Suctioning effectiveness may be increased by increasing suction catheter size or diameter, by increasing suction pressure, or by increasing suction duration. Of the options given, increasing catheter size and increasing suction pressure are appropriate.

A respiratory therapist notices the dicrotic notch is missing from the pulmonary artery catheter waveform. After unsuccessfully attempting to resolve the problem by aspiration, the therapist should A. withdraw the catheter B. advance the catheter C. replace the catheter D. rotate the catheter

The correct answer is : D Explanation : The absence of a dicrotic notch on a pulmonary artery waveform is an indication that the catheter is being occluded in some way. To correct this problem, the therapist should first aspirate the catheter. If this does not remedy pressure dampening, flushing the catheter is the next option. Finally, the catheter should be rotated. The only option given in this question that is appropriate is rotation of the catheter.

A respiratory therapist is performing a routine patient/ventilator check on a mechanically ventilated patient. Returned tidal volume is 150 mL less than delivered. A high-pitched audible leak is auscultated through the neck. What is the appropriate response? A. increase delivered tidal volume B. advance the endotracheal tube 1 cm C. reposition the patient D. add air to the cuff

The correct answer is : D Explanation : The high-pitched audible leak auscultating over the neck in conjunction with a low returned tidal volume is most likely an indication of insufficient pressure in the endotracheal tube cuff. Adding air to the cuff is most appropriate.

Pulmonary function testing is done on a patient with venous distension and a flattened diaphragm. The following pulmonary function data is recorded: Percent of Pred Actual value Fev1/FVC % 58% FEF200-1200 75% FEF25-75 52% SVC 88% FVC 81% DLCO 15 CO/min/mm Hg Which of the following most likely represents the patient's condition? A. asthma B. chronic bronchitis C. pulmonary fibrosis D. emphysema

The correct answer is : D Explanation : The pulmonary function data shows decreased flows but normal volumes. This is consistent with an obstructive defect. When looking at the answers three of the diseases are obstructive in nature. To discern which disease is most likely, one must look to the DLCO. In this case the DLCO is decreased indicating the patient has pulmonary emphysema. Of the five obstructive diseases only emphysema has a poor DLCO.

Prior to a pulmonary function test, a respiratory therapist conducts spirometry calibration with a 3.0 Liter super-syringe obtaining the following results: Trail 1 (L) Trial 2 (L) Trial 3 (L) 2.74 2.68 2.72 The spirometer is A. accurate. B. precise. C. imprecise. D. inaccurate.

The correct answer is : D Explanation : The spirometer is considered accurate if the results are no more than 3% above or 3% below the 3 L calibration syringe. This means the accuracy range is 2.85 L -3.15 L. In this case all values are outside this range and therefore the spirometer is considered to be inaccurate.

Which of the following can cause inverted T waves on a 12-lead ECG? A. hypokalemia B. second degree heart block C. hyperkalemia D. digitalis toxicity

The correct answer is : D Explanation : There are two causes of inverted T waves: cardiac ischemia and digitalis toxicity.

A patient is receiving volume-controlled ventilation in the assist/control mode. The following data are available: Peak pressure Plateau Pressure Exhaled VT 8 AM 35 cm H2O 22 cm H2O 600 mL 10 AM 53 cm H2O 24 cm H2O 600 mL The respiratory therapist should next perform which of the following? A. obtain a chest radiograph B. observe pressure/volume airway graphic C. decrease set tidal volume D. endotracheal suctioning

The correct answer is : D Explanation : This data shows a significant increase in peak airway pressures while plateau pressures remains nearly constant. This is consistent with a decrease in dynamic compliance but shows steady static compliance. A decrease in dynamic compliance is caused from temporary conditions such as secretions in the airway, bronchoconstriction, kinked endotracheal tubes, and water in the ventilator circuit, to name a few. Of the options offered, only endotracheal suctioning addresses the decrease in dynamic compliance.

A patient who weighs 65-kg (143-lb) is receiving mechanical ventilator support on the following settings with the following corresponding blood gas values: Mode SIMV Mandatory rate 16 VT 450 mL FIO2 0.60 PEEP 5 cm H2O Inspiratory flow 50 L/min Corresponding blood gases show: pH 7.29 PaCO2 52 mm Hg PaO2 78 mm Hg HCO3- 26 mEq/L BE +2 mEq/L The respiratory therapist should recommend: A. increase tidal volume to 500 B. add pressure support of 5 cmH2O C. increase PEEP to 10 cmH2O D. increase rate to 18

The correct answer is : D Explanation : This patient has arterial blood gases that show hypoventilation. Mild hypoxemia is also present. When there is a problem with both ventilation and oxygenation at the same time, ventilation should be corrected first. This is because the hypoxemia may be caused by hypoventilation. The proper way to increase ventilation is to either increase rate, or increase tidal volume. Any time the CO2 is off by more than 4 mmHg a change in tidal volume is insufficient. An increase in rate is required.

A 68-kg (150-lb) male is receiving volume-controlled ventilation secondary to cardiogenic shock. Ventilator settings and arterial blood gas data are below: Mode Assist/control FIO2 0.80 VT 500 mL Mandatory rate 14 Total rate 16 PEEP 22 cm H2O pH 7.30 PaCO2 50 torr PaO2 65 torr HCO3- 25 mEq/L BE +1 mEq/L C.I. 1 L/min/m2 A. add pressure support B. bronchodilator therapy C. increase PEEP D. decrease PEEP

The correct answer is : D Explanation : This patient is under ventilating and is hypoxic. However, examination of hemodynamic data shows cardiac instability as manifested by a low cardiac index. This condition is very dangerous for the patient and suggests that PEEP is too high. Of the options offered a reduction in PEEP is most appropriate.

A patient in the emergency room has the following arterial blood gas results: pH 7.55 PaCO2 35 mm Hg PaO2 84 mm Hg HCO3- 35 mEq/L BE +11 mEq/L SAT 95% Which of the following represents an accurate interpretation of the data? A. metabolic acidosis B. respiratory alkalosis C. mixed-respiratory and metabolic acidosis D. metabolic alkalosis

The correct answer is : D Explanation : This patient is in a state of alkalosis as manifested by a high pH of 7.55. Changes in pH are either caused by changes in CO2 or changes in HCO3-. In this case the patient's CO2 is in the normal range and therefore cannot be a cause of the alkalosis. This would mean that respiratory alkalosis is not present but metabolic alkalosis is evident.

A 9-year-old girl is receiving mechanical ventilation with an adult circuit with the following arterial blood gases values: pH 7.30 PaCO2 53 mm Hg PaO2 78 mm Hg HCO3- 25 mEq/L BE +1 mEq/L Based on these values, the respiratory therapist should A. change the circuit. B. decrease the rate. C. reduce 50 ml mechanical deadspace. D. increase the rate.

The correct answer is : D Explanation : This patient is under ventilating and under oxygenating. Of these two problems ventilation should be addressed first. This is best done by increasing the rate.

A patient is receiving non-invasive positive pressure ventilation with an IPAP of 16 and an EPAP of 8 cmH2O. The following blood gas data on these settings is available: pH 7.30 PaCO2 52 mm Hg PaO2 80 mm Hg HCO3- 24 mEq/L BE 0 mEq/L Which of the following change is most appropriate? A. decrease EPAP B. increase IPAP and EPAP C. decrease IPAP D. increase IPAP

The correct answer is : D Explanation : This patient is under ventilating but has adequate oxygenation. CO2 may be decreased by increasing the distance between the IPAP and EPAP pressures. This can be done by simply increasing IPAP.

A patient is receiving non-invasive positive pressure ventilation with an IPAP of 28 and an EPAP of 12 cmH2O. The following blood gas data on these settings is available: pH 7.37 PaCO2 42 mm Hg PaO2 72 mm Hg HCO3- 24 mEq/L BE 0 mEq/L Which of the following change is most appropriate? A. decrease EPAP B. increase IPAP C. decrease IPAP and EPAP D. increase IPAP and EPAP

The correct answer is : D Explanation : This patient shows adequate ventilation but mild hypoxemia. To correct hypoxemia, expiratory pressure should be increased. However, increasing expiratory pressure alone will decrease the distance between the inspiratory and expiratory pressures and will inadvertently decrease ventilation. This is not desirable because CO2 is already appropriate. To prevent a change in ventilation IPAP must be increased by the same degree that EPAP is increased.

A respiratory therapist auscultates a 3-year-old child in respiratory distress in the emergency department (ED). Auscultation reveals unilateral wheezing on the right and vesicular breath sounds on the left. The therapist should prepare which of the following to help the patient? A. a small volume treatment with Albuterol B. aerosolized racemic epinephrine C. aerosolized Ipratropium Bromide (Atrovent) D. a bronchoscope

The correct answer is : D Explanation : Unilateral wheezing in a small child is usually associated with foreign body aspiration. When the patient wheezes, normally, bilateral bronchoconstriction is present. Therefore, unilateral wheezing is more likely caused from an object or food in the airway on the affected side. To resolve this, a bronchoscope will both diagnose the problem and facilitate extraction of the object.

A patient with the following blood gas results has an end-tidal CO2 of 30 mm Hg. pH 7.38 PaCO2 40 mm Hg PaO2 80 mm Hg HCO3- 25 mEq/L What is the VD/VT? A. 62% B. 50% C. 30% D. 25%

The correct answer is : D Explanation : VD/VT = (PaCO2 - PetCO2) / PaCO2. In this case, VD/VT = (40-30)/40 = 10/40 or 25%.

Blood pressure obtained by a sphygmomanometer reads higher than the indicated blood pressure from an arterial line on the same patient. To correct problem, the respiratory therapist should FIRST A. discontinue use of the sphygmomanometer B. flush the art line with sodium heparin C. advance the arterial line catheter D. check for air bubbles in the transducer dome

The correct answer is : D Explanation : When blood pressure by sphygmomanometer (cuff) differs from the blood pressure obtained from an indwelling arterial line, the blood pressure taken by cuff is considered more accurate and reliable. Problems that may occur in the ART line include clots in the line and bubbles in the transducer dome.