resp care practice exam
While monitoring a patient's chest tube, you notice it is obstructed with a blood clot. The first action that should be taken is to do the following:
"milk" the chest tube
A "damped" pressure tracing on an arterial line may be caused by?
-The catheter tip resting against the wall of the vessel -A clot occluding the catheter -A clot in the transducer -Air bubbles in the line
The purpose of adding PEEP to a patient on a ventilator is to increase which of the following? 1. FRC 2. P (A-a) o2 3. Lung compliance
1 and 3 only
The following values were obtained from a patient on a 28% air entrainment mask in the cardiac care unit: PCWP 22 mm Hg PAP 34/24 mm Hg CVP 6 mm Hg These data are consistent with which of the following? 1. Left ventricular failure 2. Decreased PVR 3. Right ventricular failure
1 only
The inspiratory-to-expiratory (I:E) ratio alarm is sounding on a patient being ventilated in volume-controlled ventilation. Which of the following ventilator adjustments can correct this problem
A. Increase the flow.
The respiratory therapist is having difficulty suctioning secretions from an adult patient's tracheostomy tube. The suction regulator is set at -70 mm Hg. Which of the following is the most appropriate action?
A. Increase the suction level to-120 mm Hg.
he following data have been collected on a ventilator patient in the assist-control mode: Mode Assist-control Vo2 200 mL/min C (a-v) o2 5 vol% Hb 14 g/dL pH 7.43 PaCO2 37 mm Hg PaO2 85 mm Hg VT 650 mL Rate 10 breaths/min FIO2 0.45 PEEP 6 cm H2O This patient's QT is which of the following?
4 lpm
A patient on volume-controlled ventilation is placed on PEEP of 5 cm H2O. This should result in which of the following?
A. Increased VC
The following data are collected on a 55-year-old, 80 kg (176 lb) patient with COPD receiving volume-controlled ventilation: Mode Assist-control Ventilator rate 10 breaths/min Tidal volume 500 mL FIO2 0.32 PEEP 5 cm H2O ABGs pH 7.34 PaCO2 64 mm Hg PaO2 60 mm Hg HCO3- 36 mEq/L BE +11 Which of the following ventilator changes should the respiratory therapist recommend?
A. Maintain the current settings.
A 24-year-old woman with diabetes has the following ABG results: pH 7.18 PaCO2 18 mm Hg PaO2 78 mm Hg HCO3- 10 mEq/L BE - 15 mEq/L You interpret these ABG values which of the following?
A. Partially compensated metabolic acidosis
A patient's PaCO2 decreases from 42 to 31 mm Hg. All the following could have increased except which of the following?
A. Physiologic VD
The following data were collected from a 70-kg (154-lb) patient on volume-controlled ventilation: Mode Assist-control Ventilator rate 12 breaths/min Total rate 22 breaths/min VT 550 mL FIO2 0.60 ABGs pH 7.51 PaCO2 30 mm Hg PaO2 54 mm Hg HCO3- 25 mEq/L BE -1 mEq/L On the basis of these data, the respiratory therapist should recommend which of the following?
A. Place the patient on PEEP of 5 cm H2O.
The following data have been obtained from a 70-kg (154-lb) patient with pneumonia who is receiving volume-controlled ventilation: Mode SIMV Ventilator rate 8 breaths/min VT 550 mL FIO2 0.35 Total rate 14 breaths/min Pressure support 5 cm H2O ABGs pH 7.47 PaCO2 33 mm Hg PaO2 79 mm Hg HCO3- 25 mEq/L On the basis of these data, the respiratory therapist should recommend which of the following?
B. Decrease SIMV rate to 4 breaths/min.
Which of the values below represents the normal value for CVP?
A. 2 to 6 mm Hg
The following data have been collected from a patient on a 50% air entrainment mask: pH 7.41 PaCO2 40 mm Hg PaO2 90 mm Hg HCO3- 25 mEq/L BE +2 mEq/L The patient's P (A-a) o2 is which of the following
A. 210 mm Hg
Which of the following is the most appropriate ventilator VT setting for a female patient who is 5 ft, 5 in tall and weighs 85 kg (187 lb) ?
A. 450 mL
The physician writes an order for a patient to receive 15 L/min of an 80:20 helium-O2 mixture from a premixed heliox cylinder via a nonrebreathing mask. For the patient to receive this flow through an O2 flow meter, the flow must be set at approximately which of the following?
A. 8 L/min An 80:20 mixture of heliox diffuses through an O2 flow meter 1.8 times faster than 100% O2. To determine the correct flow rate setting, divide the desired flow (15 L/min) by 1.8.
A 10-day-old, 900-g neonate on pressure control ventilation at an FIO2 of 0.90 remains hypoxemic, with gradually increasing mean airway pressure. The chest radiograph reveals a ground glass appearance. Which of the following should the respiratory therapist recommend at this time?
A. Administer artificial surfactant.
While monitoring vital signs on a patient on a ventilator, the respiratory therapist observes a blood pressure of 175/100 mm Hg. Which of the following should be recommended at this time?A.
A. Administer nitroprusside.
These data were obtained from a 70-kg (154-lb) patient on volume-controlled ventilation in the assist-control mode: Mode Assist-control FIO2 0.70 Rate 12 breaths/min VT 550 mL PEEP 8 cm H2O ABGs pH 7.42 PaCO2 43 mm Hg PaO2 172 mm Hg HCO3- 23 mEq/L BE -2 mEq/L On the basis of this information, the respiratory therapist should recommend which of the following?
A. Decrease FIO2 to 0.60.
The following ABG results have been recorded for a patient on a 40% aerosol mask: pH 7.41 PaCO2 36 mm Hg PaO2 210 mm Hg Which of the following is the most appropriate recommendation at this time?
A. Discontinue O2 therapy.
The respiratory therapist should recommend a lateral neck radiograph film to help diagnose which of the following conditions?
A. Epiglottitis
A patient on volume-controlled ventilation is placed on PEEP of 5 cm H2O. You expect which of the following to increase?
A. FRC
The following data are collected from a 2-month-old infant with respiratory distress syndrome (RDS) who is on pressure control ventilation: Mode SIMV Ventilator rate 40 breaths/min Inspiratory pressure 24 cm H2O FIO2 0.60 PEEP 4 cm H2O PaCO2 36 mm Hg PaO2 41 mm Hg pH 7.42 HCO3- 23 mEq/L BE -1 mEq/L On the basis of these data, which of the following should the respiratory therapist recommend?
A. Increase PEEP to 6 cm H2O.
The respiratory therapist is assessing a ventilator-dependent patient's ability to be weaned. The weaning protocol states that the patient can be weaned when the patient's spontaneous tidal volume is at least 3 mL/lb of the patient's ideal body weight, which is 60 kg (132 lb) . The therapist measures the patient's spontaneous minute ventilation (VE) to be 8 L/min and the respiratory rate to be 20 breaths/min. What is the most appropriate recommendation?
A. Proceed with weaning.
The respiratory therapist is assessing a patient in the ICU with acute pulmonary edema. Which of the following best determines whether this is cardiogenic pulmonary edema?
A. Pulmonary capillary wedge pressure
While assessing a 65-kg (143-lb) postoperative patient for incentive spirometry, the respiratory therapist determines that the patient has a 600-mL VC. The therapist should do which of the following?
A. Recommend changing the therapy to IPPB.
A 14-year-old boy with a history of seasonal wheezing enters the emergency department in moderate distress and has had shortness of breath for the past hour. This patient's ABG results most likely reveal which of the following?
A. Respiratory alkalosis
The following pulmonary function values are obtained from a patient: Predicted Observed % Predicted FVC (L) 5.6 3.1 55 FEV1 (L) 3.7 1.3 35 FEV1/FVC (%) 70 42 — TLC (L) 7.0 7.9 113 Which of the following is the most likely interpretation of these results?
A. Severe obstructive pattern
A premature infant is being ventilated with pressure control ventilation. The infant's lung compliance begins to decrease. Which of the following statements is true regarding this situation?
A. The infant's delivered volume will decrease.
The physician wants a patient with a tracheostomy to be able to talk and still maintain the airway for suctioning. He wants the respiratory therapist's recommendation for the airway that would cause the least amount of airway resistance. Which of the following is the best choice?
A. Tracheostomy button
Which bedside assessment best determines whether a patient with Guillain-Barré syndrome is in need of ventilatory assistance?
A. VC
A 5-ft 4-in, 150-kg (330-lb) female patient is placed on a ventilator in the recovery room after abdominal surgery. Which of the following ventilator settings is most appropriate?
A. VT = 450 mL; rate = 12 breaths/min
The physician has ordered a 75-kg (165-lb) male patient with pneumonia to be placed on volume-controlled ventilation. Which of the following VT levels and respiratory rates is most appropriate for the initial ventilator settings?
A. VT = 600 mL, RR = 10 breaths/min
The following data are collected on a 75-kg (165-lb) patient receiving volume-controlled ventilation: Mode Assist-control Ventilator rate 15/min Tidal volume 600 mL FIO2 0.70 PEEP 10 cm H2O ABGs pH 7.36 PaCO2 41 mm Hg PaO2 139 mm Hg HCO3- 25 mEq/L BE +2 Which of the following ventilator changes should the respiratory therapist recommend?
B. Decrease the FIO2 to 0.60.
Which of the following devices is most likely to deliver contaminated particles to the patient's airway?
B. Heated jet nebulizer
The following data are from an infant with hyaline membrane disease on pressure control ventilation: Mode SIMV Ventilator rate 45 breaths/min PIP 25 cm H2O PEEP 6 cm H2O FIO2 0.50 ABGs pH 7.27 PaCO2 56 mm Hg PaO2 53 mm Hg HCO3- 22 mEq/L BE - 2 mEq/L On the basis of these data, which of the following ventilator setting changes do you recommend?
B. Increase the PIP to 30 cm H2O.
During manual ventilation, minimal resistance is found during compression of the bag, with little rise in the patient's chest. Which of the following should the respiratory therapist do to correct this problem?
B. Inflate the cuff on the patient's ET tube.
The respiratory therapist is monitoring a premature infant on pressure control ventilation. The infant's PaCO2 is 57 mm Hg and PaO2 is 56 mm Hg. The therapist should recommend increasing which of the following ventilator controls?
B. Inspiratory pressure
A patient receiving positive expiratory pressure (PEP) therapy through a mouthpiece at 10 cm H2O has minimal secretion production. Course crackles are heard during auscultation. The respiratory therapist should recommend which of the following?
C. Increase the PEP to 15 cm H2O.
A 57-year-old patient with severe COPD enters the emergency department with shortness of breath. Room air ABG levels are as follows: pH 7.44 PaCO2 49 mm Hg PaO2 47 mm Hg HCO3- 37 mEq/L BE +12 mEq/L On the basis of this information, which of the following is the most appropriate O2 therapy?
D. 28% air entrainment mask
the following data are collected from a patient on volume-controlled ventilation: Mode Assist-control Ventilator rate 10 breaths/min VT 800 mL Peak inspiratory pressure 45 cm H2O Plateau pressure 25 cm H2O PEEP 5 cm H2O On the basis of these data, this patient's static lung compliance is which of the following
D. 40 mL/cm H2O
The respiratory therapist is called to a patient's room to check the oxygen setup. The flow to the patient's mask is supplied by an air flow meter running at 15 L/min and an O2 flow meter running at 15 L/min. The delivered oxygen percentage from this device is which of the following?
D. 60%
A patient is on a 30% air entrainment mask running at 5 L/min. What is the total flow that the patient is receiving from this device?
B. 45 L/min Rationale: With the tic-tac-toe box or the equation, you should be subtracting 21 from 30 (to get 9) and 30 from 100 (to get 70) and dividing 70 by 9. This gives an air-to-O2 ratio of about 8:1. To calculate total flow, add the two ratio parts together (8 + 1 = 9) and multiply by the flow rate (9 × 5 = 45 L/min) .
The following ventilatory parameters have been measured on a 65-kg (143-lb) patient who is receiving O2 on a 2-L/min nasal cannula: VT 550 mL Respiratory rate 15 breaths/min This patient's alveolar minute volume is which of the following?
B. 6.1 L
hese data were collected on a patient on volume-controlled ventilation in the assist-control mode: Time PEEP (cm H2O) PaO2 (mm Hg) Pvo2 (mm Hg) 4:00 pm 6 68 39 6:00 pm 8 74 43 8:00 pm 10 78 41 9:00 pm 12 83 38 On the basis of this information, which of the following PEEP levels is best for this patient?
B. 8 cm H2O
After increasing a patient's PEEP level from 8 to 12 cm H2O, the partial oxygen pressure in mixed venous blood (Pvo2) drops 6 mm Hg. The respiratory therapist should suspect that which of the following has occurred?
B. Cardiac output has decreased.
You are suctioning a patient with pink frothy secretions who has a PCWP of 23 mm Hg and a PAP of 20/10 mm Hg. This assessment is consistent with which of the following conditions?
B. Cardiogenic pulmonary edema
Question: A heated humidifier is delivering 26 mg of H2O/L of gas to an intubated patient. Which of the following statements concerning this situation are true? 1. A humidity deficit exists. 2. The patient's secretions may become thicker. 3. The heater temperature should be decreased.
B. 1 and 2 only
An intubated patient's secretions tend to become thicker and harder to mobilize in which of the following conditions? 1. Absolute humidity of 18 mg H2O/L of gas 2. 48 mg of H2O/L of gas 3. Relative humidity of 100% at 25° C 4. A H2O vapor pressure of 47 mm Hg
B. 1 and 3 only
These data pertain to a sedated, paralyzed patient on volume-controlled ventilation in the assist-control mode: Mode Assist-control VT 750 mL Rate 12 breaths/min Flow 50 L/min FIO2 0.50 ABGs pH 7.52 PaCO2 27 mm Hg PaO2 98 mm Hg HCO3- 26 mEq/L BE +2 mEq/L On the basis of this information, which of the following changes could be made to correct this alkalosis? 1. Decrease the VT. 2. Increase the flow rate. 3. Decrease the ventilator rate. 4. Increase the FIO2.
B. 1 and 3 only
Which of the following are potential side effects of PEEP therapy? 1. Decreased QT 2. Decreased antidiuretic hormone (ADH) 3. Pneumothorax 4. Decreased FRC
B. 1 and 3 only
A patient is brought to emergency department with smoke inhalation. He is receiving O2 via a nonrebreathing mask at 15 L/min. ABG samples are drawn while the patient is on the nonrebreathing mask, and the results are as follows: pH 7.23 PaCO2 20 mm Hg PaO2 172 mm Hg HCO3- 12 mEq/L BE -12 mEq/L Sao2 74% On the basis of these data, which of the following is true about this patient? 1. The patient is hypoxic. 2. The O2 percentage should be decreased. 3. The patient is hypoventilating. 4. The blood gases reveal a partially compensated metabolic acidosis.
B. 1 and 4 only
The respiratory therapist is preparing to transport a patient on a 4-L/min nasal cannula from the oncology ward to the radiology department. The E cylinder used for transport contains 1500 psig. How long will the contents last running the cylinder down to 500 psig?
B. 1 hour 10 min
Which of the following do you expect to observe after the initiation of mechanical ventilation? 1. Increased pH 2. Increased PaCO2 3. Increased minute ventilation 4. Decreased P (A-a) o2
B. 1, 3, and 4 only
During O2 rounds, the respiratory therapist notices that the bed sheet is pulled over the entrainment port of a patient's air entrainment mask. Which of the following are true statements regarding this situation? 1. The FIO2 will decrease. 2. The total flow will decrease. 3. The FIO2 will increase. 4. The O2 flow will increase.
B. 2 and 3 only
Which of the following equipment cleaning techniques or chemicals have the ability to kill spores? 1. Pasteurization 2. Glutaraldehyde 3. Ethylene oxide 4. Acetic acid
B. 2 and 3 only
A 34-year-old patient with Guillain-Barré syndrome has had progressive respiratory distress for the past 6 hours. He is presently on a 2-L/min nasal cannula. The MIP has changed from -45 to -23 cm H2O. The following data have been recorded: Respiratory rate 36 breaths/min Pulse 104 beats/min pH 7.35 PaCO2 44 mm Hg PaO2 72 mm Hg HCO3- 26 mEq/L BE +1 mEq/L On the basis of these data, the respiratory therapist should recommend which of the following?
B. Intubate the patient and institute mechanical ventilation.
A patient has shortness of breath on a 60% aerosol mask. The following data are obtained: Pulse 112 beats/min Respiratory rate 34 breaths/min ABGs pH 7.27 PaCO2 53 mm Hg PaO2 68 mm Hg On the basis of this information, which of the following should be recommended at this time?
B. Intubate the patient and institute mechanical ventilation.
A patient has been diagnosed with a septal defect that results in a left-to-right shunt. A pulmonary artery catheter is inserted. Which of the following values is increased?
B. Mixed venous oxygen saturation
Which of the following statements regarding the technique of intubation is false?
B. One minute is the maximal time allowed for any given intubation attempt.
A patient on a 60% aerosol mask has the following ABG values: pH 7.47 PaCO2 34 mm Hg PaO2 58 mm Hg HCO3- 24 mEq/L BE +1 mEq/L Which of the following is the most appropriate recommendation at this time?
B. Place the patient on CPAP.
A chest radiograph shows infiltrates in the posterior basal segment of the patient's right lower lobe. The most appropriate postural drainage position is which of the following?
B. Prone position, with bed in a Trendelenburg position
The patient's chart notes that the patient has recurrent and unresolved pulmonary emboli. This may directly result in which of the following clinical conditions?
B. Right ventricular hypertrophy
Which of the following indicates that a patient is not ready to be weaned from the ventilator?
B. Spontaneous VT of 175 mL
Which of the following is measured when incentive spirometry is administered properly?
B. Sustained IC
A 26-year-old patient with pneumonia has a PaO2 of 54 mm Hg and a PaCO2 of 31 mm Hg while on a 50% air entrainment mask. Which statement is false regarding this patient?
B. The patient has a decreased (A-a) gradient.
During ventilator checks on a patient being ventilated on volume-controlled ventilation, the respiratory therapist notices that the peak inspiratory pressure has been gradually increasing over the past 5 hours, with no change in the plateau pressure. This indicates which of the following?
B. The patient may need to be suctioned.
The respiratory therapist is administering IPPB to a patient with COPD who is receiving 28% O2 via an air entrainment mask. With the air dilution mode being used, the therapist notes that the patient's respiratory rate has decreased from 18 breaths/min at the start of the treatment to 6 breaths/min after 5 minutes. The most appropriate recommendation is to:
B. Use a nasal cannula at 2 L/min and administer the treatment on room air.
The exhaled VT monitor in volume ventilation reads 550 mL. The VT control is set at 800 mL. To determine whether the problem is caused by an inaccurate VT control, the respiratory therapist should measure the volume at which of the following?
B. Ventilator outlet
After a patient is intubated, the CO2 detector on the proximal end of the ET tube reads 2%. Which of the following should the respiratory therapist do at this time?
B. Withdraw the tube completely and attempt intubation again.
A patient with ARDS is receiving mechanical ventilation with PEEP. The PEEP level is increased from 5 to 10 cm H2O. Which of the following should be monitored by the respiratory therapist to evaluate the patient's response? 1. Blood pressure 2. Heart rate 3. Body temperature 4. Fluid intake and output
C. 1, 2, and 4 only
A 24-year-old male patient weighing 65 kg (143 lb) is receiving mechanical ventilation after diagnosis of a drug overdose. His chest radiograph is consistent with pulmonary edema. Pertinent data are as follows: Mode SIMV Rate 15 breaths /min ABGs pH 7.41 PaCO2 38 mm Hg PaO2 49 mm Hg Tidal volume 500 mL FIO2 0.75 HCO3- 26 mEq/L PEEP 8 cm H2O Pressure support 5 cm H2O BE +1 PIP 52 cm H2O Sao2 83% Plateau pressure 41 cm H2O Which of the following changes should the respiratory therapist recommend at this time? 1. Change the mode to pressure control at 35 cm H2O. 2. Increase the FIO2 to 0.85. 3. Increase the PEEP to 12 cm H2O. 4. Increase the rate to 20 breaths/min.
C. 1, 3, and 4 only
The respiratory therapist is setting up a portable liquid oxygen system for a patient with chronic lung disease. The patient is on a 2-L/min nasal cannula, and the portable oxygen container holds 4 lb of oxygen. The therapist should explain to the patient that the oxygen supply will last for approximately how long?
C. 11.5 hours A shortcut to work this problem is to multiply the pounds of liquid oxygen by 344. This equals the amount of liters as a gas. Then divide the liter flow into the total liters of oxygen to determine how long the contents will last: 344 × 4 = 1376 L/2 = 688 minutes To change to hours, divide by 60: 688/60 = 11.5 hours
The respiratory therapist is calibrating a transcutaneous PO2 monitor before setup on a neonate. The barometric pressure is 747 mm Hg. At room air, the monitor should read:
C. 147 mm Hg.
o prevent pulmonary infarction from occurring during the measurement of PCWP, the cuff on the tip of the pulmonary artery catheter should remain inflated for no longer than which of the following?
C. 15 to 20 seconds
A pulse oximeter may not read accurately in which of the following situations? 1. Increased perfusion 2. Presence of HbCO 3. Hypotension
C. 2 and 3 only
An increased PCWP may be the result of which of the following conditions? 1. Pulmonary hypertension 2. Cor pulmonale 3. Left ventricular failure 4. Mitral valve stenosis
C. 3 and 4 only
A 65-kg (143-lb) patient has a respiratory rate of 18 breaths/min and a VT of 450 mL. The VE is:
C. 8.1 L.
The physician orders 30% O2 to be administered to a patient who has a VT that fluctuates between 300 and 600 mL. The respiratory therapist should recommend which O2 delivery device?
C. Air entrainment mask
An alert, spontaneously breathing patient has a PaCO2 of 33 mm Hg and a PaO2 of 55 mm Hg while receiving 70% oxygen. Which of the following is the most appropriate way to increase the patient's PaO2?
C. Apply continuous positive airway pressure (CPAP) at 60% oxygen.
A patient receiving volume-controlled ventilation suddenly becomes agitated, and the high-pressure alarm sounds with each breath. The patient is tachycardic and tachypneic. The respiratory therapist should do which of the following first?
C. Auscultate the chest bilaterally.
A 37-year-old patient receiving volume-controlled ventilation is recovering from gallbladder surgery and is receiving continuous IV infusions. Blood chemistry results reveal decreased BUN and Hb levels. The patient's urine output has remained at 50 mL/h for the past 4 hours. Assessment of this patient most likely reveals which of the following?
C. Auscultation of fine crackles
A patient with severe COPD enters the emergency department in moderate respiratory distress on a 4-L/min nasal cannula. His ABG results are as follows: pH 7.23 PaCO2 85 mm Hg PaO2 48 mm Hg HCO3- 35 mEq/L BE +12 mEq/L The most appropriate recommendation is which of the following?
C. Begin noninvasive positive pressure ventilation.
A patient's chest radiograph reveals moderate pulmonary congestion. Other data are as follows: PCWP 22 mm Hg PAP 40/21 mm Hg Qt 3.5 L/min On the basis of this information, the patient most likely has which of the following?
C. Cardiogenic pulmonary edema
he following data are collected on a 70-kg (154-lb) patient receiving volume-controlled ventilation: Mode Assist-control Ventilator rate 12 breaths/min Tidal volume 550 mL FIO2 1.0 PEEP 12 cm H2O PIP 56 cm H2O SpO2 82% A chest radiograph indicates diffuse bilateral infiltrates. The PaCO2 is 42 torr and the PaO2 is 52 torr. Which of the following ventilator changes should the respiratory therapist recommend?
C. Change to pressure control ventilation.
A 3-month-old infant with respiratory syncytial virus (RSV) has the following capillary blood gas results on a 60% O2 hood: pH 7.37 Pcco2 43 mm Hg PCO2 60 mm Hg On the basis of this information, the most appropriate action is which of the following?
C. Decrease FIO2 to 0.50.
A patient receiving volume-controlled ventilation has a PaO2 of 54 mm Hg on a PEEP of 8 cm H2O and an FIO2 of 0.50. After increasing the PEEP to 12 cm H2O, the cardiac output decreases from 5.2 to 4.0 L/min. The most appropriate action is to do which if the following?
C. Decrease PEEP to 8 cm H2O and increase the FIO2 to 0.60.
A patient on 50% oxygen has a PaO2 of 252 mm Hg. Which of the following should the respiratory therapist recommend?
C. Discontinue oxygen therapy.
A ventilator patient's cardiac index decreases from 3.5 to 2.2 L/min/m2. This may occur in which of the following situations?
C. Excessive level of PEEP
A patient's cardiac monitor indicates the patient is experiencing PVCs. Which of the following should the respiratory therapist recommend?
C. Get serum electrolyte levels.
The respiratory therapist has completed an IPPB treatment on a patient. The most appropriate charting notation is which of the following?
C. IPPB treatment given at 20 cm H2O; pulse stable at 80 beats/min during therapy; blood pressure (BP) stable at 115/75 mm Hg during therapy; patient had strong productive cough with small amount of thin white secretions; tolerated well
A 42-year-old, 75-kg (165-lb) patient with Guillain-Barré syndrome is receiving volume-controlled ventilation. Other data are as follows: Mode Assist-control Ventilator rate 10 breaths/min VT 500 mL FIO2 0.40 PEEP 4 cm H2O ABGs pH 7.28 PaCO2 52 mm Hg PaO2 68 mm Hg HCO3- 26 mEq/L BE +3 mEq/L On the basis of these data, the respiratory therapist should recommend which of the following?
C. Increase VT to 600 mL.
An order is received to set up a 60% aerosol mask on a patient. The respiratory therapist sets the flow meter at 8 L/min. One hour later, the therapist monitors the patient's response to the therapy, and the data are as follows: Respiratory rate (RR) 26 breaths/min Heart rate 122 beats/min SpO2 88% On the basis of these data, what is the most appropriate action for the therapist to take?
C. Increase flow to the nebulizer.
A 34-year-old patient with pneumonia who is on a 2-L/min nasal cannula becomes slightly cyanotic when in the Trendelenburg position during chest physical therapy. Which of the following is the most appropriate recommendation in this situation?
C. Increase the O2 flow on the patient's cannula to 5 L/min during the treatment.
The following data are obtained from a 70-kg (154-lb) male patient with pneumonia on volume-controlled ventilation: Mode SIMV Ventilator rate 4 breaths/min Pressure support 10 cm H2O VT 600 mL FIO2 0.40 PEEP 5 cm H2O pH 7.28 PaCO2 51 mm Hg PaO2 70 mm Hg HCO3- 25 mEq/L BE +1 mEq/L On the basis of these data, the respiratory therapist should recommend which of the following?
C. Increase the SIMV rate to 8 breaths/min.
A patient involved in a motor vehicle accident is sedated and receiving mechanical ventilation in the SIMV mode. His intracranial pressure (ICP) is 22 mm Hg. The physician wants the respiratory therapist to adjust the ventilator settings to help reduce the elevated ICP. Ventilator settings and arterial blood gases are recorded as follows: Mode SIMV Ventilator rate 15/min Tidal volume 700 mL PEEP 4 cm H2O Pressure support 10 cm H2O FIO2 0.35 ABGs pH 7.33 PaCO2 48 mm Hg PaO2 90 mm Hg HCO3- 22 mEq/L BE -1 Which of the following is the most appropriate recommendation?
C. Increase the ventilator rate.
The following data are collected on a patient receiving volume-controlled ventilation: Mode SIMV Ventilator rate 6 breaths/min Pressure support 10 cm H2O Tidal volume 700 mL FIO2 0.30 PEEP 4 cm H2O ABGs pH 7.49 PaCO2 31 mm Hg PaO2 94 mm Hg HCO3- 23 mEq/L BE -1 Which of the following ventilator changes should the respiratory therapist recommend?
C. Initiate a spontaneous breathing trial.
During a routine ventilator check, the high-pressure alarm begins to sound. The respiratory therapist should do which of the following to determine why the alarm is sounding?
C. Listen to the patient's breath sounds to determine whether the patient needs to be suctioned.
A chest radiograph film of a spontaneously breathing neonate in a 60% O2 hood reveals right upper and middle lobe atelectasis. Arterial blood gases are as follows: pH 7.36 PaCO2 39 mm Hg PaO2 38 mm Hg HCO3- 22 mEq/L BE -2 mEq/L To increase this infant's PaO2, the respiratory therapist should recommend a change to which of the following devices?
C. Nasal CPAP
The most effective method for determination of ET tube location after intubation is which of the following?
C. Observance on chest radiograph film
A 68-kg (150-lb) man with severe emphysema arrives in the emergency department with shortness of breath and is placed on a 28% air entrainment mask. ABG samples are drawn and the results are as follows: pH 7.34 PaCO2 82 mm Hg PaO2 43 mm Hg HCO3- 40 mEq/L BE +14 mEq/L On the basis of this information, which of the following ABG levels should the respiratory therapist be most concerned about?
C. PaO2
To best determine an asthmatic patient's degree of reversibility of disease, which value should be measured before and after a bronchodilating agent is administered?
C. Peak flow
The following ABG values are collected from a 32-year-old patient receiving 50% O2 via aerosol mask: pH 7.44 PaCO2 35 mm Hg PaO2 60 mm Hg HCO3- 23 mEq/L BE -2 mEq/L The respiratory therapist should recommend which of the following?
C. Place the patient on a CPAP mask.
A patient brought into the emergency department was found unconscious and lying on his back. He is suspected to have vomited and aspirated. Which of the following lung segments are most likely involved in the aspiration event?
C. Posterior segment of right upper lobe
A transcutaneous PO2 (TcPO2) probe is attached to a neonate's left leg and reads 41 mm Hg; another TcPO2 probe is attached to the right arm and reads 62 mm Hg. Which of the following is most likely causing this discrepancy?
C. Presence of a patent ductus arteriosus (PDA)
The following data have been collected from a patient in the ICU: CVP 14 mm Hg PAP 38/20 mm Hg PVR 9 mm Hg/L/min PCWP 5 mm Hg These data indicate that the patient has which of the following?
C. Pulmonary hypertension
Postural drainage and percussion have been ordered for a patient with cystic fibrosis with right lower lobe atelectasis. While in the Trendelenburg position, the patient's heart rate increases from 74 to 100 beats/min and the respiratory rate increases from 18 to 28 breaths/min. The patient becomes agitated and states, "I can't breathe when my head is down." The respiratory therapist should do which of the following?
C. Recommend replacing chest physical therapy with fluttervalve oscillation therapy.
A patient's systemic vascular resistance (SVR) increases from 15 to 24 mm Hg/L/min. The respiratory therapist should recommend administration of which of the following medications?
C. Sodium nitroprusside
The respiratory therapist is administering acetylcysteine (Mucomyst) via a handheld nebulizer to a patient who suddenly becomes short of breath. Which of the following is the most appropriate recommendation at this time?
C. Stop the treatment and administer albuterol.
The respiratory therapist notes the following data while reviewing the patient's chart: Dynamic compliance 48 mL/cm H2O Static compliance 30 mL/cm H2O The therapist should conclude which of the following?
C. The data are erroneous.
All of the following statements about pulse dose O2 therapy are true except which of the following?
C. This system can only be used with O2 cylinders.
Which set of ABG results indicates a partially compensated respiratory acidosis?
C. pH = 7.31; PCO2 = 53 mm Hg; PO2 = 70 mm Hg; HCO3- = 30 mEq/L
The respiratory therapist is administering IPPB to a patient with a tracheostomy tube who is having difficulty cycling the machine into the expiratory phase. Which of the following could be done to correct this problem?
Check for air in the tracheostomy tube cuff.
These data pertain to an 80-kg (176-lb) patient on volume-controlled ventilation in the assist-control mode: Mode Assist-control VT 600 mL Rate 10 breaths/min Flow 50 L/min FIO2 0.60 ABGs pH 7.41 PaCO2 37 mm Hg PaO2 53 mm Hg HCO3- 25 mEq/L BE 0 mEq/L On the basis of this information, the respiratory therapist should recommend which of the following ventilator changes?
D. Add 5 cm H2O PEEP.
The physician orders 40% O2 for a patient with dyspnea. Which of the following devices delivers this O2 level most consistently?
D. Air entrainment mask
The following data are collected from a patient on volume-controlled ventilation: Time PIP Plateau Pressure VT 0800 29 cm H2O 13 cm H2O 800 mL 0900 36 cm H2O 13 cm H2O 800 mL 1000 40 cm H2O 13 cm H2O 800 mL 1100 42 cm H2O 13 cm H2O 800 mL On the basis of these data, you conclude that:
D. Airway resistance is increasing.
A patient has just arrived in the emergency department after being pulled from a burning house. Which of the following values best determine this patient's oxygenation status?
D. CaO2
During O2 rounds, the respiratory therapist notices a nebulizer delivering very little mist to the patient's aerosol mask. Which of the following could cause this problem? 1. Inadequate flow from the flowmeter. 2. A plugged capillary tube. 3. Excessive H2O in the aerosol tubing.
D. 1, 2, and 3
Which of the following should the respiratory therapist suggest to a long-term smoker with COPD before discharge from the hospital? 1. Nicotine patches 2. Smoking cessation program 3. Breathing exercise training
D. 1, 2, and 3
Which of the following may result in an increased pulmonary vascular resistance? 1. Hypoxemia 2. Hypocapnia 3. Acidosis 4. PEEP
D. 1, 3, and 4 only
Pulmozyme is most commonly used to treat patients with which of the following lung disorders? 1. Emphysema 2. Bronchiectasis 3. Cystic fibrosis
D. 2 and 3 only
hich of the following are common findings for patients with acute respiratory distress syndrome (ARDS) ? 1. Decreased V/Q mismatch 2. Decreased lung compliance 3. PaO2/FIO2< 150 4. Normal PCWP
D. 2, 3, and 4 only
A patient with severe COPD is admitted with fever, cough, and mild confusion on a 1-L/min nasal cannula. ABG studies are ordered, and the results are recorded. On the basis of these results, you are ordered to increase the O2 flow to 4 L/min. The patient becomes less alert; the ABG results 30 minutes later are also recorded: ABG Results Nasal Cannula 1 L/min 4 L/min pH 7.32 7.21 PaCO2 63 mm Hg 74 mm Hg PaO2 39 mEq/L 88 mEq/L HCO3- 33 mm Hg 34 mm Hg On the basis of these data, the most appropriate change in this patient's treatment is which of the following?
D. Decrease the flow to 2 L/min on the nasal cannula.
The following PFT values have been obtained on a 55-year-old male patient: Parameter Actual Predicted %Predicted FEV1 1.4 L 3.0 L 47% FEV1/FVC 48% 70% — VC 2.1 L 3.8 L 55% TLC 6.4 L 4.8 L 133% FRC 3.4 L 2.5 L 136% Which of the following pulmonary disorders is consistent with these findings?
D. Emphysema
Which of the following treatments should the respiratory therapist recommend to prevent atelectasis after a hypotensive patient's abdominal surgery?
D. Incentive spirometry
These data pertain to a 60-kg (132-lb) patient on volume-controlled ventilation in the assist-control mode: Mode Assist-control VT 500 mL Rate 10 breaths/min Flow 50 L/min FIO2 0.60 PEEP 4 cm H2O ABGs pH 7.51 PaCO2 27 mm Hg PaO2 59 mm Hg HCO3- 25 mEq/L BE +1 mEq/L On the basis of this information, the respiratory therapist should recommend which of the following ventilator changes?A
D. Increase PEEP to 8 cm H2O.
A patient in the ICU is receiving noninvasive positive pressure ventilation via mask. The settings and ABG results are as follows: IPAP 14 cm H2O EPAP 5 cm H2O Respiratory rate 12 breaths/min ABGs pH 7.25 PaCO2 56 mm Hg PaO2 71 mm Hg HCO3- 25 mEq/L BE -1 Which of the following changes are appropriate at this time?
D. Increase the IPAP to 18 cm H2O.
A 2-day-old neonate is on pressure control ventilation. Ventilator settings and arterial blood gases are recorded as follows: Mode SIMV Ventilator rate 35 breaths/min Inspiratory pressure 20 cm H2O FIO2 0.60 PEEP 4 cm H2O ABGs pH 7.48 PaCO2 31 mm Hg PaO2 46 mm Hg HCO3- 23 mEq/L BE 0 On the basis of these data, which of the following is the most appropriate recommendation?
D. Increase the PEEP to 8 cm H2O.
The following data are collected on a 70-kg (154-lb) patient on volume-controlled ventilation: Mode SIMV Ventilator rate 12 breaths/min VT 450 mL FIO2 0.50 PEE 5 cm H2O Pressure support 5 cm H2O pH 7.27 PaCO2 52 mm Hg PaO2 68 mm Hg HCO3- 25 mEq/L BE +1 mEq/L On the basis of these findings, the respiratory therapist should recommend which of the following?
D. Increase the VT to 550 mL.
A premature infant on pressure control ventilation has a PaCO2 of 28 mm Hg. Which of the following ventilator settings should be decreased to correct the hypocapnia?
D. Inspiratory pressure
While manually ventilating an intubated apneic patient with a manual resuscitator, very little resistance is found when the bag is compressed, and the patient's chest rises only minimally. Which of the following may be the cause of this problem?
D. Leak through the bag intake valve
The following data were obtained from a 75-kg (165-lb) male patient on volume-controlled ventilation: Mode Assist-control Ventilator rate 12 breaths/min VT 600 mL PEEP 10 cm H2O FIO2 0.50 ABGs pH 7.37 PaCO2 41 mm Hg PaO2 82 mm Hg HCO3- 26 mEq/L BE +1 mEq/L Which of the following is the most appropriate action to take at this time?
D. Maintain current settings.
A patient being mechanically ventilated in the assist-control mode at a rate of 12 breaths/min is triggering the ventilator at a rate of 34 breaths/min. The patient is anxious and agitated and has the following ABG results: pH 7.55 PaCO2 25 mm Hg PaO2 96 mm Hg HCO3- 25 mEq/L BE +1 Which of the following medications should the respiratory therapist recommend at this time?
D. Midazolam (Versed)
A drug overdose patient is being transferred to the ICU. The patient weighs 60 kg (132 lb) and is being manually ventilated with 100% O2. Which of the following represents the most appropriate ventilator settings?
D. Mode = SIMV; tidal volume = 400 mL; rate = 12 breaths/min; FIO2 = 1.0
A patient with asthma is being discharged from the hospital. Which of the following medications should be recommended to help prevent further attacks?
D. Montelukast (Singulair)
A patient on volume-controlled ventilation has the following ABG results: pH 7.24 PaCO2 23 mm Hg PaO2 80 mm Hg HCO3- 10 mEq/L BE -13 mEq/L Which of the following ventilator changes do you recommend?
D. No ventilator changes are necessary.
During a pulmonary assessment, the patient tells the respiratory therapist that he has been coughing up green, foul-smelling secretions. This suggests to the therapist that the patient most likely has which of the following?
D. Pseudomonas infection
A 4-year-old child with croup and inspiratory stridor is admitted to the pediatric department. The respiratory therapist recommends cool mist to be delivered to the airway to do which of the following?
D. Reduce upper airway swelling.
The respiratory therapist is assessing a patient with emphysema and observes pedal edema and jugular venous distention. The therapist should note in the patient's chart that these signs are most likely the result of which of the following?
D. Right ventricular hypertrophy
Venous return is least impaired by which of the following modes of ventilation?
D. SIMV mode, rate of 8 breaths/min
After the patient is placed on the ventilator, the low exhaled volume alarm begins to sound. Which of the following could be causing this problem?
D. The exhalation valve is malfunctioning.
Chest film results reveal that a patient has consolidation in the left upper lobe. For selective suctioning of the left mainstem bronchus, the respiratory therapist should recommend which of the following?
D. Use a coude-tip suction catheter.
o decrease the incidence of damage to the tracheal wall by the ET tube cuff, which of the following should be recommended?
D. Use the minimal leak technique.
These data are collected from a sedated, paralyzed patient on volume-controlled ventilation in the assist-control mode: Mode Assist-control Rate 10 breaths/min VT 600 mL (0.6 L) FIO2 0.40 ABGs pH 7.29 PaCO2 50 mm Hg PaO2 77 mm Hg HCO3- 27 mEq/L BE +3 mEq/L Which of the following ventilator settings would decrease the patient's PaCO 2 to 40 mm Hg?
D. VT = 750 mL; rate = 10 breaths/min
A 40% aerosol mask being analyzed with a polarographic O2 analyzer reads 75%. Which of the following is the appropriate action?
Drain the H2O out of the aerosol tubing.
The nitrogen washout test is performed to determine which of the following values?
FRC
This set of ABG results was obtained on a patient in the ICU on a 2-L/min nasal cannula: pH 7.22 PaCO2 27 mm Hg PaO2 78 mm Hg HCO3- 12 mEq/L BE - 13 mEq/L The correct interpretation of these ABG results is which of the following?
Partially compensated metabolic acidosis
The following ABG results have been collected on a 52-year-old man with a pulmonary embolism. The patient was not receiving O2 when the sample was drawn. pH 7.55 PaCO2 28 mm Hg PaO2 142 mm Hg Which of the following should the respiratory therapist recommend at this time?
Redraw the ABG sample because this result suggests air in the sample.
Room air will not be entrained through the exhalation ports of an aerosol mask if:
The total gas flow exceeds the pts inspiratory flow demands
Laboratory results indicate that a patient's sputum sample has an elevated eosinophil count. This is indicative of which of the following?
asthma
A 54-year-old patient enters the emergency department with mild chest pain and shortness of breath. Oxygen is started at 3 L/min per nasal cannula. The ABGs drawn 30 minutes later are as follows: pH 7.36 PaCO2 44 mm Hg PaO2 62 mm Hg HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should recommend which of the following?
increase O2 flow to 5 L/min
The respiratory therapist has been administering PEP therapy at 10 cm H2O to a patient with cystic fibrosis. Secretion clearance has not improved. Which of the following should the therapist recommend at this time?
increase the PEP level to 15 cmh20
Shortly after PEEP is increased from 8 to 12 cm H2O, the patient becomes restless and agitated. Auscultation of breath sounds reveals diminished breath sounds on the right side, and chest inspection reveals the trachea shifted to the left of midline. These abnormal findings are most likely the result of which of the following?
right sided tension pneumo
A patient on a ventilator has become agitated and combative, and the high-pressure alarm is sounding with each breath. To paralyze the patient to prevent him from fighting the ventilator, the respiratory therapist should recommend which of the following medications?
vecuronium
