TMC (LJU version 3)

As part of the instruction of a 5-year-old child who will be using a small volume nebulizer at home, the respiratory therapist should also A. Ensure the caregiver understands all instructions to perform the therapy B. Provide the patient with a telephone number that can be used to ask questions C. Have the patient record the treatments in a daily journal D. Remind the child of the consequences of abusing the medication

The correct answer is : A Explanation : A 5-year-old patient is not likely able to understand and retain instructions regarding the use of a small volume nebulizer and the management of the associated medication. Therefore, it is most appropriate to ensure the caregiver of the patient understands all instructions. This may be done by having the caregiver repeat back the instructions given or to demonstrate their understanding

A child has been extubated and is demonstrating mild stridor. Which of the following agents would be most helpful to administer by aerosol? A. racemic epinephrine B. Aminophylline C. Atropine D. Albuterol

The correct answer is : A Explanation : A child who has mild stridor can be treated by one of two ways - administration of racemic epinephrine or administration of a cool aerosol. Moderate stridor requires the use of racemic epinephrine and severe or marked stridor would require intubation.

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

The correct answer is : A Explanation : A patient with COPD should not receive more than 28% oxygen, or more than 1-2 liters per minute by nasal cannula. Excessive oxygen delivery can result in suppression of the ventilatory drive, which can lead to disorientation, hypoventilation, and ventilatory failure. Oxygen saturation should be kept at or below 94%.

A 45-year-old 74-kg (163-lb) adult female is receiving mechanical ventilatory support. Settings are as follows: Mode Assist/control Mandatory rate 12 Total rate 16 Tidal volume 400 mL FIO2 0.6 PEEP 5 cm H2O The patient is appears to be anxious. SpO2 is 86%. The respiratory therapist will recommend which of the following? A. increase tidal volume B. increase inspiratory flow rate C. increase FIO2 D. decrease mandatory rate

The correct answer is : A Explanation : All of the answers in this question are indicating a need to change the ventilator settings. However, there is no blood gas data available to a change in settings. When this happens, we must look closer at the ventilator settings where we will likely find a problem. The patient weighs 74 kg. The minimum tidal volume for this patient is 6 mL per kilogram, or 450 mL. The set tidal volume is 400 mL. This must be corrected immediately.

Which of the following would be most helpful at identifying optimal PEEP? A. C(a-v)O2 B. CVP C. Vd/VT D. A-aDO2

The correct answer is : A Explanation : Among these options, optimal PEEP can best be identified by including data associated with the C(a-v)O2.

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

The correct answer is : A Explanation : Apgar scores of 4 to 6 indicate the administration of supplemental oxygen and general stimulation of the infant. Apgar scores higher than six require only routine care of the infant. Apgar scores of 0-3 indicate the need for CPR.

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

The correct answer is : A Explanation : Arterial blood gas reveal hypoventilation and hypoxemia. However, the patient is not quite yet demonstrating acute ventilatory failure. When CO2 rises and pH falls below 7.25, acute ventilatory failure is present and mechanical ventilatory assistance is indicated. In this case, the patient is just shy of acute ventilatory failure and may benefit from non-invasive positive pressure ventilation (NIPPV or BiPAP).

L/min/m2 is the unit of measure for A. cardiac index B. cardiac output C. stroke volume D. systemic vascular resistance

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

Which of the following data is needed to calculate cardiac output? A. stroke volume B. A-aDO2 C. VO2 D. QS/QT

The correct answer is : A Explanation : Cardiac output may be calculated using stroke volume and multiplying it by the heart rate. Of the options listed, only these two would be helpful.

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

The correct answer is : A Explanation : Decreasing the suction duration is an appropriate method to reduce the cardiac stress and prevent PVCs during the suctioning procedure.

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

The correct answer is : A Explanation : In this case there are two problems: poor ventilation, as manifested by high CO2, and over oxygenation, as manifested by a high PaO2. Both problems may be fixed with one change which is to lower the EPAP setting. Lowering the EPAP will decrease oxygenation but will also increase ventilation by increasing the distance between the EPAP and IPAP settings.

The following data is available for a patient receiving volume-controlled mechanical ventilation: 6 am 9 am Ppeak(cm H2O) 20 32 Pplat (cm H2O) 13 25 Set VT (L) 0.6 0.6 PEEP (cm H2O) 5 5 Which of the following is most consistent with these data? A. Decreasing pulmonary compliance B. bronchoconstriction C. kyphoscoliosis D. increasing dynamic airway resistance

The correct answer is : A Explanation : In this problem peak pressures are obviously rising. Plateau pressures, however, are also rising. This indicates decreasing pulmonary compliance - the lungs are becoming stiffer.

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

The correct answer is : A Explanation : Maximum inspiratory pressure is most useful in evaluating for inspiratory muscle strength, or the ability to sustain ventilation. To determine if a patient has a restricted pulmonary defect one would need to do a pulmonary function test. The effectiveness of a cough would be assessed through doing a maximum expiratory pressure maneuver, or MEP.

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

The correct answer is : A Explanation : Mixed venous blood must be taken from the distal end of pulmonary artery catheter to determine PvO2.

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

The correct answer is : A Explanation : Patients with asthma may prevent bronchoconstriction episodes by monitoring peak flow measurements routinely and avoiding triggers to bronchoconstriction. Additionally, cromolyn sodium may be used to coat the mast cell and prevent the release of histamine, which is a source of bronchoconstriction.

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

The correct answer is : A Explanation : The NBRC knows that in real life, when you hear a ventilator alarm, you're tempted to cancel the alarm or attempt to immediately solve the problem. However, the correct answer is always to first provide manual ventilation to the patient. This is true of any ventilator alarm. Your first action should be to stabilize the ventilatory status of the patient, and then troubleshoot the problem.

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

The correct answer is : A Explanation : The arterial blood gas reveals that the patient is under oxygenating. Therefore, a change in either PEEP or FIO2 is appropriate. Normally, FIO2 should be increased up to 60% first before PEEP is adjusted. In this case the FIO2 is already at 60%, so the next logical step is to increase the PEEP.

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

The correct answer is : A Explanation : The presence of thick, yellow sputum, in conjunction with an elevated white blood cell count, prove that the patient has an infection in the pulmonary system. The most appropriate action is to address the infection by determining a culture and sensitivity. This will help identify the bacteria that is present and the antibiotic that is most suitable for killing that particular bacteria.

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

The correct answer is : A Explanation : The proper goal for incentive spirometry postoperatively is one half of what was achieved preoperatively. However, if the patient is unable to come close to that number, modification of the goal is appropriate. Since the incentive spirometer is supposed to incentivize or encourage its continued use, the most appropriate goal would be a number just slightly higher than the number the patient is able to achieve.

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

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

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

The correct answer is : A Explanation : There are multiple ways to determine the proper positioning of an endotracheal tube. While examining markings on the tube, observing chest rise and symmetry, and auscultating breath sounds are quick and helpful, the best way to CONFIRM proper positioning is to do a chest x-ray, also called a chest radiograph.

A patient is receiving volume-controlled ventilation in the assist/control mode. The following data are available: Peak pressure Plateau Pressure Exhaled VT 2 PM 35 cm H2O 22 cm H2O 696 mL 5 PM 53 cm H2O 24 cm H2O 702 mL 7 PM 55 cm H2O 23 cm H2O 700 mL The respiratory therapist would categorize the most significant problem noted from this data as A. decreasing dynamic compliance B. increasing dynamic compliance C. increasing static compliance D. decreasing static compliance

The correct answer is : A Explanation : This data shows a significant increase in peak airway pressures but plateau pressures are remaining nearly steady. An increase in peak airway pressures with steady plateau pressures is associated with a decrease in dynamic compliance and is caused from such temporary conditions as bronchoconstriction, secretions in the airway, and occlusion of the endotracheal tube, to name a few.

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

The correct answer is : B Explanation : A respirometer is the most important piece of equipment when measuring an SVC. A Collins water spirometer would also accomplish an SVC, but it is large equipment that is not transferable to bed side.

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

The correct answer is : A Explanation : This kind of question can be difficult because you have to know exactly how much the pH will move given a certain amount of CO2. The answer to that question is that pH will decrease by 0.1 for every 10 mmHg of CO2. In this case, the CO2 is approximately 10 mmHg above normal. Therefore the pH should be roughly 0.1 below its normal, or 7.30. However, the pH in this blood gas is 7.10. This means that the respiratory system plays only a part in the acidodic pH but there must be metabolic involvement because the pH is lower than what would be predicted for the CO2.

A 60 kg (132 lb) male patient is undergoing weaning from mechanical ventilation. The following clinical and laboratory data is available: Mode SIMV Mandatory rate 4 Total rate 28 FIO2 0.40 VT (set) 400 mL VT (spont) 280 mL Pressure support 5 cm H2O pH 7.44 PaCO2 35 torr PaO2 82 torr HCO3- 24 mEq/L BE +1 mEq/L The respiratory therapist should recommend which of the following changes? A. Increase pressure support to 10 cm H2O B. Administer sedative medication C. Switch to pressure-control ventilation D. Discontinue mechanical ventilation

The correct answer is : A Explanation : This patient is obviously leaning from mechanical ventilatory support. However, they are demonstrating a high respiratory rate of 28 and a low spontaneous tidal volume of 280 mL. The key issue here is the low tidal volume. This can be best addressed by increasing pressure support. Pressure support will increase spontaneous tidal volumes and lead to a natural decrease in rate, which will lower work of breathing.

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

The correct answer is : A Explanation : This patient is receiving 30% oxygen though a Heliox mixture. One look at the blood gas shows a PaO2 of 110 mmHg. This over oxygenation state indicates a need to lower supplemental oxygen. Changing to an 80-20% Heliox mixture is most appropriate

A patient with rocky mountain spotted fever is receiving non-invasive positive pressure breathing by mask at the following settings: IPAP 18 cm H2O EPAP 6 cm H2O Corresponding blood gases are: pH 7.36 PaCO2 43 mm Hg PaO2 72 mm Hg HCO3- 24 mEq/L BE 0 mEq/L FIO2 0.60 The respiratory therapist should recommend which of the following change(s)? A. increase IPAP to 20, EPAP to 8 cm H2O B. increase EPAP to 10 cm H2O C. increase FIO2 to 0.7 D. increase IPAP to 22 cm H2O

The correct answer is : A Explanation : This patient on bilevel therapy is having a problem with oxygenation. Ventilation appears to be okay. When this happens, the primary control to increase oxygenation is EPAP. However, the amount of ventilation relates to the distance between the inspiratory and expiratory pressure. Consequently, raising EPAP by itself has an indirect effect on ventilation because the distance between the two values is inadvertently diminished. Thus, when EPAP is increased, IPAP must be increased by the same amount to maintain consistent ventilation.

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

The correct answer is : A Explanation : To be a candidate for weaning deadspace-tidal volume ratio must be less than 60%, A-a gradient must be less than 300 mmHg, RSBI must be less than 106, and WBC must be near-normal. In this question, the deadspace-tidal volume ratio is too high and is a reason to delay weaning.

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

The correct answer is : A Explanation : To determine the effectiveness of a bronchodilator one must measure the flow. In this case a peak flow meter would be most appropriate. A respirometer would measure volume which is not what we are looking for in this circumstance.

A physician is concerned about autoPEEP developing in a patient receiving volume-controlled ventilation on the following settings: Mode Assist/control VT 600 mL Rate 16 FIO2 1.0 PEEP 10 cm H2O Insp flow 50 L/min I:E 1:2 Which of the following adjustments will reduce autoPEEP? A. decrease rate and/or increase flow B. increase PEEP C. decrease PEEP D. increase VT

The correct answer is : A Explanation : Two ways of decreasing autoPEEP and air-trapping is to increase expiratory time by increasing inspiratory flow or by decreasing mandatory rate.

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

The correct answer is : A Explanation : Ventricular tachycardia without a pulse is treated by defibrillation that 300-360 Joules monophasic and about 150 Joules biphasic If the patient has a pulse with ventricular tachycardia, cardioversion at 50-100 J would be appropriate. Another note: defibrillation occurs with synchronization off while cardioversion requires that the synchronization be set to active.

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

The correct answer is : A Explanation : When a pulse oximeter is reading a low oxygen saturation but has a different heart rate compared to that which can be palpated, the oxygen saturation reading is in error and should not be reported. The cause for this is likely poor peripheral perfusion caused by a number of factors. But, the solution is to first try a different location with the pulse ox probe.

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

The correct answer is : A Explanation : When helium-oxygen mixtures are run through flow meters that are intended for oxygen only, the indicated flow on the flow meter is inaccurate. This is because the helium-oxygen mixture is less viscous and does not push the indicator ball up as much as does oxygen. In this case, a correction factor must be used depending upon the mixture percentages. For an 80/20% mixture a correction factor of 1.8 must be used. A 70/30% mixture has a correction factor of 1.6 and a 60/40% mixture has a correction factor of 1.4. In this problem the 60/40% mixture factor of 1.4 must be multiplied by the indicated flow on the oxygen flow meter to calculate actual total gas flow. When we do this we get a total gas flow of 14 L/min.

Which pressure should not be exceeded when adding air to an oral endotracheal tube cuff? A. 20 mmHg B. 30 mmHg C. 25 mmHg D. 15 mmHg

The correct answer is : A Explanation : When inflating an oral endotracheal tube cuff the pressure not to be exceeded is 25 cmH2O. More commonly, the exam uses the units of mmHg or torr. In those units, the pressure should not exceed 20 mmHg or torr. The reason for this limitation is that the capillary bed in the trachea has a mean pressure of about 20 mmHg. If the cuff pressure exceeds that, there is a risk of restricting blood flow and causing damage to the tissues of the trachea.

Which of the following can be examined to initially determine the approximate position of the oral endotracheal tube? A. ET tube markings at the lips B. lateral neck radiograph C. diaphragmatic excursion D. chest radiograph

The correct answer is : A Explanation : When initially examining for proper positioning of the endotracheal tube, the first option should be to perform the quickest examination as possible. In this case the best answer would be to visualize the ET tube markings at the lips. Obtaining an x-ray of any sort would be too time-consuming. Examining diaphragmatic excursion would not be helpful at all.

A 68-year-old male patient has the following pulmonary function values: Fev1/FVC% 79% FVC 62% of predicted FEF25-75 81% of predicted FEF200-1200 84% of predicted Which of the following could represent the patient's diagnosis? A. idiopathic pulmonary fibrosis B. bronchiectasis C. chronic asthma D. chronic bronchitis

The correct answer is : A Explanation : When looking at pulmonary function data, the primary purpose is to differentiate between an obstructive defect and a restrictive effect. To determine if the patient is obstructive, we must look at flows. To determine if they are restrictive we must look at volumes. In this case the Fev1/FVC% is 79%. Most pulmonary function data requires 80% of predicted or higher to be considered normal. With Fev1/FVC%, 75% is considered normal. This is because it is not a predicted value but the actual value of the ratio. In other words, a person should be able to blow out 75% of their forced vital capacity in one second. This data indicates that the patient is not obstructive. Further examination shows a forced vital capacity of 62% of predicted. This is consistent with a restrictive pulmonary defect. Examining the options reveals three diseases that are obstructive in nature and only one that is restrictive - idiopathic pulmonary fibrosis.

The following pulmonary function data is obtained from a 32-year-old male with a history of pulmonary fibrosis: Percent (%) of Predicted SVC 62 FVC 69 FEV1.0 80 FEF25-75 79 FEF200-1200 82 DLCO 91 The respiratory therapist should interpret this data as A. moderate diffusion impairment B. poor patient effort C. mild obstructive defect D. severe restrictive disease

The correct answer is : B Explanation : A close look at these pulmonary function values reveals something peculiar - SVC is less than the FVC. This is not normal. When a patient breathes out slowly they are able to exhale more fully. When the patient exhales forcefully turbulent airflow reduces the exhaled volume. Consequently, a SVC measurement should always be greater than a FVC on a given patient. When this is not the case it indicates poor patient effort and the slow vital capacity should be repeated.

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

The correct answer is : B Explanation : A left-to-right cardiac shunt would best be observed by examining the oxygen saturation of mixed venous blood.

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

The correct answer is : B Explanation : A low-pressure alarm is caused by a leak or a disconnection or by the patient if he or she is inhaling at a higher inspiratory demand than that being delivered by the ventilator. The solution of this problem is to look each of the answers and determine which one of those things could cause a low-pressure alarm. In this case a crack in the Y plastic piece would cause a leak. A herniated cuff, excess secretions in the airway, and a kinked ET tube would all cause high-pressure alarms.

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

The correct answer is : B Explanation : A patient who is showing signs of hypoxemia should receive supplemental oxygen. If the patient is not a COPD patient and the situation is not an emergency, then the proper supplemental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options available only 5 L/min nasal cannula will approach this. Other options are either insufficient or too much.

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

The correct answer is : B Explanation : A patient with COPD receiving mechanical ventilation benefits most from prolonged expiratory time. This allows exhalation of gases and prevents further air trapping. To increase expiratory time, inspiratory time must be decreased. That is best accomplished by increasing inspiratory flow rate. That will leave more time for the expiratory phase to occur and for the patient to exhale more fully.

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

The correct answer is : B Explanation : A round-shaped infiltrate found on an x-ray is concerning because it may be a cancerous mass. If it is a mass it will have a three-dimensional quality to it and therefore a series of x-rays (radiographs) taken from different angles will show the three dimensional shape of the object. The purpose of chest x-rays taken from nontraditional angles is to focus on an object and get a three-dimensional understanding of its shape.

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

The correct answer is : B Explanation : According to national asthma guidelines, a peak flow of 75% of baseline peak flow measurement is an indication to administer further rescue medication.

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

The correct answer is : B Explanation : An end-tidal CO2 of only 3% is low. This indicates poor ventilation. In looking at the answers the best one is poor alveolar perfusion. A clean infrared device does not relate and the calibration of the capnograph is not pertinent.

An 84-kg (185-lb) 6-ft 1-in (185-cm) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: Mandatory rate 18/min VT 600 mL FIO2 0.4 PEEP 5 cm H2O ABGs pH 7.28 PaCO2 56 mm Hg PO2 71 mm Hg HCO3- 27 mEq/L BE +3 mEq/L Which of the following represents the most appropriate action? A. increase PEEP to 8 cmH2O B. increase rate to 20 C. increase FIO2 to 0.5 D. increase VT to 650

The correct answer is : B Explanation : Arterial blood gases show the patient is not ventilating and is under oxygenating. Because ventilation should be corrected first it is appropriate to either increase the tidal volume or increase the rate. In this case the PaCO2 is off by more than 4 mm Hg and therefore should be addressed only with an increase in rate.

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

The correct answer is : B Explanation : Because a patient with myasthenia gravis has no pervasive pulmonary problems, they may be weaned or removed from mechanical ventilatory support quickly, once their paralysis has dissipated. Further, ventilatory parameters show that the patient is ready to wean or be removed from the ventilator.

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

The correct answer is : B Explanation : CVP is slightly high and mPAP is also high, indicating there is no problem with the right heart. mPAP is high but PCWP is normal, indicating improper blood flow through the pulmonary vasculature. This means there is a problem in the lungs. The answer most closely related is pulmonary hypertension. Cor Pulmonale is a problem with the right heart and left heart failure is obviously a problem in the left heart.

Which of the following is needed to determine C(a-v)O2? A. PvO2 B. hemoglobin C. PaO2 D. VD/VT

The correct answer is : B Explanation : For this question you must memorize the components that make up CaO2. They are: hemoglobin, PaO2, and SaO2. Additionally, once you know the CaO2, simply subtract the CvO2 to get C(a-v)O2.

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

The correct answer is : B Explanation : Hemodynamic values are all increased. This is most closely associated with over hydration of the patient, or hypervolemia. The solution to this is to administer a diuretic medication. The most appropriate medication is Lasix, which is a loop diuretic.

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

The correct answer is : B Explanation : In addition to monitoring rate, blood pressure, oxygen saturation, and heart rate, the patient's mental status should also be monitored when doing T-piece trials or performing any kind of ventilator weaning. In this case, the patient has developed confusion and has become disoriented to time, person, or place. Any confusion or disorientation noted during any weaning process is an indication the weaning has failed and should be halted.

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

The correct answer is : B Explanation : Of the options given, huff coughing, serial coughing, and autogenic drainage are methods associated with mobilization of secretions and airway clearance. Pursed-lip breathing is not specifically designed to clear the airway but is intended for those patients who have chronic air trapping to help exhale gases more effectively and prevent air-trapping. Specifically, it is intended to help COPD patients decrease their FRC.

Which of the following is considered objective information? A. chest pain B. spontaneous tidal volume C. dyspnea D. dysphagia

The correct answer is : B Explanation : Subjective information are those data that must be reported by the patient. This kind of data is also known as symptoms. Data that can be observed independent of the patient's input is known as objective information, otherwise called signs. Of the options offered, only spontaneous tidal volume can be measured directly by the practitioner. Chest pain, dyspnea, and dysphagia are all examples of subjective information because they must be reported by the patient.

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

The correct answer is : B Explanation : The endotracheal tube is properly positioned when the end is 2 to 5 cm above the carina. In this case, the tube is only 1 cm above the carina. Withdrawing the by 2 to 4 cm is appropriate.

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

The correct answer is : B Explanation : The most common nosocomial infection source is from poor hand washing. Although frequent disconnection of a ventilator circuit will also increase incidence of infection, poor hand washing is by far more common.

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

The correct answer is : B Explanation : The primary treatment for a cardiac rhythm asystole is chest compressions. However, prior to administration of chest compressions the asystole rhythm must be confirmed. This should be done by ensuring the leads are properly placed and that the rhythm can be seen in the second lead.

During a preoperational test of the ventilator with a test lung, the respiratory therapist notes a return tidal volume of 600 cc. Ventilator settings are: Mode Assist/control FIO2 0.50 Mandatory rate 10 VT 750 mL What action should the therapist take? A. Obtain a larger test lung B. Examine the ventilator circuit for proper connections C. Increase the set tidal volume to 900 mL D. Obtain a smaller test lung

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

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

The correct answer is : B Explanation : This patient has profound hypoxemia on 5 L/min nasal cannula, which is equivalent to 35 to 40% oxygen. This would indicate the patient needs 100% oxygen to resolve hypoxemia. Although not offered in this question, the patient would also benefit from noninvasive positive pressure breathing, or BiPAP.

The following pulmonary function data is obtained from a 72-year-old male: Percent (%) of Predicted Actual value (%) SVC 81 FVC 79 FEV1.0 /FVC % 70 FEF25-75 69 FEF200-1200 63 DLCO 16 The respiratory therapist should interpret this data as A. asthma B. pulmonary emphysema C. severe diffusion impairment D. sarcoidosis

The correct answer is : B Explanation : This pulmonary function data shows a slow vital capacity of 81% of predicted. This means the patient is not restrictive. However, the FEV1/FVC% is 70%. This is not a predicted value but rather an actual ratio. In other words, of the patient's vital capacity only 70% is exhaled in one second. A normal person should be able to exhale at least 75% of their vital capacity. This indicates the patient is mildly obstructive. The choices offered consist of two diseases that are obstructive - asthma and pulmonary emphysema. To distinguish between these two, one must look at the DLCO. Of the obstructive diseases, only emphysema has a poor DLCO. In this case, the patient's DLCO is 64% of predicted, proving that the patient has emphysema.

A patient is showing signs of respiratory distress with a respiratory rate to 30/min and a spontaneous tidal volume of 800 mL. The patient is receiving oxygen at 60% by large volume nebulizer with the flow set at 10 L/min. The respiratory therapist should suggest to A. decrease FIO2 to 0.50 B. increase flow to 15 L/min C. sedate the patient D. increase FIO2 to 1.0 and the flow to 15 L/min

The correct answer is : B Explanation : This question is about recognizing that the patient is not receiving adequate inspiratory flow, or that the inspiratory demanded the patient is not being met. Some simple math will show you that the patient's minute ventilation is higher than the total flow being received from the large volume nebulizer. 800 mL multiplied by 30 times a minute is equal to a minute ventilation of 24 L per minute. The ratio of air to oxygen at 60% is 1:1. 1 +1 = 2. Next, 2 x 10 L/min = total gas flow of 20 L/min., 10 L/min less than the inspiratory demand of the patient. Although the question does not ask this, the remedy for this situation would be to implement a tandem device, or another side-by-side large volume nebulizer. This would double the total gas flow to the patient and exceed the inspiratory demand, which is what we want.

Which of the following is needed to calculate alveolar oxygen tension? A. QS/QT, deadspace B. BP and FIO2 C. PetCO2 and PaO2 D. VD/VT, PAO2

The correct answer is : B Explanation : To answer this question one must know the formula for the alveolar air equation. Barometric pressure, FIO2, and PaO2 are all included in the formula.

Which of the following pressures is most consistent with a normal pulmonary artery pressure (PAP)? A. 12/8 mmHg B. 25/8 mmHg C. 120/80 mmHg D. 25/4 mmHg

The correct answer is : B Explanation : To answer this question you must memorize normal mPAP. Normally we look at PAP as a mean value and therefore has a single number. But, it can also be expressed as a systolic over a diastolic number. In this case 25/8 mmHg.

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

The correct answer is : B Explanation : To decrease the I:E ratio, expiratory time must be increased by decreasing inspiratory time. This is done by decreasing inspiratory flow rate.

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

The correct answer is : B Explanation : Vigorous bubbling in the water seal chamber is abnormal and indicates the presence of a leak in the chest tube drainage system. The leak may exist somewhere between the water seal compartment and the patient. However, the leak may be caused from a perforated lung.

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

The correct answer is : B 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 performing a biopsy of a tissue extracted from a patient's right mainstem bronchus with a bronchoscope, the physician reports sudden bleeding from the site. Which of the following should the respiratory therapist have ready to instill? A. atropine sulfate B. epinephrine C. racemic epinephrine D. normal saline

The correct answer is : B Explanation : When encountering a bleed in the bronchial tree during a bronchoscopy, the first step to stop the bleed is to instill epinephrine on the site through the bronchoscope. After doing so, the site should be compressed with the bronchoscope. Ultimately, a Fogarty catheter may be inserted to tamponade any remaining bleeding.

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

The correct answer is : B Explanation : When inserting a nasopharyngeal airway (trumpet), the proper length is of primary concern. Proper length can be determined by matching the length of the trumpet with the distance between the ear lobe and the nasal septum. When inserted, if the patient begins to cough uncontrollably, this means the nasal trumpet is too long and is entering too far into the sensitive airway. The solution is to remove the trumpet and insert shorter one.

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

The correct answer is : B Explanation : When performing minimum seal or minimum occluding volume technique to inflate and ET tube cuff, the therapist should not be able to auscultate any sound over the trachea at the top of each mechanical breath. If the sound is audible, more air is needed in the ET tube cuff. This ensures only a minimal amount of pressure is placed on the trachea wall. If a minimum leak is permitted, then the technique is called a minimum leak technique and has the same purpose.

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

The correct answer is : B Explanation : When the patient has an adverse reaction to a specific medication, the therapist must modify the therapy. Modifying therapy means to change to a different method or modality that accomplishes the same objective. In this case, switching to albuterol, which is another bronchodilator, is most appropriate. Decreasing the dose of Xopenex to 0.31 mg is inappropriate because that is a pediatric dose. Cromolyn sodium is not a bronchodilator and should specifically not be used when the patient has bronchoconstriction. Atropine sulfate, while it technically is a bronchodilator, is rarely used in this kind of situation.

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

The correct answer is : C Explanation : A bronchoscopy can be done on an intubated patient with the use of an adapter that permits the entrance of the bronchoscope while maintaining assisted ventilation around the scope.

A spiral CT scan would be most helpful in evaluating which of the following? A. atelectasis B. pneumonia C. mass in the left lobe D. asbestosis

The correct answer is : C Explanation : A spiral CT scan is a way of examining the lungs in a three-dimensional fashion. So, it would be most useful for evaluating a mass in the left lobe. Pneumonia, atelectasis, and asbestos do not have three-dimensional qualities and therefore do not need to be observed through a spiral CT scan.

Which of the following volumes is being observed when a patient is using a volume-type incentive spirometer? A. IRV B. TLC C. IC D. ERV

The correct answer is : C Explanation : A volume type incentive spirometer measures inspiratory capacity or IC.

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

The correct answer is : C Explanation : Altitude causes hypoxemia because of the decreased barometric pressure, which results primarily in decreased alveolar oxygen tension or PAO2.

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

The correct answer is : C Explanation : An oral pharyngeal airway is the primary mechanism used to prevent the time from falling back and obstructing the airway. Although a double lumen endobronchial tube would also do this, it is far too invasive and not necessary.

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

The correct answer is : C Explanation : Because the distal lumen of a pulmonary artery catheter is in the pulmonary artery, blood obtained from this lumen is mixed venous blood. This, in fact, is the best place to obtain mixed venous blood.

A 42-year-old female presents in the emergency department (ED) complaining of body aches and general malaise. The patient reports sickness over the last two days with excessive vomiting and diarrhea. Which of the following laboratory tests should the respiratory therapist suggest? A. Theophylline level B. Blood urea nitrogen (BUN) C. Serum electrolytes D. Arterial blood gas

The correct answer is : C Explanation : Body aches and general malaise is most often a clear indicator of electrolyte imbalance. This suggestion is further indicated by the fact that the patient has been expectorating fluid in various forms and has likely become dehydrated. Loss of fluid often results in electrolyte imbalance.

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

The correct answer is : C Explanation : During an exercise tolerance test, also known as a stress test, blood pressure and heart rate should rise as workload is increased. If this does not occur, the patient is said to have an abnormal blood pressure and/or abnormal cardiac response. In this case the patient's heart rate did increase but the blood pressure did not. The best interpretation is "normal cardiac response with an abnormal response in blood pressure".

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

The correct answer is : C Explanation : Excessive bubbling in the water seal compartment, in addition to low return volume during mechanical ventilation, is an indication that a leak may be occurring through a perforation in the lung tissue - delivered volumes may be lost through a hole in the lung into the chest tube drainage system.

Hypovolemia would first be manifested in which of the following values? A. PAP B. PCWP C. CVP D. PVR

The correct answer is : C Explanation : Hypovolemia is shown hemodynamically by a reduction in all hemodynamic values including CVP, PAP, PCWP, and cardiac output. Among these values CVP is the first and most significant indicator when fluid levels in the body are high or low. Remember, CVP may be known by other names such as, right atrial pressure, right side preload, right ventricular filling pressure, and right ventricular end-diastolic pressure.

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

The correct answer is : C Explanation : If you have a low pressure or low exhaled volume ventilator alarm, you must look for the problem that could cause that specific type of alarm. If you look at the answers, a kink in the endotracheal tube would cause a high-pressure alarm so that cannot be the cause. Excess water in the limbs of the circuit would do the same. A high-pressure alarm would also develop if there is a herniated endotracheal tube cuff. This leaves the only possible answer which is a disconnected thermistor line.

Which of the following is most indicative of right heart failure? A. decreased CVP, decreased PAP B. increased PAP, decreased cardiac output C. increased CVP, decreased PAP D. increased PAP, decreased PCWP

The correct answer is : C Explanation : In order to assess the function of the right heart hemodynamically, one must look to those hemodynamic values immediately preceding and following the right heart. In this case, CVP and PAP. If CVP is increased and PAP is decreased or is normal, blood is having difficulty transitioning through the right heart. Right heart failure and core pulmonale are associated with this condition.

Which of following calculations will determine inspiratory capacity (IC)? A. ERV + VT + IRV B. TLC - VT - ERV C. TLC - FRC D. IRV - TLC - RV

The correct answer is : C Explanation : These types of questions can be difficult. Memorizing pulmonary function volume chart is a good place to start. To find a solution to this problem you generally have to take each answer one by one, do the calculation, and determine if the correct result can be achieved. In this case, inspiratory capacity can be calculated by subtracting the FRC from the TLC.

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

The correct answer is : C Explanation : In this problem the CO2 is slightly low. When we need to raise CO2 there are three choices - decreasing tidal volume, decreasing rate, or adding dead space. In this case, decreasing the rate from 16 to 10 to change CO2 by only a few points is too drastic. A tidal volume of 500 mL is less than the patient's range based on their predicted body weight. The best option is to add 50 mL of dead space.

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

The correct answer is : C Explanation : Infants have the same blood gas values as adults except for the PaO2. Close examination of the data provided shows that arterial CO2 and arterial oxygen is not what is being reported. The small "c" noted before the CO2 and O2 level indicate the blood was taken from the capillaries. When this is the case it must be remembered that capillary CO2 and the corresponding pH may be trusted but capillary oxygen levels are not accurate and may not be used. Therefore, this capillary blood gas reveals normal levels in term so ventilation. But the capillary oxygen data must be ignored entirely.

A pressure-volume ventilator graphic is observed on a patient receiving mechanical ventilation. The patient's estimated dynamic compliance is A. 32 mL/cmH2O B. 44 mL/cmH2O C. 20 mL/cmH2O D. 50 mL/cmH2O

The correct answer is : C Explanation : Most of the time we are given numbers to calculate the patient's dynamic compliance. In this case, however, we are given a graph. Examination of the graph reveals a peak pressure of 40 cmH2O. When we take the volume, 800 mL, and divide it by 40 cmH2O, we get a dynamic compliance of 20 mL/cmH2O.

Which of the following hemodynamic values is associated with the function of the left heart? A. central venous pressure B. systemic vascular resistance C. pulmonary capillary wedge pressure D. mean pulmonary artery pressure

The correct answer is : C Explanation : Of the four hemodynamic pressures, pulmonary capillary wedge pressure is most related to the function of the left heart. Central venous pressure is most related to the right heart and the general fluid status of the patient.

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

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

A patient with ARDS is showing signs of refractory hypoxemia after 22 days of volume controlled ventilation. Which of the following ventilator controls is most effective at combating refractory hypoxemia? A. Tidal volume B. Amplitude C. PEEP D. Injector line

The correct answer is : C Explanation : Refractory hypoxemia among patients with ARDS is primarily treated with positive end-expiratory pressure (PEEP).

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

The correct answer is : C Explanation : The best way to determine the effectiveness of hyperinflation therapy on a patient who has atelectasis is to do a chest radiograph. This will help visualize inflation and the presence of atelectasis in the lungs. Assessing expiratory flows will not be helpful and obtaining a DLCO measurement is not related.

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

The correct answer is : C Explanation : The problem we should recognize first, in this case, is it the patient's ideal body weight is significant. The ET tube used is likely too small. 100 kg male should have an ET tube size of about 9 mm to 10 mm. Use of a larger tube will allow the use of a larger suction catheter, which will drastically improve suctioning efficiency.

For which of the following is the respiratory therapist observing if obtaining a series of oblique chest radiographs? A. pleural effusion B. pneumothorax C. cancerous mass in the lung D. pneumonia

The correct answer is : C Explanation : The purpose of a series of chest x-rays taken from different angles is to increase the three dimensionality of that which is seen in the lung. Pneumonia, secretions, a pneumothorax, and pleural effusion do not require a three-dimensional examination. However, a cancerous mass or object inside the lung is three-dimensional in nature. For instance, if you saw a round object from a PA x-ray in the lung, and then you obtained a lateral x-ray and the object was round from that point of view as well, you know the shape of the object is spherical. Spherical objects in the lung are usually associated with cancerous masses.

For which of the following conditions is chest wall oscillation therapy most beneficial? A. ARDS B. drug overdose C. cystic fibrosis D. Guillain-Barre syndrome

The correct answer is : C Explanation : The purpose of chest wall oscillation is to help clear secretions. Of these options, only cystic fibrosis is the disease where the clearing of secretions is a major concern.

What is the primary purpose for a helium dilution test? A. quantify alveolar deadspace B. determine alveolar diffusion capacity C. determine FRC D. directly measure TLC

The correct answer is : C Explanation : The purpose of the helium dilution test is to determine lung volumes such as TLC, RV, and FRC. On the NBRC exam the primary purpose of the helium dilution (and nitrogen washout) test is to determine FRC.

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

The correct answer is : C Explanation : Transport ventilators work fludically. This means they're not powered by electrical means but rather, by the gas pressure in the tanks. As pressure decreases and the tank gets close to empty, the transport ventilator will respond by gradually decreasing in function, including a decrease in both rate and delivered volume.

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

The correct answer is : C Explanation : When a patient is experiencing an adverse reaction from a breathing treatment or any other procedure, the first action should be to stop therapy. However, this is not offered in this question. The next option would be to modify the therapy to accomplish the same objective. In this case the 0.5 mL of albuterol may be reduced to another acceptable adult dosage, 0.25 mL. Keep in mind that you can reduce a dosage only if the new dosage is still in the acceptable therpeutic range. For instance, if the patient was receiving 0.25 mL of albuterol, it would be unacceptable to cut that dose in half. In this case, it is acceptable because the adult therapeutic range of albuterol is 0.25-0.5 mL.

Which of the following would be most beneficial in resolving microatelectasis? A. Thoracentesis B. Percutaneous ventilation C. Chest tubes D. Bronchoscopy

The correct answer is : D Explanation : A bronchoscopy would be most beneficial because it can ventilate and recruit alveoli in the lung. The other options will not decrease atelectasis.

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

The correct answer is : D Explanation : A fixed upper airway obstruction means air is having difficulty moving both in and out. It is usually caused by cancer or other non-changeable conditions. In this case the best thing we can do is decrease airway resistance by using helium or Heliox therapy.

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

The correct answer is : D Explanation : A galvanic oxygen analyzer will read erroneously under two conditions: the probe or the fuel cell is depleted or the analyzer requires calibration. In this case the probe, which provides the energy for the analyzer, is the most likely culprit and should be changed.

Which of the following diagnostic procedures should the respiratory therapist recommend to more clearly identify what looks like a mass in the upper right lung field? A. PA chest radiograph B. Transesophagus echocardiogram (TE) C. AP chest radiograph D. Magnetic resonance imaging (MRI)

The correct answer is : D Explanation : A mass in the lung field can be further evaluated by examinations that show the three dimensionality of the suspicious area. Because a mass is three-dimensional in nature, magnetic resonance imaging, or MRI, would be the most appropriate exam, of the options given.

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

The correct answer is : D Explanation : A patient that is taking nebulizer treatments needs to be able to demonstrate manual dexterity, and the ability to hold and manipulate the nebulizer. During the instruction, appropriate language skills are also important but English proficiency is not required. What is NOT important is the patient's spousal support. This will have no effect on their ability to self administer nebulizer treatments.

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

The correct answer is : D Explanation : A patient who is orally intubated should have endotracheal tube markings at the lip line that are in the low 20s. In this case, chest movement is asymmetrical, further evidence that the endotracheal tube is inserted too far. To correct this, the endotracheal tube should be withdrawn by several centimeters and an x-ray should be obtained to observe the exact location of the tube.

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

The correct answer is : D Explanation : A properly placed endotracheal tube will cause even chest rise and symmetry during ventilation. ET tube markings will be in the low 20s, if an oral intubation. A chest x-ray will show the end of the tube 2 to 5 cm above the carina or level with the aortic arch. Thus, all options indicate inappropriate positioning of the endotracheal tube.

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

The correct answer is : D Explanation : A straw-colored stain noted about the face indicates the presence of meconium. The appropriate first action is to suction any possible meconium from the patient's mouth and oropharynx to prevent the patient from inhaling the meconium during initial breaths.

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

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

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

The correct answer is : D Explanation : Acute epiglottitis is characterized by significant inflammation in the upper airway. If intubation is opted, the respiratory care practitioner must use extreme caution and be careful not to increase the inflammation by probing or touching the tissues in the upper airway. This is considered to be a complicated intubation. Thus, the patient must either receive a tracheostomy or be intubated with direct visualization through a bronchoscope.

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

The correct answer is : D Explanation : An airway resistance of 1.2 cmH2O/L/sec is considered normal. Elevated airway resistance is associated with asthma.

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

The correct answer is : D Explanation : An end-tidal CO2 of 47 mmHg is consistent hypoventilation.

The respiratory therapist is caring for a 28-week-old gestational age infant currently receiving mechanical ventilatory support on the following settings: PIP 30 cm H2O FIO2 0.70 PEEP 5 cm H2O Mandatory rate 40 A chest radiograph shows bilateral haziness. Arterial blood gas analysis shows pH 7.22 PaCO2 67 torr PaO2 44 torr HCO3- 27 mEq/L BE +1 mEq/L The most appropriate recommendation would be to A. Decrease mandatory rate B. Increase FIO2 C. Increase PIP D. Administer Survanta®

The correct answer is : D Explanation : An infant's chest x-ray that shows bilateral haziness is related to pulmonary immaturity. Fetal lung immaturity is best remedied by the administration of surfactant. Survanta is the only surfactant offered among the answers listed.

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

The correct answer is : D Explanation : Anectine is the medication that manifests muscle twitching about the face and neck when it is working properly.

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

The correct answer is : D Explanation : Bilateral wheezing is associated with bronchoconstriction. When the bronchials constrict, they are not usually capable of constricting on one side of the lung only. Therefore, unilateral wheezing indicates the problem must be something other than bronchoconstriction and is most likely associated with foreign body aspiration. To remove the object a bronchoscopy is most appropriate.

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

The correct answer is : D Explanation : Cardiac output may be calculated by any number of methods. In this case the most appropriate method is multiplying the heart rate by the stroke volume.

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

The correct answer is : D Explanation : For this patient further bronchodilator therapy is most appropriate. Continuous bronchodilator therapy would also be appropriate but the option offers only 3 mg per hour, which is subtherareutic.

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

The correct answer is : D Explanation : In this problem blood pressure is reduced as well as all other hemodynamic values. When hemodynamic values are all low, especially CVP, the patient is dehydrated and requires fluids. Additionally, it is noted that the patient has had recent surgery and because the blood pressure is low it is more likely the patient is hemorrhaging. The most likely solution, therefore, is the administration of blood. Although not mentioned, it would also be appropriate to send this patient back to surgery to be examined for a leaky vessel.

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

The correct answer is : D Explanation : Inspiratory muscle strength is determined by measuring the maximum inspiratory pressure. This is done with a pressure manometer. The other devices measure flow, which is not what we are needing.

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

The correct answer is : D Explanation : Nosocomial infections are those that are spread in hospitals among patients. The most common cause of nosocomial infection is poor handwashing among healthcare givers. Thus, the most effective method at preventing nosocomial infections is to encourage diligent and proper handwashing techniques.

Which of the following should be used to determine the gestational age of a neonate? A. Request the information from the mother B. APGAR C. Lung compliance D. Ballard

The correct answer is : D Explanation : Of the options offered, the new Ballard assessment is the only assessment shown that will assess the gestational age of the infant.

Which of the following patients or conditions would benefit most from pressure control ventilation? A. myasthenia gravis B. pneumonia C. COPD D. ARDS

The correct answer is : D Explanation : Pressure control ventilation is primarily helpful for patients with adult respiratory distress syndrome. They require significant pressures to deliver volumes. When pressures get over 50 cmH2O, switching to pressure control ventilation will help to reduce barotrauma and increase alveolar ventilation.

During the administration of an IPPB treatment, the patient becomes unresponsive and develops the ECG rhythm as shown below. Which of the following is the best initial action? A. Arterial blood gas analysis B. Connect a pacemaker C. Defibrillate at 50 joules D. Begin CPR

The correct answer is : D Explanation : The best option in this case is to begin CPR. This is because the ECG rhythm is consistent with the absence of cardiac contraction. Combined with the fact that the patient has suddenly become unresponsive, this is adequate data indicating the need to intervene with cardiopulmonary resuscitation.

A 65-kg (143-lb) patient with pneumonia is receiving mechanical ventilator support by a Servo adult ventilator on the following settings with corresponding arterial blood gas values: Mode Assist/control Mandatory rate 10/min VT 700 mL FIO2 0.5 pH 7.48 PaCO2 33 mmHg PaO2 98 mmHg HCO3- 24 mEq/L BE 0 mEq/L Which of the following actions is most appropriate? A. increase tidal volume B. decrease mandatory rate C. decrease FIO2 D. decrease tidal volume

The correct answer is : D Explanation : The blood gas in this case shows acute respiratory alkalosis caused by over-ventilation from the ventilator. Decreasing mandatory rate would be appropriate except the CO2 is off target by only 2 mmHg. But, there is a more significant problem. The patient only weighs 65 kg which means the maximum tidal volume size should be 650 mL. The patient's set tidal volume is 700 mL. This is too high and should be adjusted immediately to reduce the chance of barotrauma. This will also decrease and eliminate the alkalosis.

A patient has the following arterial blood gas results and ventilatory parameters: pH 7.12 PaCO2 30 mm Hg PaO2 80 mm Hg HCO3- 9 mEq/L BE +15 mEq/L RR 34 VT (spont) 400 mL Which of the following would provide helpful diagnostic information? A. venous level of HCO3- B. creatinine C. BUN D. blood glucose level

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

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

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

The correct answer is : D Explanation : The device that may be attached to the end of the ET tube that allows PEEP to be maintained during a bronchoscopy is called a Bodai adapter. This adapter attaches to then of the ET tube and has a small port that fits snugly around the broncoscope tube.

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

The correct answer is : D Explanation : The flow volume loop is short and fat indicating diminished flows but normal volumes. This is associated with patients who have obstructive lung defect and is commonly seen in patients with COPD. To find the correct answer, one must pick the disease that is obstructive. In this question in, emphysema is the only obstructive disease offered.

Left heart failure would be manifested in which of the following values? A. CVP and mPAP B. mPAP and wedge pressure C. MAP and SVR D. cardiac output and wedge pressure

The correct answer is : D Explanation : The function of the left heart, specifically the left ventricle, is best assessed hemodynamically by looking at those values that precede and come after the left heart. In this case pulmonary capillary wedge pressure and cardiac output (or cardiac index) are the values found before and after the left heart.

While assisting a physician during a bronchoscopy procedure, the therapist notices bright red blood in the specimen tube. The therapist should prepare which of the following NEXT? A. Heparin B. cold normal saline C. Atropine D. epinephrine

The correct answer is : D Explanation : The installation of epinephrine down the bronchoscope to an actively bleeding site will help to immediately stop the bleeding. This should be the first step in treating a bleed in the bronchial tree. The next step should be to compress the site with the bronchoscope followed by the insertion of the Fogarty catheter to tamponade the bleeding site.

Which of the following would be most helpful in determining if a patient regularly smokes tobacco products? A. DLCO B. pulse oximetery C. end-tidal carbon dioxide D. COHb

The correct answer is : D Explanation : The most reliable data that indicates the degree to which the patient has recently been smoking comes from a COHb analysis.

The balloon on a balloon-tipped, flow-directed pulmonary artery catheter may be found A. mid-catheter B. proximal to the transducer C. distal to the tip D. proximal to the tip

The correct answer is : D Explanation : The terms "distal" and "proximal" are often related to "near" and "far", respectively. The term "distal" may also mean "after" and proximal means "before". The best description of the location of the balloon on the pulmonary artery catheter is "before" or "proximal" to the tip.

2 PM 5 PM Peak airway pressure 45 cm H2O 56 cm H2O Static airway pressure 35 cm H2O 46 cm H2O PEEP 5 cm H2O 5 cm H2O Delivered tidal volume 750 mL 750 mL Inspiratory flow 55 L/min 55 L/min The following data is available for a patient receiving mechanical ventilation: What is the next action the respiratory therapist should take? A. Decrease tidal volume B. Perform bronchial hygiene C. Increase inspiratory flow D. Obtain a chest radiograph

The correct answer is : D Explanation : This data shows an increase in static airway pressure which indicates the lungs are becoming stiffer or less compliant. There is no specific, immediate treatment for this but additional data may be gathered to determine the possible cause of the change in compliance. Of the options offered, obtaining a chest radiograph is most appropriate.

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

The correct answer is : D Explanation : This data shows that the patient is putting out more fluid than he or she is taking in. This means that the patient is becoming dehydrated and dehydration results in lower cardiac output. To answer this question one must be familiar with the formula to determine pulmonary vascular resistance. PVR is determined by subtracting the PCWP from the PAP and dividing by cardiac output. If you divide this number by a lower cardiac output the result is a higher number.

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

The correct answer is : D Explanation : This patient has profound hypoxemia even with supplemental oxygen. It is evident that a small increase in oxygen will not be sufficient. 100% oxygen by a non-rebreather mask is the most appropriate option.

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

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

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

The correct answer is : D Explanation : This question involves doing some math. You must look at each pH and add and subtract 0.5%. You must do the same for the PO2, using 3%. From there you can look at the results and determine which Run is out of control. In this case only Run two is out of control.

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

The correct answer is : D Explanation : This question is really about chain of command. If the therapist has a problem of any sort that cannot be resolved, whether that is with the machine or a patient, the next immediate person the therapist should talk to is the supervisor. After the supervisor, the medical director may be appropriate. In this case reporting the problem to the supervisor is the next logical step.

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

The correct answer is : D Explanation : When T waves on an ECG are flipped, or point in the opposite direction compared to P waves, cardiac ischemia is indicated. Furthermore, elevation of the ST segment is related to myocardial infarction. Therefore, myocardial ischemia and infarction appear to be present.

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

The correct answer is : D Explanation : When a COPD patient exercises the patient accidentally lowers FIO2 because they entrain more room air through their nose when they breathe more deeply. One way to compensate for this is to place them on a Venturi mask at the same approximate FIO2. A Venturi mask set at 28% is equivalent to 2 L/min. nasal cannula.

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

The correct answer is : D Explanation : When a patient is receiving oxygen by non-rebreathing mask, they are drawing most of their breath from the reservoir bag. If the bag collapses completely during each breath, the flow to the bag is inadequate. The solution is to increase flow so that the reservoir bag collapses only partially with each breath. If the bag does not collapse at all it most likely means there is a poor seal between the patient and the mask. Another cause, however, could be that the flow is set too high.

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

The correct answer is : D Explanation : When a patient on a ventilator is unable to exhale completely before the inhalation cycle starts, the result will be air-trapping, which will result in autoPEEP.

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

The correct answer is : D Explanation : When a reservoir bag on and on nonrebreathing mask does not collapse at all with each breath, the cause may be one of two problems: It may be due to an improper seal between the mask and the patient's face. It may also be due to excessive total gas flow going to the reservoir bag.

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

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

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

The correct answer is : D Explanation : When providing humidity to the patient on a ventilator, because the natural humidification processes of the body are bypassed, 100% humidity must be provided through the ventilator. Only heated humidification can accomplish this. Non-heated passover humidification is inadequate. An HME is meant for short-term use only (a few hours). A centrifugal and large volume nebulizers are not devices used with the mechanical ventilation.

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

The correct answer is: D Explanation : This question requires you to remember what is needed to calculate A-a gradient. You only need two things - the alveolar oxygen tension (PAO2), and the arterial oxygen tension, determined from an arterial blood gas.