all clinical test

A patient's IS device is a flow-displacement type. With good coaching he can raise the ball requiring 700 cc/sec of flow. He can keep it elevated for 1.5 sec. What is his IC?

1050 cc

You are about to suction a female patient who has an 8.0 mm(ID) endotracheal tube in place. What is the maximum size catheter you would use in this case?

12 French

Which of the following statements are true concerning volume displacement incentive spirometers? 1. Require a set inspiratory flow rate in order to display the patient's inspiratory volume 2. Do not require a fast flowrate for patient use 3. Display the patient's maximum inspiratory volume regardless of their inspiratory flow rate 4 . Display the patient's expiratory volume

2 and 3

Which of the following oxygen administration devices would qualify as a "low-flow" oxygen system? I. Simple mask II. Nasal cannula III. Venturi mask IV. Partial rebreathing mask

I, II, and IV only

A patient with pneumonia and fever of 103 degrees F is sitting up in bed. Her respiratory rate is regular and 35 times a minute. Accessory muscles of ventilation are being used. She is demonstrating which of the following?

Tachypnea

A patient's chart has a note on the front stating a "DNR status". What does this indicate to care givers?

That the patient does not want to be resuscitated

Before suctioning a patient you note that there is vacuum being generated at the catheter thumb port when occluded. The manometer registers a -120 mmHg. But, as you are applying suction to the catheter while withdrawing it from a patient's ET tube, secretions are not being removed. Which of the following is the most likely problem?

The catheter end-tip is obstructed

Which statement represents one of the criteria of a suction catheter for suctioning through an ET tube?

The catheter's external diameter should not exceed one-half of the internal diameter of the ET tube

Which of the following volume-pressure characteristics should an adult endotracheal tube cuff have?

High residual volume and low pressure

What is the proper rate of external chest compressions for children up to 8 and to the age of puberty?

100/minute

What is the normal range of negative pressure to use when suctioning children?

-80 to -100 mmHg

The usual range for suction pressure for nasal, oral, pharyngeal and tracheobronchial suctioning in adults is __________ mmHg.

-80 to -120

A pneumatic nebulizer that delivers 70% oxygen would have a air to oxygen ratio of :

.6:1

A patient with bronchiectasis has been receiving postural drainage and percussion for 2 days. The patient's chest x-ray has not shown improvement, and he still is having difficulty expectorating sputum. Which of the following therapies may be of benefit in the treatment of this patient? 1. Ensure that patient is adequately hydrated 2. Nebulize Mucomyst in addition to CPT 3. Increase frequency of CPT to every hour

1 and 2

Incentive spirometers are available in which of the following types? 1. Volume-oriented 2. Flow -oriented 3. Pressure-oriented

1 and 2

The RCP is administering IPPB therapy to a postoperative patient using a mouthpiece. During the treatment, the patient is unable to cycle the machine off. What could be done to correct this problem? 1. Check for leak in the system 2. Recommend the use of a Bennett seal 3. Decrease the cycling pressure to 10 cmH2O 4. Adjust the sensitivity

1 and 2 only

A 24-year-old female has sustained a broken arm and fractured ribs in a windsurfing accident. She has been instructed to use an IS by taking slow, deep, sustained breaths for approximately 10 breaths every hour. Two days later, the patient reports that she has been able to reach the IS goal pointer set at the 600 ml mark with every inspiratory effort, although it causes pain at the rib-fracture site. What should the RRT recommend? I. A rest period of 30 seconds between inspirations 2. That pain medication be given to the patient every hour 3. That the patient perform a rapid inspiration but continue to perform breath-holding at the end of each attempt 4. That the IS goal pointer be advanced to a higher inspiratory volume

1 and 4 only

A RCP is teaching a parent of a child with cystic fibrosis how to manage thick secretions. You advise that the child be given PEP therapy along with aerosolized antibiotics and bronchodilators. Instructions on how to properly use the PEP device include: 1. A deep inspiration is followed by a long expiration 2. Aerosol treatments should be administered with PEP therapy 3. PEP therapy should be followed by huff coughing

1, 2, and 3

Important steps to take when administering an IPPB treatment to a patient with a tracheostomy tube include: 1. Adjust sensitivity so that inspiration is begun easily 2. Monitor the exhaled tidal volume 3. Deflate the cuff to prevent tracheal sores 4. Wash hands before treatment

1, 2, and 4

The physician has ordered IPPB treatments for a patient with pneumonia. Before starting the treatment, steps to take include: 1. Check the physician's order 2. Assess patient's vital signs and breath sounds 3. Set peak pressure at 25 cmH2O 4. Ensure that the flow is set to create an I:E of 1:1 5. Set sensitivity at -2 cmH2O

1, 2, and 5

Contraindications to chest physiotherapy include which of the following? 1. Osteoporosis 2. Atelectasis 3. Recent spinal surgery 4. Active pulmonary hemorrhage

1, 3, and only

When suctioning a tracheostomy tube in an adult patient, suctioning should be applied for _____ seconds:

10 - 15

Total application time for endotracheal suction in infants should not exceed which of the following?

10 seconds

Heavy smokers commonly have HbCO levels as high as:

10%

In the Bird Mark 7 or 8 IPPB devices, pushing in the air-mix control will result in which of the following?

100% pure source gas is delivered

A patient is receiving oxygen from an "E" cylinder at 4 L/min through a nasal cannula. The cylinder pressure is1900 psig. How long will the cylinder run until it is empty?

2.2 hours

What should be the maximum time devoted to any intubation attempt?

30 seconds

You are caring for a patient who attempted suicide by inhaling poisonous fumes in a car with the engine running. What level of COHb is lethal for this patient?

30%

A nebulizer driven by oxygen at 8 liters per minute with an FiO2 of .40 will have a total flow between:

30-34 L/min

The compression-breath ratio for one-rescuer CPR on an adult victim is which of the following?

30:2

A patient with a tracheostomy tube is receiving humidity via a heated wick humidifier. What temperature should the heater be kept at in order to provide proper humidity to this patient?

31 to 35 degrees C

A nasal cannula at a liter flow of 3 L/min applied to a patient with a normal ventilatory pattern delivers an oxygen concentration of approximately:

32%

Your patient has a temperature of 98.6 degrees F (37 degrees C). To saturate the inhaled air to normal body conditions, how much absolute humidity must be provided?

44 mg/l

A patient is on a 30% Venturi mask at an O2 flow of 5 L/min. The total flow delivered by this device is which of the following?

45 L/min

How long will an E cylinder with 1000 psig last running at 5 L/min until it reaches 200 psig?

45 minutes

An H cylinder of oxygen was placed in service with 2000 psig and has been used for 5 hours at a flow rate of 10 L/min. It can be used for how many additional hours?

5

Two flowmeters are needed to supply a FiO2 of 60%. What flow rate needs to be set on the oxygen flowmeter, and what flow rate needs to be set on the air flowmeter to deliver 60% FiO2 and keep the total flow at 10 L/min?

5 L O2 and 5 L Air

You receive a physician's order to provide 28% oxygen via nebulizer to a spontaneously breathing patient with a peak inspiratory flow rate of 48 L/min. What flowmeter setting must be utilized in order to provide a total flow rate of gas delivery that is greater than the patient's inspiratory flow rate?

5 L/min

How long will an H cylinder take to empty running at 12 LPM with 1200 psig?

5 hours

In order to help prevent Retinopathy of Prematurity, it is recommended that the PaO2 should be kept to what values during the first week of life?

50 to 60 mmHg

A patient receiving 38 mmHg per liter of gas from a nebulizer has a humidity deficit of which of the following?

6 mg/L

A COPD patient is experiencing dyspnea and a dry cough on a day when the temperature is 33 degrees C. The air can hold 36 mg/L of humidity, but the content is actually 28 mg/L. What is the relative humidity under these conditions?

77%

A heart rate of 160 beats/minute could be considered normal for which of the following patient's?

A neonate at birth

It is determined that a patient's respiratory rate is 35 beats/minute. This would be considered normal with which patient age population?

A newborn or infant

Pulse oximetry should NOT be recommended to determine oxygenation status in which of the following situations?

A patient arrives in the ER department after being pulled from a burning house.

Which of the following patient's would be most prone to pulmonary barotraumas during an IPPB treatment?

A patient with bullous emphysema

Most IPPB devices cycle to end inspiration when:

A preset pressure is reached

A patient on 2L/min nasal cannula has the following ABG results: pH 7.51 PaCO2 27 mmHg PaO2 62 mmHg HCO3- 23 mEq/L These results indicate which of the following conditions?

Acute respiratory alkalosis

A patient is receiving O2 via simple mask at 5 L/min. The patient's SpO2 drops with attempts to decrease the O2 and it is decided that the patient should wear the mask until he becomes more stable. Which of the following should the RCP recommend?

Add a bubble humidifier to the oxygen set-up

IPPB with Albuterol has been ordered for an asthmatic patient postoperatively. Upon preliminary assessment, the patient is noted to have a vital capacity of 17 ml/kg. What recommendation should the RRT make regarding therapy?

Administer Albuterol by SVN

After two attempts at opening the airway and providing ventilation to an infant, you cannot confirm adequate air movement. At this point, what should you do?

Apply back blows followed by chest thrust

Which of the following methods may best determine decreased cardiac output and perfusion in the extremities?

Assessing capillary refill

Bilateral, high-pitched polyphonic expiratory wheezes most likely indicate:

Asthma

A patient has been ordered to receive IPPB therapy. Her arterial blood gas results on room air are as follows: PH 7.36 PCO2 56 mmHg PO2 66 mmHg HCO3- 33 mEq/l Which of the following ventilators should be used for this patient?

Bird Mark 7 plugged into an air wall outlet

When instructing a patient on how to use an incentive spirometry (sustained maximal inspiration) device, you should tell them:

Blow all of your air out first, then take a deep breath through the device and hold for 3 seconds

Which of the following arteries is palpated to determine absence of a pulse in infants?

Brachial artery

You enter a patient's room to give a treatment and observe the patient is unconscious and not breathing. Your first action should be which of the following?

Call for help

On receiving a new medication nebulizer treatment order, the RCP checks the order and finds the order is written incorrectly. What should the RCP do?

Call the physician and clarify the order

The following data have been obtained from a 70-year-old male who has been receiving IS following upper abdominal surgery: RR 23/minute, Temp - 100 F, HR - 105/minute, PaO2 - 65 torr, BBS - crackles present in the bases, IC - 25% of predicted, CXR - RLL atelectasis with consolidation. Which of the following therapeutic modalities is appropriate at this time?

Change to IPPB therapy

The respiratory therapist has received an order to obtain ABG levels from a patient, but an Allen's test indicates collateral circulation is not present in the right wrist. At this time the therapist would:

Check collateral circulation in the left wrist

A patient is ineffectively breathing with a consistent large tidal volume, a variable respiratory rate and short periods of apnea. This patient could be suffering from:

Head injury

A CRT is about to nasotracheally suction a patient and notes that the suction manometer reads -100 mmHg. When the CRT covers the thumb port, no suction occurs at the catheter tip. At this point, the CRT should perform which of the following tasks?

Check the connections at the catheter and collection container

A patient displays the following physical findings: prolonged expiratory times, an increased AP chest diameter, use of accessory muscles, depressed hemidiaphragms and diminished breath sounds. These findings suggest:

Chronic Obstruction Pulmonary Disease

You are performing an initial evaluation of a patient who complains of dyspnea. The patient informs you that he becomes dyspneic after climbing one flight of stairs. You would record this as:

Class IV dyspnea

You are a RCP working in the ER when a MVA victim arrives. You quickly determine that the patient is in severe respiratory distress and has crepitus on the left side of his chest. What should you do to further evaluate these findings?

Collect an ABG and order a STAT chest x-ray

A patient who is receiving IS is consistently not achieving the preset goal on the device. What action is recommended to correct this situation?

Continue IS and encourage patient to reach her goal

A patient with pneumonia and severely decreased breath sounds develops coarse crackles and an increase in sputum production with chest physiotherapy. Which of the following should the RCP recommend?

Continue chest physiotherapy as ordered.

An RCP has just performed incentive spirometry on a post-operative patient and when you ask the patient to cough, she states that it is too painful to cough. The RCP should encourage which of the following modifications to coughing?

Cough assisance with splinting

For which of the following types of surgical patients would the Trendelenburg position during postural drainage be contraindicated?

Cranial surgery

Autogenic drainage and HFCWO are alternative bronchial hygiene therapies that are most beneficial for patients diagnosed with:

Cystic fibrosis

You are called to ER to see Mr. Jones who is lethargic and cyanotic. He has a history of emphysema. He was complaining of SOB and was placed on 6 L/min via a nasal cannula. His ABGs after 20 minutes are as follows:pH 7.32PaCO2 74 torrPaO2 80 torrHCO3- 31 mEq/LWhat is the cause of his symptoms?

Decreased hypoxic drive

While administering an IPPB treatment with a Bird Mark 7 ventilator, which of the following could occur if the flow rate was increased?

Decreased inspiratory time

A patient with pneumonia has been receiving CPT for the last 5 days. You assess the patient and determine the following; temperature of 98.8 degrees F, RR of 18/minute, CXR is clearing, BBS - slight expiratory wheezes, and cough producing about 10 ml of pale yellow sputum. The physician asks your recommendation about patient's therapy. You would suggest:

Discontinue CPT, but continue bronchodilator therapy

Considerations for proper and optimal use of a MDI include all of the following EXCEPT:

Do not use a holding chamber for an adult asthmatic patient receiving a steroid

If a small hole is present in the exhalation valve diaphragm of an IPPB circuit, the machine:

Does not cycle into exhalation

A patient has come to the ER with nasal trauma due to a burn. His eyes and nasal area are also very swollen. Which of the following devices would be appropriate to deliver O2 to this patient?

Face tent

A patient arrives in the emergency room in a full cardiopulmonary arrest with a cervical neck collar in place. The best alternative site that could be used to check the pulse would be the:

Femoral pulse

A patient enters the emergency department and on initial examination, the respiratory care practitioner observes paradoxical respirations. Which of the following should the practitioner suspect?

Flail Chest

All of the following are conditions where bronchial and bronchovesicular breath sounds may be heard over consolidated areas EXCEPT:

Foreign body aspiration

The RRT is summoned to evaluate a 24-hour, post-op, thoracotomy patient. The patient complains of severe pain in the incisional area and difficulty obtaining a deep breath. Upon auscultation of the patent's chest, breath sounds are diminished bilaterally. Which mode of therapy would be appropriate for the RRT to recommend at this time?

Have the patient perform IS and deep coughing maneuver

Chest assessment indicates that retained secretions have caused atelectasis of the RML in a 45-year-old, non-smoking patient. The patient has received CPT and has used the directed-cough technique. Both measures have been ineffective. What should the RRT recommend to help remove secretions and to facilitate the reversal of the atelectasis?

Hydrate the patient and use PEP

Complications of tracheal suctioning include all of the following EXCEPT:

Hyperinflation

What is the most common complication of suctioning?

Hypoxemia

Indications for warm humidity therapy include which of the following? I. Treat hypothermic patient II. Provide humidity to a patient with a tracheostomy tube in place III. Treat a pediatric patient with croup IV. Treat an adult patient with acute laryngospasm

I and II only

Which of the following are true statements regarding needle and instrument precautions? I. Needles and sharp instruments should be placed into puncture-resistant containers II. Soiled needles and sharp instruments are considered infectious waste III. Recapping of needles is allowed in emergency situations

I and II only

While palpating the chest, the respiratory care practitioner determines that is decreased vibrations (decreased tactile fremitus) over the right lower lobe. This may be the result of which of the following? I. Pneumothroax II. Pleural effusion III. Pneumonia

I and II only

While performing ET suctioning on a mechanically ventilated patient, the CRT notices that the SpO2 falls to 83%. Which of the following actions are most appropriate for the CRT to take? I. Withdraw the suction catheter II. Postoxygenate with 100% O2 for a minimum of one minute III. Deflate the cuff

I and II only

You set up a bubble humidifier and no bubbling occurs. What could be the cause of this? I. The humidifier jar is loose II. The delivery (capillary) tube is obstructed III. The flowmeter is set too high

I and II only

A fenesterated tracheostomy tube can be used for which of the following reasons? I. To assess a patient's ability to be extubated II. To decrease the risk of infection III. To enable the patient to speak IV. To decrease the incidence of postextubation edema

I and III

Absolute contraindications for nasotracheal suctioning includes which of the following? I. Epiglottis II. Facial injuries III. Croup IV. Vomiting

I and III

During the administration of an IPPB treatment, the patient complains of dizziness and paresthesia. The RRTs response should be to: I. Instruct the patient to perform an inspiratory pause II. Encourage the patient to cough III. Coach the patient to breathe more slowly IV. Instruct the patient to breathe rapidly and deeply

I and III

It is determined that the P50 for a patient is 42 mmHg. Which of the following conditions could this patient be experiencing? I. High fever II. Exposure to carbon monoxide III. Acute acidosis IV. Decreased PCO2

I and III

The physician has ordered that a 35 year old patient receive postural drainage therapy of the posterior basal segment of the right lower lobe. To do this, you would: I. Elevate the foot of the bed 30 degrees II. Have the patient lie on his left side III. Have the patient lie prone IV. Elevate the foot of the bed 15 degrees V. Keep the bed flat but put a pillow under the patient's hip

I and III

Which of the following humidity devices is capable of providing 100% of a patient's body humidity? I. Heated passover membrane humidifier II. HME III. Heated wick humidifier IV. Bubble humidifier

I and III

A air entrainment mask will deliver a higher FiO2 than expected if: I. The internal diameter of the jet is increased II. The external diameter of the jet is decreased III. The entrainment ports have been blocked IV. The flow rate on the flowmeter has been increased

I and III only

A patient coughs up dark, yellow sputum after an IPPB treatment. Which one of the following statements is TRUE in regard to this sputum production? I. It can be termed purulent II. It is termed hemoptysis III. It is often found in patients who have pneumonia IV. It is a normal color for pulmonary edema

I and III only

When performing nasotracheal suctioning, what signs are used to indicate that the catheter tip has been advanced into the trachea? I. Gagging II. Hoarse vocalization III. Coughing IV. Dyspnea

I and III only

Which of the following are considered high flow devices? I. Venturi mask at 40% II. Partial rebreathing mask at 12 L/min III. Aerosol face mask at 60% IV. Simple O2 mask at 6 L/min

I and III only

Which of the following oxygen delivery devices may have their FiO2's vary due to changes in a patient's ventilatory pattern? I. Partial rebreathing mask II. Nasal cannula III. Entrainment (venturi) mask IV. Simple oxygen mask

I, II, and IV

Which of the following conditions would be standard requirements for a patient with localized herpes zoster (shingles) I. Gloves and handwashing II. A special respirator mask III. Gown IV. Patient placed in a room with negative pressure ventilation

I and III only

Which of the following statements concerning aerosol particles are needed to ensure lower airway and alveolar deposition? I. Particles of 2 to 5 microns are needed II. Patients should be instructed to forcefully exhale after inspiration III. Patients should be instructed to inhale slowly to inspiratory capacity

I and III only

While making O2 rounds you discover that the 6-inch reservoir tubing on a T-piece (Briggs) adapter setup has fallen off. What may result from this? I. Delivered FiO2 would decrease II. Delivered FiO2 would increase III. The patient would entrain room air during inspiration

I and III only

When using mechanical ventilation with a heated humidifier, the large bore tubing circuit has a loop and drainage bag below the patient: I. To prevent condensate from entering the inspiratory side II. To prevent back pressure from affecting the ventilator III. To prevent the humidifer from overheating IV. To prevent condensate from entering the reservoir

I and IV

A 35-year-old male who is sedated and orally intubated with an 8.5 mm I.D. ET tube is being mechanically ventilated via a pressure-cycled ventilator. The CRT has been called to the patient's room because the nurse has noticed that the ventilator will not cycle off. Which of the following conditions might have caused this occurrence? I. The ET tube cuff has ruptured II. The ET tube is too large for this patient III. The ET tube has slipped down into the right mainstem bronchus IV. There is a slow leak in the pilot balloon

I and IV only

Dark yellow secretions with a foul odor may be due to: I. Bronchiectasis II. Asthma III. Pulmonary edema IV. Lung abscess

I and IV only

Which of the following methods of disinfection are effective against TB, bacteria, viruses, and fungi? I. Cidex 7 II. Iodine with 70% ethyl alcohol III. Pasteurization IV. Vinegar solutions

I, II and III

When selecting a manual resuscitator for use in the clinical setting, which of the following features would be desired? I. Self-inflating II. Capability of providing 100% O2 III. Nonrebreathing valve mechanism IV. Universal connector on the resucitator valve V. Pressure limit with override capability

I, II, III, IV, and V

The CRT has just inserted an orotracheal tube into a patient's airway. Which of the following statements are true concerning endotracheal tube placement and cuff inflation pressure? I. Normal insertion depth of the tube for an adult is 23 cm from the teeth II. The tube should not be secured until the placement of the tube is confirmed by auscultation III. Intracuff pressure should be maintained a 20 mmHg or less if needed IV. Capnography might be helpful to determine tube placement

I, II, III, and IV

Which of the following are possible techniques to accurately check a patient's pulse rate? I. Listen to heart tones with a stethoscope II. Locate and palpate the radial artery III. Locate and palpate the brachial artery IV. Locate and palpate the carotid artery

I, II, III, and IV

A patient complaining of chest pressure is sweating profusely. Which of the following should the RCP recommend: I. Check patient's BP II. Check patient's pulse and respiratory rate III. Administer O2 at 2 lpm BNC

I, II, and III

Which of the following could influence the results of pulse oximetry? I. Nail polish II. Motion artifact III. Hypotension

I, II, and III

After tracheal intubation, proper tube placement should be assessed by which procedure? I. Auscultation of the chest II. Observation for equal, bilateral chest expansion III. Observation for an adequate cough mechanism IV. Portable CXR

I, II, and IV

To protect yourself from contamination by a patient who coughs violently during endotracheal suctioning, which of the following should be done? I. Wear a mask II. Wear goggles III. Restrain the patient IV. Wear gloves

I, II, and IV

You are performing CPT on a 72-year-old patient from a nursing home. She is positioned to drain the left lower lobe; she suddenly vomits and coughs violently. You should proceed to: I. Stop therapy and administer O2 II. Suction patient's airway and continue therapy III. Place patient un upright position IV. Suction patient's airway and contact physician

I, III, and IV

A patient has a productive cough of clear to white sputum. What does this indicate about the patient's secretions? I. The secretions contain cellular debris II. The patient is likely suffering from asthma III. White blood cells are present in the sputum IV. The sputum is mucoid

I,II, and IV only

A patient enters the ER in moderate respiratory distress. The RCP is called to asses the patient and determines the following: intercostal muscle use, stridor, slow respiratory rate with an I:E of 1:1. What are possible causes of these findings? I. Croup II. Laryngeal edema III. COPD IV. Bronchitis V. Airway tumor

I,II, and V

A RCP is ensuring that a patient is receiving 40% from a nebulizer with an aerosol face mask. When analyzed, the reading is 65%. The RCP should do which of the following I. Open the air-entrainment port to a larger size II. Drain any condensation from the large bore tubing III. Analyze the O2 percentage near the patient IV. Decrease flow from the flowmeter

II and III

A patient is admitted to the hospital with the diagnosis of Haemophilus influlenze type B. The best way to prevent spread of this type of infection is to: I. Place patient in a room with negative airflow ventilation II. Wear gloves and gown when bathing the patient III. Wear an isolation mask when administrating aerosol therapy IV. Use your own stethoscope when listening to breath sounds

II and III

A patient with CAD is scheduled for surgery, and you are instructing the patient on the use of IS. Which of the following methods could be used to determine an appropriate goal for this patient? I. Set a goal of 50% of the patient's IC II. Set a goal of 60% of the patient's IC III. Set a goal at twice the patient's tidal volume IV. Set a goal equal to the patient's tidal volume

II and III

During a physical examination, it is determined that a patient has 2+ pitting edema in the extremities. What are possible explanations of this finding? I. Patient has pulmonary fibrosis II. Patient has CHF III. Patient has sepsis IV. Patient has pneumonia

II and III

Which of the following cleaning methods sterilize equipment? I. Pasteurization II. Ethylene oxide gas III. Steam autoclave IV. Alcohol

II and III

You are called to the nursery to help provide emergency care to a 9-month-old infant. The infant has had a cardiac arrest. Which of the following apply to correct technique for providing external chest compressions to this infant? I. Sternum should be depressed 3 inches with each compression II. A compression: ventilation ratio of 30:2 should be used III. Two fingers should be placed just below the nipple line IV. A compression: ventilation ratio of 5: 1 should be used

II and III

A RCP is asked to disinfect a piece of respiratory equipment. Which of the following procedures would you choose to do this? I. Pasteurization for 10 minutes II. Immersion in Cidex for 10 minutes III. Complete immersion in a 70% ethyl alcohol solution IV. Autoclave exposure at 100 degrees C for 20 minutes

II and III only

A patient is being manually ventilated at a rate of 12/min with a bag-valve resuscitation bag. With the oxygen flow running at 8 L/min into the bag, the patient's PaO2 is 55 torr. Which of the following actions would increase the FiO2 delivered to the patient? I. Increasing the ventilation rate to 30/min II. Increasing the oxygen flow to 15 L/min III. Ensue that an oxygen reservoir is connected to the bag

II and III only

Crackles (rales) are generally heard when the patient has: I. Pneumothorax II. Atelectasis III. Pulmonary edema IV. Pleural effusion

II and III only

Which of the following are required for correct use of a DPI? I. Patient flowrates of 10 to 15 LPM II. Good breath hold after inhalation of medication from DPI III. Keep DPI in upright position after puncturing medicating capsule

II and III only

A patient presents to the ER with the following clinical signs and symptoms: weak pulse, mentally confused, decreased urine output, and decreased blood pressure. Possible causes are: I. Patient is in severe pain II. Patient has possible blood loss III. Patient has taken vasoconstricting drugs IV. Patient is in shock

II and IV

A patient who has just been extubated is exhibiting mild respiratory distress. The RCP is asked to administer aerosol therapy to the patient. Which of the following statements are true in this situation? I. The RCP needs to administer a hypertonic saline solution II. The RCP needs to administer aerosol at room temperature III. The RCP needs to add heat to the aerosol therapy to assist with coughing IV. The RCP needs to administer a sterile water solution

II and IV

During a chest physical exam, it is noted that there is decreased tactile fremitus on the right side. This could be due to: I. Pneumonia on the right side II. Pneumothorax on the right side III. Atelectasis on the right side IV. Severe emphysema

II and IV

Clubbing of the fingers in associated with: I. Acute lung disease II. Bronchogenic carcionoma III. Acute cardiovascular disease IV. Chronic obstructivelung disease

II and IV only

Failure to hyperoxygenate a patient on a ventilator before ET suctioning may result in: I. Hypocarbia II. Hypoxemia III. Hypertension IV. Bradycardia

II and IV only

Signs of pneumonia on the chest x-ray may include: I. Hyperlucency II. Consolidation of the affected area III. Flattened diaphragm

II only

Physical examination of a patient with pleural effusion might reveal which of the following? I. Paradoxical respirations II. Decreased tactile fremitus III. Decreased chest expansion on the affected IV. Diminished breath sounds on the affected side

II, III, and IV

Which of the following conditions conform to the standards set for a patient in tuberculosis (AFB) isolation? I. Private room with positive airflow ventilation II. Approved respirator mask III. Gloves required of all persons entering room IV. Patient placed in a room with negative airflow capabilities

II, III, and IV

A RCP is teaching a patient who is to be discharged how to clean their small volume nebulizer at home. Important steps would include: I. Purchase Cidex 7 for home use and store in a well-ventilated area II. Wash equipment in detergent solution and rinse well III. Soak equipment in a vinegar solution of 1 part vinegar and 3 parts water IV. Soak equipment in a 10% ethyl alcohol solution V. Rinse equipment well after soaking and air dry

II, III, and V

Which of the following conditions will appear hyperlucent with retrosternal air space on a chest x-ray? I. Atelectasis II. Pneumothorax III. Pneumonia IV. Emphysema V. Acute asthma

II, IV, and V

While administering O2 through a non-rebreather mask, a patient suddenly becomes more dyspneic and experiences respiratory distress. Which of the following actions are correct for the RCP to take? I. Change the non-rebreathing mask to a simple mask at 15 lpm II. Check the patient's SpO2 III. Increase the flow to the reservoir bag on the NRB mask IV. Ensure that the mask fits snuggly and tight on the patent's face

II,III, and IV only

After obtaining a blood gas sample, the respiratory care practitioner fails to rid the sample of an air bubble before analyzing the blood. This could result in: I. An abnormal high CO2 II. An abnormal low pH III. An abnormal high O2 IV. An abnormal low CO2

III and IV

A postoperative patient is to be treated for the prevention of atelectasis. The patient is still heavily sedated. Which type of therapy should be recommended?

IPPB with a mask

Your patient had her spleen removed and is in the recovery room. She is reluctant to take a deep breath. The physician asks for your recommendation to prevent the development of atelectasis. Which of the following would you suggest?

Incentive spirometry

Strenuous patient coughing during postural drainage in the head-down positions is contraindicated because it can:

Increase intracranial pressure

After setting up a partial rebreathing mask on a patient at a flow of 8 L/min, the reservoir bag collapses before the patient finishes inspiring. The respiratory care practitioner should do which of the following?

Increase the flow

While administering an IPPB treatment to an anxious patient you note the pressure manometer needle hesitates for several seconds then abruptly reaches the preset cycling pressure. To correct this situation you would:

Increase the flow control setting

The RRT has been summoned to evaluate a 45-year-old, two-day post abdominal surgery patient who is conscious, oriented, and afebrile. Her vital signs are as follows: Temperature: 37 degrees C Respiratory rate: 19/minute Heart rate: 72/minute This patient has been receiving flow-oriented IS for the last two days at a frequency of 10 sustained maximum inspirations TID. Auscultation of the patient's thorax reveals diminished breath sounds in the lung bases, with a few late inspiratory crackles. The RRT is asked to make a recommendation regarding this patient's therapeutic regimen. Which of the following modifications to therapy should the RRT recommend?

Increase the frequency of IS to Q 1hr

A patient is set up on 40% flow-by, and during inspiration mist is not visible exiting the T-tube reservoir. What should the respiratory care practitioner recommend?

Increase the nebulizer flow.

While cutting the tape to secure an ET tube of a patient who is being mechanically ventilated, the CRT inadvertently severs the cuff inflation line. What should the CRT do at this time?

Insert a needle, attached to a stopcock and small syringe, into the severed line and inject some air

An adult patient has a Shiley cuffed tracheostomy tube inserted and is receiving aerosol therapy from a T-piece. The patient complains of difficulty breathing. The CRT is unable to pass a 14 French suction catheter into the patient's trachea. Which of the following courses of action would be appropriate to take at this time?

Inspect the inner cannula

A patient with a pH of 7.15 is breathing abnormally. He has an increased respiratory rate and increased tidal volume for his size. This type of breathing pattern is called:

Kussmaul's respirations

In inspecting an elderly female patient, you note that her spine has an abnormal anteroposterior (AP) curvature of the upper spine which results in a hunchback appearance. Which of the following terms would you use in charting this observation?

Kyphosis

During a bedside assessment of an adult patient, the respiratory care practitioner hears a harsh, monophonic, inspiratory sound over the larynx. A note should be put in the chart that this represents:

Laryngeal edema

On performing a chest assessment, you hear high-pitched wheezes over both lower lobes. This could be caused by all of the following except:

Laryngospasm

A 3-year-old child enters the ER in mild respiratory distress and is exhibiting stridor. The mother of the child suspects that the child has aspirated a coin. What should the RCP recommend?

Lateral x-ray of the neck and upper airway be taken

A physical exam reveals the following: decreased expansion, a dull percussion note on the left lower lobe area, absence of breath sounds in the left lower lobe and a shift of the trachea to the left. These findings suggest:

Left sided atelectasis

As you enter the patient's room to administer a nebulizer treatment, younotice the patient is breathing rapidly and looks to be in distress. You noticethe following during the physical exam: reduced chest expansion, a hyperresonant percussion note on the left side, absence of breath soundson the left and a tracheal shift to the right. This suggests:

Left sided pneumothorax

During an IPPB treatment, the patient suddenly complains of chest pain and becomes short of breath. Upon assessing the patient, you ausculate decreased breath sounds on the left and the trachea is shifted to the right. These findings are consistent with:

Left sided tension pneumothorax

A normal ICP pressure is:

Less than 10 mmHg

A patient who has overdosed on narcotics has been admitted to the ER. The RCP hears course breath sounds in the right lower lobe and it is determined that the patient has aspirated vomitus. Which of the following chest x-ray findings is consistent with this diagnosis?

Lobar consolidation and air bronchograms on the right

A MVA victim who has oral trauma requires nasotracheal intubation. Which of the following devices should be used to assist with insertion of the endotracheal tube through the larynx?

Magill forceps

Chest percussors can be powered by which of the following means?

Manually Electrically Pneumatically All are correct All are correct

A physician orders IPPB therapy for a post-op patient exhibiting clinical signs and symptoms of atelectasis. Which of the following measurements will most help you deliver effective therapy?

Measuring exhaled tidal volume

A patient is admitted to the hospital with the diagnosis of a severe intestinal virus. An arterial blood gas sample drawn while the patient is breathing room air reveals the following results: pH 7.54 PaCO2 38 torr PaO2 83 torr HCO3- 33 mEq/L The patient's arterial blood gas results indicate:

Metabolic alkalosis

A 50-year-old patient has a PaO2 of 72 torr when breathing room air. You would interpret this as:

Mild hypoxemia

A physician orders an ABG on a patient who is receiving O2 via a non-rebreather at 15 LPM. The RCP should record the O2 percentage on the ABG order form as:

NRB at 15 L/min

It is recommended to use a filter small volume nebulizer when administering which of the following drugs?

NebuPent

Which of the following oxygen administration devices would you recommend for a patient suffering from acute carbon monoxide poisoning?

Non-Rebreathing mask

You measure the blood pressure of a patient as 88/53. Which of the following entries would you use to describe this finding?

Patient is hypotensive

The technique recommended for initially establishing an airway in an unconscious patient is:

Oral intubation

When asking a patient if she knows what hospital she is in and what day of the week it is, you are trying to assess the patient's:

Orientation to place and time

A term used to describe a condition in which a patient has difficulty breathing while in a supine position is which of the following?

Orthopnea

Which of the following PaO2 findings is considered severe at any age?

PaO2 of 40 mmHg

You are preparing to perform a right radial puncture on a patient and are doing the Allen's test prior to the puncture. The response to the test is for the patient's hand to "pink up" after pressure is released. The results are consistent with:

Patent ulnar artery

When training a patient to perform incentive spirometry, the patient should be taught that a common adverse effect is:

Patient fatigue

A patient who is in bed is in respiratory distress, displaying use of accessory muscles and nasal flaring. What is the best explanation for the nasal flaring?

Patient is attempting to decrease airway resistance by dilating nares

The RCT receives an order for postural drainage on a patient to mobilize secretions from the anterior segment of the right upper lobe of the lung. How should the patient be positioned for the lung to drain most effectively?

Patient lying supine with pillows under the knees

Which of the following controls should be adjusted to increase the volume during an IPPB treatment using a Bennett PR II or Bird Mark 7 ventilator?

Peak pressure

The E cylinder has a special oxygen connection. This connection is to ensure safety in the use of oxygen. This system is called:

Pin Index Safety System

In order to palpate for symmetrical chest movement of a patient, the respiratory care practitioner should do which of the following?

Place a hand on the chest and observe chest movement

A patient is determined to have pneumonia in the right middle and lower lobes. The patient's SpO2 is measured at 89%. Which of the following would you suggest to improve the patient's SpO2?

Place the patient on the left side and administer supplemental O2.

After an intubation attempt, a capnogram (disposable CO2 end-tidal device) indicates a CO2 level near zero. What does this finding probably indicate?

Placement of the ET tube into the esophagus

A patient is admitted with a diagnosis of bronchiectasis. On evaluating her you find that she has coarse rhonchi in her left lower lobe. Her chest x-ray film shows infiltrates in the same area. What treatment would you recommend?

Postural drainage and percussion

If a physician's goal were to facilitate the mobilization of respiratory tract secretions in a patient with an ineffective cough, which of the following chest physical therapy techniques would you recommend?

Postural drainage and percussion

What is the most cost-effective method of minimizing the contamination of a tracheostomy patient's airway?

Practice proper handwashing technique

While the high-pressure alarm on a mechanical ventilator is sounding, the CRT hears gurgling coming from the airway of an adult patient. The CRT is preparing to suction the patient but is alerted by the nurse that this patient often has PVCs. What can the CRT do to minimize the risk of this dysrhythmia during suctioning?

Preoxygenate the patient with 100% O2 before suctioning to reduce myocardial instability

To prevent hypoxemia when suctioning a patient, the respiratory care practitioner should initially do which of the following?

Preoxygenate the patient with 100% oxygen

A patient receiving IPPB treatment with a PR II pressure limited respiratory is having difficulty reaching the pressure limit. Which of the following controls should be adjusted for this problem?

Pressure?

Chest physical therapy is indicated in all of the following EXCEPT:

Pulmonary effusion

You are giving an IPPB treatment to a patient using a Bird Mark 14 unit. The patient easily cycles the machine on, keeps the mouthpiece tightly sealed, but the machine does not cycle into expiration. What could be done to correct the problem?

Put nose clips on the patient

Which of the following actions will cause a decrease in the oxygen delivery with a manual resuscitator?

Rapid ventilatory rate

A RCP is called to give a STAT aerosol treatment with Xopenex to a patient in respiratory distress. The patient appears very fearful and anxious and tells the RCP that he does not want the treatment. What action should the RCP take at this time?

Reassure the patient, explain the benefits of the treatment and attempt to give the treatment again

The most effective way to communicate with other members of the health care team about a patient's condition is by:

Recording the information in the patient's chart

After removing an oxygen flowmeter from the wall connector, you note that oxygen starts leaking from the wall connector. The best IMMEDIATE action would be to:

Reinsert the flowmeter into the wall connector and turn flowmeter off

While making 02 rounds you notice that a disposable bubble humidifier contains only 20 ml of sterile water. What is the appropriate action to take?

Replace it with a new disposable humidifier

After occluding a pre-filled disposable bubble humidifier by pinching the tubing, no whistling noise occurs. The correct action to take would be to:

Replace the humidifier with a new one

While you administer an IPPB treatment to a patient, she complains of dizziness and tingling in her fingers. What is the most likely cause of these symptoms?

Respiratory alkalosis

Which of the following is not necessary for incentive spirometry to be effective?

Respiratory rate < 8 B/M

While ventilating a patient with a manual resuscitator, you notice the bag is not refilling adequately. What could be the cause of this problem?

Reversed or improperly placed one-way valve

What is the purpose of a cuff on an artificial tracheal airway?

Seal off and protect the lower airway

During the administration of IPPB with the Bird Mark 7, the RCP notices that the machine repeatedly cycles on shortly after the patient has begun expiration. To correct this problem, the practitioner should check which one of the following controls?

Sensitivity control

While you are performing percussion on the superior segment of a patient's left lower lobe, he coughs vigorously. The sputum is mixed with a large amount of bright red blood. You would proceed to:

Stop the treatment and inform the physician

You are called to the ER to assess a patient who has suffered blunt chest trauma in an automobile accident. Which of the following clinical signs could indicate the presence of a pneumothorax?

Subcutaneous emphysema (crepitus)

A patient has been supported by a mechanical ventilator using a hygroscopic condenser humidifier (HME) for the last 3 days. Suctioning reveals an increase in the amount and tenacity of secretions. Which of the following actions are indicated?

Switch the patient to a heated wick humidifier

Arterial blood gas results obtained from a patient are as follows: pH 7.24 PaCO2 54 torr PaO2 81 torr HCO3- 25 mEq/L B.E. -1 You would interpret these ABG results as:

Uncompensated respiratory acidosis

All of the following statements concerning a Bourdon gauge are true EXCEPT:

The gauge reads lower than the amount the patient actually receives

What will happen in conjunction with an IPPB device if the nebulizer line becomes disconnected during a treatment?

The inspiratory phase will not terminate

Before suctioning a patient, auscultation reveals coarse rhonchi during both inspiration and expiration. After suctioning, the rhonchi disappear, but expiratory wheezing is heard over both lung fields. What is most likely the problem?

The patient has hyperactive airways and has developed bronchospasm

Aerosol output of an ultrasonic nebulizer is dependent upon:

The setting on the amplitude control

After applying percussion and postural drainage to a patient's lower lobes, the RRT hears increased aeration and a decrease in rhonchi over the posterior chest. What do these findings indicate in reference to the CPT?

The therapy is effective and should be continued

In examining the AP CXR for proper ET tube placement, which of the following descriptions is appropriate for ET tube positioning in the adult patient?

The tube tip should be at approximately 3 cm above the carina

A patient arrives in the ER after being pulled from a burning house. The RCP places a pulse oximeter on the patient's ear lobe and obtains a SpO2 reading of 93%. An ABG is drawn and the SaO2 analyzed by co-oximetry is 76%. Which of the following is the most likely reason for the discrepancy in the two saturation readings?

There is an elevated HbCO level

Biologic indicators are used in decontamination procedures for which of the following reasons?

They determine if the decontamination process was effective

After verifying an order to start postural drainage therapy with percussion and vibration, it is important to first:

Thoroughly auscultate the patient's breath sounds

All of the following indicate the need for IPPB EXCEPT:

To treat an alert asthmatic patient with bronchospasm

A patient is on a nasal cannula at 8 LPM; the patient is complaining of discomfort, this is primarily due to:

Too high of a flow

A physician intends to wean a patient from a tracheostomy tube but still wants to prevent the stoma from closing and wants to maintain access to the trachea for suctioning or for emergency ventilation. Which of the following devices should the CRT select to accomplish these purposes?

Tracheal button

Your patient has an endotracheal tube in place. Which of the following devices would be the least effective in reducing this patient's humidity deficit?

Unheated bubble-type humidifier

For postural drainage, with the patient sitting upright and slightly forward, the bronchus most effectively drained is:

Upper lobe - posterior segment

When measuring cuff pressures, the CRT obtains an intracuff pressure reading of 32 cm H2O. Which of the following changes should the CRT perform first?

Use the minimal leak technique to decrease the pressure to 20 cmH2O

The physician orders 28% oxygen to be administered to a COPD patient who is extremely short of breath. Which device will most accurately achieve this?

Venturi mask at 28%

A patient has normal breath sounds following therapy. Which of the following best describes this finding?

Vesicular

How often should patients be suctioned?

When physical findings support the need

While an oropharyngeal airway is being inserted into apparently unconscious patient, the patient suddenly begins coughing violently. What should the CRT do to ensure a patient airway in this patient?

Withdraw the oropharyngeal airway and insert a nasopharyngeal airway

You are caring for a patient has been previously intubated and note that the patient is exhibiting signs of respiratory distress. Upon auscultation, you note decreased breath sounds on the left and the patient's SpO2 has dropped from 94% to 87%. What action should you take:

Withdraw the tube until equal breath sounds are heard

Which of the following suction devices is appropriate to use for removing vomitus or large particulate foreign matter from the oropharynx?

Yankauer tonsil tip

As a general rule, most hospitals require that infectious waste and body fluids be placed in which container?

a red bag

Which of the following is not a hazard of IPPB?

increased venous blood return

A RCP enters a patient's room to administer an IPPB treatment. The RCP finds the patient sleepy with slow responses and answers inappropriately to questions. This finding would be termed:

lethargic

A RCP has just administered an IPPB treatment to a patient. The patient's BBS reveal rhonchi and the therapist encourages the patient to cough by pushing on the abdominal area during the coughing effort. This patient most likely has which of the following diagnosis?

neuromuscular defect

The physician has ordered and active 3-year-old to be placed on 40% oxygen. Which device would you recommend as being the most tolerable for this patient?

oxygen tent

Which of the following sets of ABG measurements would be indicative of a renal compensated respiratory acidosis?

pH 7.37, PCO2 58 torr, PO2 60 torr, HCO3- 31 mEq/L, BE +8