RCP 111 Quiz 1 Answer Key

If your patient's Hb is 12 what is the estimation of the HCT (hematocrit)?

12x3=36

Please calculate the Anion Gap for the following patient values: Na+- 140mEq/L Cl- - 105mEq/L HCO3- - 24 mEq/L

140-(105+24)=11 Na+ - (Cl- + HCO3)

Please match the p/f ratio with the correct severity: 398 155 56 265

398 - Normal 155 - Moderate 56 - Severe 265 - Mild

A respiratory therapist is calibrating the Wheatstone Bridge helium analyzer. What value would the respiratory therapist expect to observe when calibrating the analyzer to air? A) 0% B) 0.2% C) 21% D) 0.8%

A) 0% Because there is virtually no helium in ambient air, calibrating a Wheatstone-Bridge helium analyzer with air should result in a value of 0%

During 2 point calibration on a blood gas analyzer, the oxygen gas percentages for high and low concentrations are: A) 0% and 12 or 20% B) 5% and 10% C) 21% and 100% D) 50% and 100%

A) 0% and 12 or 20%

The following capnographic waveform is recorded for a patient on a ventilator. Which of the following is most likely? A) A disconnect from the ventilator B) Myocardial infarction C) Pulmonary embolism D) Pulmonary infarction

A) A disconnect from the ventilator

An ABG analysis shows the following: pH 7.32 PaCO2 49 mmHg PaO2 56 mmHg HCO3- 25 mEq/L BE -2 mEq/L SO2 (calc) 89% Which of the following best describes these results? A) Acute respiratory acidosis with moderate hypoxemia B) Acute respiratory alkalosis with mild hypoxemia C) Compensated metabolic acidosis with mild hypoxemia D) Compensated metabolic alkalosis with moderate hypoxemia

A) Acute respiratory acidosis with moderate hypoxemia

While reviewing a patient's medical record, the RT notes that the patient has the following clinical data: pH 7.45 PaCO2 36 torr PaO2 89 torr SpO2 94% Na: 139 K: 3.9 Cl: 90 mEq/L Hb: 8 g/dL BUN: 15 mg/dL Glucose: 90 mg/dL The patient is receiving oxygen at 5lpm via nasal cannula and is complaining of ShOB. The RT would conclude that the patient has: A) Anemia B) Hemophilia C) Hypokalemia D) Hypernatremia

A) Anemia

While measuring the FiO2 inside an infant's oxyhood, an RT notices that the galvanic oxygen analyzer is showing an oxygen reading of 70% while the lg. vol. nebulizer is set at 35%. The therapist should A) Calibrate the analyzer B) Replace the probe C) Decrease the FiO2 D) Replace the lg. vol nebulizer

A) Calibrate the analyzer

After a transcutaneous electrode is attached to a pt's skin, a RT should wait a few minutes for the values to stabilize. This wait is associated with A) Capillary dilation B) Cerebral blood perfusion C) Barometric pressure equilibrium D) Electrode calibration

A) Capillary dilation The site must be heated for 2-5 mins to facilitate capillary dilation. Once dilation occurs, transcutaneous values will stabilize

Which of the following would be the most helpful at monitoring a patient's ventilation continuously? A) Capnography B) Pulse oximetry C) TcPO2 D) Multiple wavelength spectrophotometry

A) Capnography Key word- ventilation, not oxygenation

A pregnant patient presents to the emergency room with shortness of breath. Her arterial blood gas results reveal a COHb of 6.1%. Possible causes are: A) Exposure to automobile exhaust or exposure to second hand cigarette smoke B) Exposure to radiation C) Cystic fibrosis D) Sickle cell anemia

A) Exposure to automobile exhaust or exposure to second hand cigarette smoke Basically, anything that burns produces carbon monoxide. When a patient inhales carbon monoxide, carboxyhemoglobin (COHb) levels increase. Exposure to cigarette smoke, gasoline engine exhaust, or various types of heating systems can result in dangerous carbon monoxide levels.

The following Levy Jennings chart is observed for an ABG analyzer. Based on this information, the analyzer is A) In control, but has an outlier B) Out of control, and should not be used C) Demonstrating a gradual shift D) Is in need of a 2 point calibration

A) In control, but has an outlier

A patient breathing air has a reported PaO2 of 150 mm Hg. The respiratory therapist should A) Not report the results. B) Place the patient on a simple mask without source gas flow. C) Coach the patient to slow down their breathing. D) Check the pH and PaCO2

A) Not report the results. After properly calculating the alveolar air equation for a patient breathing room air, even if they are hyperventilating, it is clear to see that a PaO2 of 150 torr is not possible. Therefore these results should not be reported in the medical record.

The RT notes the pulse ox reading on a pt. is 64% and HR is 36. Palpated pulse rate is actually 99 b/min and they are pink and are not short of breath. What is the most likely cause of this disparity? A) Poor peripheral perfusion B) Hypothermia C) Febrile conditions D) Elevated metHB

A) Poor peripheral perfusion

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

A) Refractory hypoxemia with mild hypocapnia This patient has profound hypoxemia in spite of maximum FIO2. This is known as refractory hypoxemia. Additionally, hypocapnia (reduced CO2) is present.

A 1,000 g neonate is stable in the NICU. Which of the following should the RT use to monitor the neonates overall cardiopulmonary status? A) TcPCO2 and TcPO2 monitor B) Capillary gas analysis Q 8 hours C) SpO2 monitor D) Arterial blood gas analysis Q4 hours

A) TcPCO2 and TcPO2 monitor ABGs are invasive, painful, and Q 4 hours is overkill. A small baby can become anemic and hypovolemic with all that blood removal. CBGs only give you pH and PaCO2 and not oxygenation, SpO2 only gives oxygenation and does not help us with ventilation. Therefore, the best answer is a transcutaneous monitor which can continuously monitor ventilation and oxygenation noninvasively

Which of the following can contribute to an inaccurate pulse ox reading? 1. Hypotension 2. Hyperthermia 3. High ambient light 4. Fingernail polish A) 2, 3, and 4 only B) 1, 3, and 4 only C) 1 and 4 only D) 1, 2, and 3 only

B) 1, 3, and 4 only

For a 2 point calibration on an ABG analyzer, the gas concentration for CO2 for the high point is: A) 5% B) 10% C) 12% D) 21%

B) 10%

When you calibrate a galvanic fuel cell oxygen analyzer, you would calibrate it to ___ and ___ percent A) 0% and 12 or 20% B) 21% and 100% C) 5% and 10% D) 50% and 100%

B) 21% and 100%

The respiratory therapist notes the following results of an arterial blood gas with a patient breathing air: pH 7.42 PaCO2 38 torr PaO2 124 torr HCO3- 24 mEq/L BE 0 mEq/L Which of the following could explain the reason for these results? A) Normal V/Q matching B) Air bubbles in the sample C) Blood has coagulated D) Hyperventilation

B) Air bubbles in the sample It is impossible for a patient breathing room air to have a PaO2 this high. Calculation of the alveolar air equation shows that the maximum possible oxygen tension in the alveoli is approximately 97 mmHg. A PaO2 very much higher than this is not possible on room air. Circumstances that could lead to this error include too much heparin in the syringe or the presence of bubbles in the arterial sample.

Please choose the most common complication of an ABG draw A) Hematoma B) Arteriospasm C) Anaphylaxis D) VasoVagal response

B) Arteriospasm

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

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

Patient who is receiving oxygen by high-flow device set at 30% has the following corresponding blood gas: pH 7.36 PaCO2 44 mmHg PaO2 201 mmHg HCO3- 23 mEq/L BE -2 mEq/L The respiratory therapist should A) Switch to a nasal cannula B) Calibrate the blood gas analyzer C) Discontinue supplemental oxygen D) Place the patient on bi-level ventilation by mask

B) Calibrate the blood gas analyzer On 30%, that PO2 is impossible. It is outside the reportable range

An 8-year-old hypotensive male patient has been brought in by paramedics to the emergency room following a house fire. He was found unconscious in the garage where smoke was prevalent. Which of the following is a definitive measure to assess carbon monoxide poisoning? A) Methemoglobin level B) Carboxyhemoglobin level C) Rapid measurement with a multiple wavelength spectrophotometer D) Arterial blood gas

B) Carboxyhemoglobin level The clinical background strongly suggests smoke inhalation, which would result in carbon monoxide poisoning. The most definitive way to assess for this condition is by measuring the carboxyhemoglobin level in the blood. One might be tempted to select rapid measurement with a spectrophotometer, but the keyword "definitive" in the question indicates that a diagnostic procedure should be utilized.

The following capnographic tracing is noted for a pt. receiving mech. Ventilation. The RT should: A) Check the exhalation valve for a malfunction B) Evaluate the pt. for airways obstruction C) Calculate the gradient between PaCO2 and PETCO2 D) Recommend the SIMV mode of ventilation

B) Evaluate the pt. for airways obstruction The lack of a plateau and upward sloping shape of the curves demonstrate impairment of exhalation due to an obstructive process or airways collapse.

Your patient has an anion gap of 17 mEq. This is considered ______. A) Low B) High C) Normal

B) High

An RT notes the absence of a plateau on a capnometry waveform (end tidal CO2). Which of the following could be the cause? A) Pulmonary fibrosis B) High airway resistance C) Low static compliance D) A pulmonary embolus

B) High airway resistance

A therapist would expect to see which of the following capnographic data after providing the first few manual ventilations on a patient who has been apneic for 4 minutes? A) High PetCO2 B) Low PetCO2 C) Low PaCO2 D) Unreadable PetCO2

B) Low PetCO2 When the patient has not been breathing for some time and is placed on an end-tidal CO2 monitor (a capnograph), the initial end-tidal CO2 reading would be low. This is because the patient has not been breathing and therefore CO2 has not crossed the alveolar capillary membrane. Only when ventilation is occurring does the CO2 began to cross that membrane, fill up the alveoli with CO2, and then be shown on an end-tidal CO2 monitor.

During a routine screening for a patient participating in a smoking cessation program, a male patient who reports he has reduced his smoking habits by 50% has a COHb level of 6.7. This finding is: A) An inaccurate result that should be repeated after a two point calibration of the instrument B) Normal level for a smoker C) A venous carboxyhemoglobin sample reading D) A low level for a smoker, explained by the recently reported reduction in smoking

B) Normal level for a smoker A carboxyhemoglobin (COHb) level between approximately 5 and 10% is what is commonly seen for active smokers, or those who are exposed to high amounts of second-hand cigarette smoke. The patient is not likely being factual in his report, although some very heavy smokers can reach carboxyhemoglobin levels of up to 15%.

A RT is monitoring a pt in the ICU who is receiving PC A/C ventilation with an IP of 28 cmH2O, PEEP 5 cmH2O, FiO2 0.50. The therapist observes a sudden decrease of PetCO2 from 40 mmHg to 19 mmHg occurring over 10 minutes. The RT should FIRST recommend: A) Scheduling a V/Q scan B) Obtaining an ABG C) Switching to SIMV D) Decreasing inspiratory pressure

B) Obtaining an ABG When a PE is suspected (which it should be with a sudden decrease in PetCO2), the first step should be to obtain an ABG to compare the PaCO2 to the end-tidal CO2. IF there is a great disparity (high or normal PaCO2 with low PetCO2), a PE is indicated, and confirming studies should then be done (such as a V/Q scan). Although it is tempting to perform a V/Q scan first, less expensive measures should be taken first (ABG)

The following ABG analyzer QC chart is observed by an RT. Based on this information, the analyzer is: A) In control with several outliers B) Out of control C) Demonstrating a shift D) In control

B) Out of control

Which of the following is the best indicator of the adequacy of alveolar ventilation? A) Color B) PaCO2 from an arterial blood gas analysis C) Respiratory rate D) Tidal volume

B) PaCO2 from an arterial blood gas analysis Adequate alveolar ventilation is best manifest by the exhalation of CO2 observed on an arterial blood gas. Tidal volume, respiratory rate, or color are not good indicators of the adequacy of alveolar ventilation.

An ABG machine reports the PaO2 outside of the reportable range for the analyzer. The RT should: A) Perform a 1 point calibration B) Perform a 2 point calibration C) Replace the Sanz electrode D) Replace the Clark electrode

B) Perform a 2 point calibration

The following capnographic data is recorded on a pt. who has a normal arterial CO2 level. Which of the following should be suspected? A) Paradoxical ventilation syndrome B) Pulmonary embolism C) Reduced alveolar ventilation D) Ventilatory failure

B) Pulmonary embolism

An emergency room patient has the following data reported from an arterial blood sample: pH 7.49 PaCO2 31 torr PaO2 90 torr HCO3- 24.3 mEq/L Hb 15 gm/dL COHb 15% Which of the following conditions exists? A) Mild hypoxemia B) Respiratory alkalosis only C) V/Q Mismatch D) CO Poisoning

B) Respiratory alkalosis only Respiratory alkalosis is present due to the pH level, which is greater than 7.45 coupled with a PaCO2 level that is below 35 torr. While the PaO2 is 90 torr, the oxygen saturation is severely reduced due to the presence of carbon monoxide in the blood. Oxygen transport is definitely diminished because CO has taken the place of oxygen molecules in the binding process with hemoglobin. 20% COHb meets the definition of CO poisoning.

An arterial blood gas analyzer undergoes quality control every 8 hours. The following control chart shows: A) A random oulier exists B) The analyzer is in control C) The analyzer is out of control D) The analyzer is trending out of control

B) The analyzer is in control

The therapist is observing the quality control results in order to determine the accuracy and precision of the blood gas analyzer. According to the documentation that came with the quality control material, pH is supposed to analyze at 7.40 with 0.5% upper and lower standard deviation. The PCO2 analyzer is supposed to measure 30 mmHg with 5% upper and lower standard deviation tolerance. Which of the following runs are consistent with an analyzer that is out-of-control? pH Pco2 Run 1: 7.37 25 Run 2: 7.41 31 Run 3: 7.34 29 A) 1 only B) 2 only C) 1 and 3 D) 3 only

C) 1 and 3 Runs one and three, when calculated, exceed the pH or PCO2 limit and therefore are consistent with a blood gas analyzer that is out of control.

Which of the following could cause an erroneous reading from a galvanic type oxygen analyzer? 1. Depleted fuel cell 2. Positive pressure 3. High altitude 4. Water on the electrode A) 1, 2, 3, and 4 B) 1 and 3 only C) 2, 3, and 4 only D) 2 and 4 only

C) 2, 3, and 4 only A depleted fuel cell will result in no reading at all

Which of the following Carboxyhemoglobin levels is consistent with that of a regular, frequent smoker? A) 20% B) 1.5% C) 7.0% D) 2.9%

C) 7.0% Regular frequent smokers will commonly have carboxyhemoglobin levels between 5 and 10% and heavy smokers up to 15%

In preparation for ventilator weaning the physician requests a VD/VT ratio assessment. Which of the following is needed to determine the deadspace-tidal volume ratio? A) Helium dilution study and single breath nitrogen elimination B) Helium dilution study and an arterial blood gas C) Arterial blood gases and capnographic data D) Single breath nitrogen elimination and capnographic data

C) Arterial blood gases and capnographic data This question is just about knowing what it takes to calculate a VD/VT ratio. You really only need two things - PO2 and end tidal CO2. End tidal CO2 comes from a device called a capnograph.

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

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

Which of the following should the RT suspect if a neonate's transcutaneous oxygen reading shows a sudden rise in PO2? A) Capillary vessel temperature is insufficient B) Probe membrane requires replacement C) Disconnected probe D) Monitor is out of calibration

C) Disconnected probe A disconnected probe will be reading room air and the PO2 will rise (remember room air has a PO2 of 159 mmHg)

An RT is measuring the delivered oxygen (FDO2) from a volume controlled ventilator. The RT notes the galvanic oxygen analyzer needle does not move from 0. The therapist should A) Replace the electrolyte solution B) Calibrate the probe (fuel cell) C) Replace the probe (fuel cell) D) Replace the batterie

C) Replace the probe (fuel cell)

The therapist is observing the quality control results in order to determine the accuracy and precision of the blood gas analyzer. According to the documentation that came with the quality control material, pH is supposed to analyze at 7.25 with 0.5% upper and lower standard deviation. The PO2 analyzer is supposed to measure 80 mmHg with 3% upper and lower standard deviation tolerance. Which of the following runs are consistent with an analyzer that is out-of-control? pH PO2 (mm Hg) Run 1 7.27 78Run 2 7.22 75Run 3 7.20 82 A) Run 3 only B) Runs 1, 2, and 3 C) Runs 2 and 3 only D) Runs 1 and 2 only

C) Runs 2 and 3 only Only runs two and three, when calculated, show a deviation in pH and PO2 that is beyond the manufacturers recommendation and therefore indicate the arterial blood gas machine is out of control.

The RT is reviewing the quality control records for a blood gas analyzer. The following graphic is observed: the RT should interpret this data as a(an) A) Outlier B) Out of control analyzer C) Shift D) Trend

C) Shift

A pt. is brought to the ED after being recovered from a burning building. Vitals are stable. Pt. is on a 15lpm non rebreather mask. the Dr. is concerned about smoke and carbon monoxide inhalation. Which of the following would help to quickly evaluate the patient for these concerns? A) COHb B) Pulse oximetery C) SpCO from a multiple wavelength spectrophotometer D) DLCO

C) SpCO from a multiple wavelength spectrophotometer

Which of the following is used to monitor the partial pressure of transcutaneous carbon dioxide? A) Red-light absorption sensor B) Electromechanical transducer C) Stow-Severinghaus electrode D) Infrared analyzer

C) Stow-Severinghaus electrode A red light absorption sensor is used in a pulse oximeter, an electromechanical transducer measures airway pressures, an infrared analyzer is used in a capnometer and in PFTs(DLCO). But a Stow-Severinghaus blood gas electrode is used in transcutaneous monitors.

The following Levy Jennings quality control chart is recorded for a blood gas analyzer. What can accurately be stated? A) The analyzer is currently out of control B) A control shift is present C) There is a trend downward D) The analyzer will soon be out of control

C) There is a trend downward

The following capnographic waveform is noted on a 22 year old, spontaneously breathing patient who has just ingested barbiturates: What is most likely present? A) Pulmonary embolism B) Pulmonary shunt C) Ventilatory failure D) Deadspace disease

C) Ventilatory failure

You have a medium blood spill on the counter after you analyze an ABG. What should you use to clean it up with? A) Hot soapy water B) Acetic acid C) Alkaline gluteraldehyde D) Bleach

D) Bleach

The most reliable test to determine if a pulmonary rehab patient has stopped smoking is a: A) Complete PFT B) Methemoglobin level C) Treadmill trial D) Carboxyhemoglobin level

D) Carboxyhemoglobin level Carboxyhemoglobin, as measured by a co-oximeter, is the most reliable test for determining levels of carbon monoxide created by smoking.

A known COPD patient presents to the emergency room with increasing shortness of breath and large amounts of yellow sputum. ABGs on 2 L/min nasal cannula are: pH 7.46 PaCO2 48 torr PaO2 48 torr HCO3- 34 mEq/L The proper interpretation for the arterial blood gas is: A) The blood gas analysis is in error B) Compensated respiratory alkalosis C) Compensated metabolic alkalosis D) Compensated respiratory acidosis

D) Compensated respiratory acidosis At first glance, the respiratory therapist may believe that the patient had alkalosis because the pH is on the high-end of the normal range. However, with a closer review you will see that the patient has a very high HCO3-, is known to have COPD, and is likely experiencing an acute on chronic episode. This is further confirmed with a very low PaO2 while receiving supplemental oxygen. The low hypoxemia is causing a much higher then normal minute ventilation due to air hunger. This is the cause of the pH being in the high-end of the range. When the patient does not have an infection, the normal blood gas values probably show a pH on the low side of the usual range, a very high PaCO2, with a very high HCO3-.

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

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

Which of the following can be used to estimate HCT? A) Leukocyte count B) MetHb C) WBC D) Hb

D) Hb There is a relationship between hematocrit, hemoglobin, and red blood cell count. Each of these items have a multiplier of three in common. For instance, normal RBC is about 5. Hemoglobin can be estimated by taking the RBC and multiplying is by 3. That would give you a hemoglobin of 15. Hematocrit can be estimated by taking the hemoglobin and multiply it by 3, which would give you 45%. Therefore, to estimate hemoglobin, hematocrit, and RBC, one only has to know one of the other values. From there, you can estimate the other two.

An RT provides manual resuscitation on a patient after being found down for several minutes. An infrared CO2 detector is attached to the ETT of the pt. What end tidal CO2 trend is most likely as manual resuscitation is provided? A) High PECO2 followed by a steady decrease B) High PECO2 followed by a slight increase then a decrease C) Erratic PECO2 for several minutes D) Low PECO2 initially followed by a steady rise

D) Low PECO2 initially followed by a steady rise

A patient is brought by paramedics to the ER after being found unconscious in a garage with a car running. A note was left on the scene. Which of the following devices will be most helpful in immediately assessing the patient? A) Arterial blood gas analyzer B) Blood gas analyzer with CO-OX ability C) Single wavelength pulse oximetry D) Obtain a reading from a multiple wavelength spectrophotometer

D) Obtain a reading from a multiple wavelength spectrophotometer This pt. likely has a high carbon monoxide level. To assess the degree of carbon monoxide poisoning, COHb would be an appropriate exam. Although this is an option, there is a better option. Unlike a normal pulse oximeter, a multiple wavelength spectrophotometer can assess carbon monoxide in a similar fashion as a pulse oximeter - by finger probe. This is a superior option because it is quicker, less painful, non invasive, and less expensive.

An adult requires frequent blood sampling and medication administrations through an IV for 1 month. The preferred vascular access is a: A) Internal jugular catheter. B) Standard peripheral IV line C) Subclavian central vascular line (CVP) D) Peripherally inserted central catheter (PICC)

D) Peripherally inserted central catheter (PICC) A PICC line is the best choice for long term IV access and allows for blood sampling and medication administration (NOT hemodynamic monitoring)

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

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

Which of the following can be used to estimate the level of Hemoglobin? A) Theophylline level B) PAO2 C) C(a-v)O2 D) RBC

D) RBC There is a relationship between hematocrit, hemoglobin, and red blood cell count. Each of these items have a multiplier of three in common. For instance, normal RBC is about 5. Hemoglobin can be estimated by taking the RBC and multiplying is by 3. That would give you a hemoglobin of 15. Hematocrit can be estimated by taking the hemoglobin and multiply it by 3, which would give you 45%. Therefore, to estimate hemoglobin, hematocrit, and RBC, one only has to know one of the other values. From there, you can estimate the other two.

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

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

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

D) pH 7.48 PaCO2 50 mm Hg PaO2 51 mm Hg HCO3- 34 mEq/L An acute on chronic episode occurs when a patient with COPD with compensated respiratory acidosis experiences an exacerbation, which causes the respiratory rate to significantly increase, usually due to hypoxemia. The "acute" increase in minute ventilation drives the pH upward and even the PaCO2 is reduced from its normally high level to a lower level that still may be higher than the normal range but low for the patient. PaO2 is often significantly low in these scenarios. HCO3- will be significantly increased. These are difficult blood gases to interpret, and require critical thinking by the respiratory therapist.

Please match the disease process with the anion gap (high/normal) Lactic acidosis Pancreatic fistula

Lactic = High Pancreatic = Normal

Please match the blood access area with the correct description (Antecubital vein, radial artery, PICC line in upper arm, pulmonary artery) Most often where arterial blood is drawn: Standard peripheral/short term IV line: Where we place flow directed balloon tipped Swanz Ganz catheters (where they end up): Good for long term medication needs:

Most often where arterial blood is drawn: Radial artery Standard peripheral/short term IV line: Antecubital vein Where we place flow directed balloon tipped Swanz Ganz catheters (where they end up): Pulmonary artery Good for long term medication needs: PICC line in upper arm

Please match the electrodes with the correct name: PO2, PCO2, pH

PO2 - Clark PCO2 - Severinghaus pH - Sanz

Please match the electrode or analyzer with the correct measurement: Red light absorption sensor Infrared absorption pH TcPCO2 TcPO2

Red light absorption sensor - Pulse ox Infrared absorption - PetCO2 pH - Sanz TcPCO2 - Severinghaus TcPO2 - Clark