test
How soon following hospital admission should medication reconciliation be carried out and documented in the medical record?
24 hrs
The standard frequency for dosing of inhaled Tiotropium Bromide is every:
A. 12 hours B. 24 hours C. 4 hours D. 6 hours
A 16 YEAR -OLD MALE PRESENT TO THE PULMONARY CLINIC WITH A HISTORY OF DAYTIME DYSPNEA, NASAL CONGESTION AND A PERSISTENT COUGH EACH SUMMER. WHICH OF THE FOLLOWING DRUG CLASSIFICATIONS SHOULD THE RESPIRATORY THERAPIST RECOMMEND TO CONTROL SYMPTOMS?
A. ANTICHOLINERGIC B. BETA 2 ADRENERGIC C. LEUKOTRIENE INHIBITOR D. IgE IMMUNOGLOBULIN INHIBITOR
A premature neonate with respiratory distress syndrome receives the first dose of surfactant replacement therapy. Two hours later, the neonate's Fi02 requirements have increased from 0.30 to 0.70. Which of the following should the Respiratory Therapist recommend first?
A. HFV (High Frequency Ventilation) B. Inhaled Nitric Oxide C. Chest radiograph D. 2nd dose of surfactant
ABG: pH 7.28 PaCO2 51 torr PaO2 86 torr, HCO3 24 mEq/L BE -3mEq/L WHICH OF THE FOLLOWING SHOULD THE RESPIRATORY THERAPIST RECOMMEND?
A. INCREASE MANDATORY RATE TO 14 B. INCREASE VT TO 600 ML C. INCREASE I-TIME TO 1.5 SEC D. PEEP TO 10cm H20
66-year-old male 168 cm (5 ft 6 in) 65 kg (142 lbs.) patient had a recent right-sided pneumonectomy and currently on mechanical ventilation in VC- AC. Mechanical ventilation settings are : Mandatory rate 14 PEEP 3 cmH20 VT 300 ml FiO2 60% ABG: pH 7.34 PaCO2 48 PaO2 76 Total CO2 content 24 BE -1 Based on the data above what would you do first?
A. Increase VT to 600 ml B. Increase rate to 16 C. Increase PEEP to 5 D. Increase FiO2 to 70%
You just intubated a patient nasally, in respiratory distress and he is currently ventilated on PC-AC FiO2 100%. CXR: Diffuse alveolar infiltrates. ABG: pH 7.34, PaCO2 78 PaO2 67 HCO3 34 ETT currently at 24 cm mark at the patient left nare. What must you do as the Respiratory Therapist?
A. Leave ETT in place B. Withdraw ETT 2 cm to 22 cm mark C. Advance ETT to 26 cm mark D. Withdraw ETT to 24 cm mark
A patient presents with 6 -month history of intermittent dyspnea with exercise and exertion. Physician orders ECG, chest radiograph, echocardiogram and labs in which they are all normal. Spirometry is completed with results below: Pre-bronchodilator Post-bronchodilator FEV1 2.9L 3.2L FVC 3.3L 3.3L Which of the following test should the Respiratory Therapist recommend NEXT?
A. Lung volume measurements B. CT Chest High Resolution C. Pulse Oximetry study D. Bronchoprovocation study
73-year-old female patient with COPD currently in MICU with moderate bilateral pneumonia. Vitals are: SpO2 91% on 2L HR 120 bpm BP 210/100 Temp 99.0 MD orders RN to give Nitroprusside IV STAT. Which of the follow would you expect to increase?
A. Mean PAP B. V/Q mismatch C. Pulmonary shunting D. Gas distribution
According to the Berlin Criteria a patient with a PF (PaO2/FiO2)ratio of 180 has :
A. Moderate ARDS B. Mild ARDS C. Severe ARDS D. Normal
MODERATE STRIDOR WITH RETRACTIONS IS NOTED POST EXTUBATION OF A 15-YEAR-OLD PATIENT IN ICU. WHAT WOULD YOU RECOMMEND TO THE PHYSICIAN?
A. NASOPHARYNGEAL AIRWAY STAT B. INHALED CORTICOSTEROIDS C. NEBULIZED RACEMIC EPINEPHRINE D. COOL BLAND AEROSOL THERAPY STAT
70 year -old patient in ICU, the chest radiograph shows a diffuse alveolar infiltrates in both lungs. The following data is available: CVP 13 mmHg PCWP 25 mmHg Right Atrial Pressure 15 mmHg Mean PAP 30 mmHg Cardiac Index 1.7L/min/m2 The Respiratory Therapist should recommend administering:
A. Nitric Oxide B. IVF Bolus STAT C. Albuterol D. Diuretics
54-year-old male patient status post open-heart surgery in ICU. Upon assessment patient has a productive cough and a temp of 100.2. Patient currently on 2L NC with a SpO2 94%. Incentive spirometry has been ordered per resident. Prior to surgery spirometry was performed. Spirometry data: SVC 4.4L, FEV1 3.4L, FVC 3.5L, IC 1.8L What would you recommend for this patient?
A. Switch to flow type spirometer B. Perform nasotracheal suctioning C. Give bronchodilator q4hrs and IC after each treatment D. Set the incentive spirometer goal at 900-1000mL
The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered?
A.0.25 mLB.0.50 mLC.1.25 mLD.2.5 mL
After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include 1. bronchospasm. 2. pneumothorax. 3. pulmonary hemorrhage.
A.1 and 2 onlyB.1 and 3 onlyC.2 and 3 onlyD.1, 2, and 3
Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? 1. FEV1 2. PEFR 3. FRC 4. RV
A.1 and 2 onlyB.1 and 3 onlyC.2 and 4 onlyD.3 and 4 only
Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation? 1. Select a ventilator that uses demand valves rather than a reservoir IMV system. 2. Calculate oxygen cylinder duration of flow. 3. Selecting a ventilator that incorporates an internal air compressor.
A.1 and 2 onlyB.2 and 3onlyC.3 onlyD.1, 2, and 3
The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor 1. electrocardiogram. 2. electroencephalogram. 3. nasal air flow. 4. chest wall impedance.
A.1 and 2 onlyB.3 and 4 onlyC.2, 3, and 4 onlyD.1, 2, and 3 only
A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation? 1. Increase the pressure limit 2. Increase the sensitivity 3. Increase the mandatory rate 4. Decrease the inspiratory time
A.1 and 4 onlyB.1 and 3 onlyC.2 and 3 onlyD.1, 2 and 4 only
Transcutaneous monitoring of PO2 values will correlate well with arterial blood gas PO2 values in which of the following situations? 1. Hypotension 2. Hypothermia 3. Pneumonia
A.1 onlyB.3 onlyC.1 and 2 onlyD.2 and 3 only
A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 1. Tidal volume 2. Respiratory Rate 3. Inspiratory flow 4. Sensitivity
A.1, 2, and 3 only B.1, 2, and 4 only C.1, 3, and 4 only D.2, 3, and 4 only
An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a nonrebreathing mask with an oxygen flowmeter set at 10 L/min. What is the actual flow being delivered to the mask?
A.10 L/minB.13 L/minC.16 L/minD.18 L/min
What increase in FEV1 during post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern?
A.10% and 100 mLB.12% and 200 mLC.15% and 100 mLD.20% and 200 mL
A patient in the intensive care unit has the following hemodynamic measurements: CVP (mm Hg)5PAP (mm Hg)29/8PCWP (mm Hg)8BP (mm Hg)130/70Cardiac output (L/min)5.1Cardiac index (L/min/m2)2.7 What is the pulse pressure?
A.15 mm HgB.21 mm HgC.60 mm HgD.90 mm Hg
What is the normal range for central venous pressure in an adult?
A.2 - 6 mm HgB.4 - 12 mm HgC.9 - 18 mm HgD.21 - 28 mm Hg
During review of the medical record prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm3. Based on this finding, what should the therapist do? 1. Perform ABG as normal. 2. Refuse to perform the ABG. 3. Hold pressure on the puncture site for a longer time after sample is collected. 4. Recommend that an ABG should be performed on the patient only if absolutely necessary.
A.2 and 4 onlyB.1 and 3 onlyC.3 and 4 onlyD.2 only
A capnograph used for continuous monitoring of a patient on mechanical ventilation should be recalibrated every
A.2 hours.B.4 hours.C.8 hours.D.24 hours.
A patient receives CPAP at 10 cm H2O and 0.30 FIO2 with the heated humidifier set at 40° C. As the gas is delivered to the patient through large bore tubing, which of the following will occur? 1. Excess water will rain out 2. Humidity deficit will occur 3. Relative humidity will decrease 4. Relative humidity will remain 100%
A.2 onlyB.2 and 4 onlyC.1 and 3 onlyD.1 and 4 only
Following cardiac surgery, a 55 year-old patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.
A.2.5 vol%B.4.0 vol%C.5.0 vol%D.5.5 vol%
A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance?
A.25 mL/cm H2OB.35 mL/cm H2OC.45 mL/cm H2OD.50 mL/cm H2O
A patient with bilateral pneumonia receives mechanical ventilation in the intensive care unit. The following data is obtained:ModePC, ACSet rate12 /minTotal rate12 /minVE8.6 LFIO20.60PIP31 cm H2OPEEP10 cm H2OpH7.41PaCO240 torrPaO295 torrSaO296%HCO3-23 mEq/LBE+1 mEq/LPAO2370 torrC(a-v)O23.5 vol%The respiratory therapist should report the A-aDO2 as
A.275 torr.B.300 torr.C.345 torr.D.370 torr.
At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned?
A.4 & 8B.5 & 9C.5 & 10D.6 & 10
While performing a 12-lead electrocardiograph on a 68-year-old male patient, the respiratory therapist notices a sudden increase in artifact on the ECG paper. Upon further investigation, the therapist discovers that the V2 electrode has fallen off the chest. Where on the patient should the therapist place this electrode?
A.4th intercostal space on the left side of the sternum.B.5th intercostal space, left mid-clavicular line.C.6th intercostal space, left mid-axillary line.D.7th intercostal space, right mid-clavicular line.
What is the normal VD/VT ratio for a patient breathing room air?
A.5 - 15%B.20 - 40%C.45 - 55%D.65 - 75%
The respiratory therapist prepares to administer inhaled nitric oxide to a neonate with respiratory distress syndrome. The most appropriate initial dose of iNO for this patient is
A.5 ppm.B.10 ppm.C.15 ppm.D.20 ppm.
A healthy adult female can exhale what portion of her forced vital capacity in the first second?
A.50%B.60%C.70%D.80%
Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube?
A.8 FrB.10 FrC.12 FrD.14 Fr
Which of the following is a FALSE statement about self-inflating resuscitation devices?
A.A reservoir is utilized to increase the delivered oxygen concentration.B.The respiratory therapist can sense changes in the patient's lung compliance and airway resistance.C.A compressed gas source is necessary for the device to operate.D.Excessive gas flow may cause the valve to malfunction.
A well-penetrated chest X-ray has which of the following qualities?
A.Air bronchograms are prominently displayed.B.Heart borders and pleural spaces are clearly visible.C.Lung parenchyma is black without blood vessels.D.Vertebrae are just visible behind the heart.
Which of the following patients would most likely benefit from pressure support ventilation?
A.An intubated patient with an absent respiratory drive.B.A patient on SIMV with a mandatory rate of 12/min and total rate of 24/min.C.A patient with acute lung injury.D.A patient who requires short-term post-operative ventilatory support.
The respiratory therapist calibrates a spirometer and checks the volume with a 3.0 liter super syringe. The volumes recorded are: 2.85 L, 2.8 L, and 2.8 L. Based upon the information obtained which of the following is a correct statement?
A.Another syringe needs to be usedB.Spirometer is accurateC.The plunger was advanced too slowlyD.Spirometer may have a leak
The respiratory therapist receives an order for postural drainage and vibration. With the bed flat, the therapist places the patient in a prone position with pillows under his hips. Which lung segments are being treated with this position?
A.Anterior segments of the upper lobesB.Superior segments of the upper lobesC.Posterior basal segments of the lower lobesD.Superior segments of the lower lobes
Which of the following is an indication for high frequency jet ventilation?
A.Bronchopleural fistulaB.Wilson Mikity syndromeC.Necrotizing lesion of right lungD.Centrilobular emphysema
A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon deflated. Which of the following pressures will be measured by the distal lumen?
A.CVPB.PAPC.PCWPD.MAP
A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon inflated. Which of the following pressures will be measured by the distal lumen?
A.CVPB.PAPC.PCWPD.MAP
The respiratory therapist assists with elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST?
A.Check the inlet valve.B.Check the patient valve.C.Replace the manual resuscitation bag.D.Check for excessive oxygen flow.
Which of the following will give the most accurate measurement of volume and flow for spirometry?
A.Collins water-sealed spirometerB.Vortex-shedding pneumotachometerC.Wright respirometerD.Dry-rolling spirometer
The physician asks the respiratory therapist to select ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician's request?
A.DeceleratingB.Square waveC.ConstantD.Accelerating
Following abdominal surgery, a 70 year-old patient receives mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 torr and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend?
A.Decrease the PEEP.B.Increase the FIO2.C.Initiation diuretic therapy.D.Continue to monitor closely.
All of the following are TRUE statements about spacers and holding chambers, EXCEPT
A.Do not require patient cooperation with their breathing pattern.B.Improve the efficiency of MDI.C.Can be used for drug delivery by MDI to intubated and mechanically ventilated patients.D.If a patient exhales immediately following activation of the inhaler, they will clear the medication from the device and waste the dose.
A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff?
A.Enough to achieve a pressure of 25-35 cm H2O.B.Enough to achieve a minimal occluding volume.C.A minimum of 20 mL.D.Until firm tension is felt in the pilot balloon.
The respiratory therapist instructs a patient to take a maximal inspiration followed by a maximal exhalation without force. Which of the following values are being measured?
A.Expiratory reserve volumeB.Residual volumeC.Functional residual capacityD.Slow vital capacity
A patient receives 40% oxygen via a Venturi mask at 8 L/min. While performing oxygen rounds, the respiratory therapist notes that the flowmeter setting has been changed to 12 L/min. How would this affect the accuracy of this device?
A.FIO2 will remain unchangedB.FIO2 will decrease to 0.35C.Air entrainment factor will decreaseD.FIO2 will increase to 0.50
A patient with a closed head injury has had a cuffed tracheostomy tube in place for several weeks. The physician wishes to decannulate the patient but maintain the patency of the stoma for secretion removal. Which of the following devices would facilitate this request?
A.Fenestrated trach tubeB.Transtracheal catheterC.Laryngectomy tubeD.Tracheostomy button
A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position?
A.Head down, patient supine with a pillow under kneesB.Patient prone with a pillow under head, bed flatC.Patient supine with a pillow under knees, bed flatD.Head down, patient prone with a pillow under hips
Which of the following measurements is most indicative of congestive heart failure?
A.Heart rate of 120/minB.Blood pressure of 92/72 mm HgC.Pulmonary artery pressure of 25/10 mm HgD.Pulmonary capillary wedge pressure of 30 mm Hg
A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend?
A.Helium dilution studyB.DLCOC.PlethysmographyD.Bronchial provocation
A patient with chronic hypercapnia is brought to the ED after losing consciousness at home. A pulmonary artery catheter has been placed with the following measurements obtained: PAP25/10 mm HgBP76/50 mm HgPCWP4 mm HgSVR1360 dynesCVP0 mm HgCI1.8 L/min/m2 Which of the following is the most likely cause for his condition?
A.HypovolemiaB.Drug overdoseC.Cor pulmonaleD.High FIO2 vasodilation
A 60 kg (132 lb) patient is mechanically ventilated at the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure?
A.Increase the frequency.B.Change to airway pressure release ventilation.C.Decrease the inspiratory time.D.Increase PEEP to 15 cm H2O.
Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray?
A.Increased fremitusB.Decreased intensity of breath soundsC.Diminished diaphragmatic excursionD.Hyperresonance to percussion
A 68 year-old patient with advanced emphysema is receiving oxygen by nasal cannula at 1 L/min. The physician has ordered that the patient's SpO2 be maintained at 90%. ABG on 1 L/min are pH 7.34, PaCO2 65 torr, PaO2 55 torr, HCO3 35 mEq/L. What should the respiratory therapist recommend FIRST?
A.Initiate NIPPVB.Titrate oxygen flow to the nasal cannulaC.Change to a simple maskD.Change to a non-rebreather mask
A 43-year-old female patient undergoes a total abdominal hysterectomy. The patient arrives in the Post Anesthesia Care Unit obtunded with minimal response to painful stimulus. What treatment should the respiratory therapist recommend for this patient?
A.Initiate assisted ventilationB.Insert oropharyngeal airwayC.Obtain positron emission tomographyD.Initiate noninvasive capnography
A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes?
A.Initiate bronchial hygiene therapy.B.Obtain a sputum gram stain.C.Administer IPV.D.Insert a CASS tube.
During ventilator rounds in ICU, the respiratory therapist notes that the patient in Room 3 has the following waveform graphic displayed on her ventilator: autopeep What action should the therapist take?
A.Initiate pressure support.B.Increase respiratory rate.C.Decrease inspiratory time.D.Add an inspiratory plateau.
Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at frequencies of 100 to 250/min?
A.Intrapulmonary percussive ventilationB.Autogenic drainageC.High-frequency chest wall compression deviceD.Positive expiratory pressure breathing
Which of the following statements is TRUE concerning positive expiratory pressure (PEP) therapy?
A.It applies expiratory positive airway pressure (EPAP) using a one-way expiratory valve and a one-way inspiratory flow resistor.B.It is used for 5 - 10 minute intervals every hour.C.The inspiratory flow resistor prevents end-inspiratory pressures from rising above zero.D.It may help improve secretion expectoration, decrease hyperinflation and improve airway maintenance
The respiratory therapist prepares to assist with the intubation of an adult male patient. The anesthesia resident wishes to administer a neuromuscular blocker that has a fast onset and short duration. Which of the following should the therapist recommend?
A.KetamineB.VecuroniumC.RocuroniumD.Succinylcholine
What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea?
A.Less than 5B.5 to 15C.16 to 30D.Greater than 30
A 13 year-old patient in the ED complains of dyspnea, chest tightness, and a loose productive cough. The patient has a respiratory rate of 33 breaths/minute and bilateral wheezing in the lungs. What treatment should the respiratory therapist initiate?
A.LevalbuterolB.OxygenC.SalmeterolD.PEP
A heat moisture exchanger is indicated for humidification in which of the following situations?
A.Mechanical ventilation in a long-term care facility.B.Transport to a tertiary care center.C.Patient with tenacious secretions.D.Delivery of aerosolized bronchodilators.
A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient?
A.Obtain a sputum specimen.B.Obtain an ABG.C.Measure peak expiratory flow.D.Determine the Glasgow Coma Score.
A patient in the intensive care unit has the following hemodynamic measurements: CVP: 12 mm Hg PAP: 48/16 mm Hg PCWP: 15 mm Hg MAP: 109 mm Hg Cardiac Output: 8.0 L/min. Cardiac Index: 4.7 L/min/m2Which of the following should the respiratory therapist recommend?
A.OxygenB.DopamineC.LidocaineD.Furosemide
Which of the following physiologic values would be present in a patient who has proper fluid balance?
A.PCWP of 22 mm HgB.CVP between 3 and 6 mm HgC.Urine output of 20 mL/hrD.PAP of 25/8 mm Hg
The physician asks the respiratory therapist to set an optimal PEEP level for a mechanically ventilated patient . The PEEP level is optimal when
A.PEEP levels are less than 18 cm H2O.B.PaO2 is 60 torr or greater.C.Oxygen delivery to the tissues is maximal.D.C(a-v)O2 is decreasing.
A 50 kg (110 lb) patient is mechanically ventilated with the following settings: VC, A/C, VT 400 mL, respiratory rate 14/min, FIO2 0.60 and 10 cm H2O PEEP. The chest radiograph demonstrates diffuse bilateral radiopacity. ABG results are: pH 7.36, PaCO2 47 torr, PaO2 50 torr, and HCO3- 26 mEq/L. The respiratory therapist should increase the
A.PEEP.B.FIO2.C.expiratory time.D.respiratory rate.
A patient with a flail chest is intubated and mechanically ventilated with PEEP therapy. Pancuronium bromide has been administered. Which of the following ventilator alarms would be most important to set correctly for this patient?
A.Peak pressure alarmB.Low pressure alarmC.I:E ratio alarmD.Low exhaled volume alarm
What is the correct formula to calculate the static lung compliance of a patient receiving mechanical ventilation?
A.Peak pressure ÷ tidal volumeB.Tidal volume ÷ (plateau pressure - PEEP)C.Tidal volume ÷ (peak pressure + PEEP)D.(Plateau pressure - PEEP) ÷ tidal volume
Which of the following values should the respiratory therapist report as indicative of pulmonary embolism in a patient with acute dyspnea?
A.QS/QT of 10%B.VD/VT of 60%C.CL of 60 mL/cm H2OD.RAW of 2.4 cm H2O/L/sec
The following measurements were obtained from a patient with a pulmonary artery catheter in place: CVP1 mm HgPAP10 mm Hg (mean)PCWP8 mm HgCI1.6 L/min/m2BP110/90 mm Hg Based on the above information, all of the following values would be decreased EXCEPT
A.RVEDP.B.PVR.C.SVR.D.QT.
A 64-year-old, 70 kg (154 lb) man with severe COPD receives independent (differential) lung ventilation following thoracotomy and right lower lobectomy. Which of the following setting combinations would be most appropriate for this patient?
A.Right lung 50 mL; left lung 450 mLB.Right lung 150 mL; left lung 350 mLC.Right lung 250 mL; left lung 250 mLD.Right lung 350 mL; left lung 150 mL
Following surgery to correct an abdominal aortic aneurysm, a 54-year-old female patient suddenly develops intense substernal chest pain with severe dyspnea. The pain does not appear to be aggravated by her respirations. Auscultation reveals bilateral, basilar, moist, crepitant rales. The patient appears pale, cold and clammy. Which of the following should the respiratory therapist recommend for initial assessment of this patient?
A.Serum electrolytesB.Chest x-rayC.Complete blood cell countD.Electrocardiograph
The following pulmonary function data was reported for a 45 year old patient: TLC - 5.4 LRV - 1.0 LIRV - 2.6 LVC - 4.2 LERV - 1.0 LVT - 0.6 LFRC - 2.0 LIC - 3.2 L Which of the above capacities is incorrect?
A.TLCB.VCC.FRCD.IC
Which of the following would NOT cause a capnography reading to change from 36 torr to 30 torr?
A.TachypneaB.HyperventilationC.Pulmonary emboliD.Endotracheal tube positioned in the right mainstem bronchus
A patient performs both a forced vital capacity and a slow vital capacity maneuver with the following results: FVC 2.40 L SVC 2.18 LWhich of the following statements is TRUE regarding these results?
A.The data meets ATS-ERS standards and should be reported.B.The SVC shows poor effort and should be repeated.C.The FVC shows poor effort and should be repeated.D.The patient has obstructive lung disease.
A 2-year-old child with croup has been intubated for 4 days with a 4 mm ID uncuffed endotracheal tube. Heated aerosol at an FIO2 of 0.30 has been delivered to the patient. The physician asks the respiratory therapist to evaluate the patient for possible extubation. Which of the following would most likely indicate that the patient is ready for extubation?
A.The patient is making normal quiet ventilatory efforts.B.A negative sputum culture and sensitivity has been reported.C.The patient's ABG are within normal range.D.Breath sounds are heard around the tube on auscultation.
A sudden decrease in end-tidal CO2 occurs in a mechanically ventilated patient. A repeat analysis yields the same results. Which of the following situations might account for these readings?
A.The ventilator circuit has become disconnected.B.There is a leak around the endotracheal tube.C.There is an increase in alveolar dead space.D.The carbon dioxide absorber is exhausted.
A 2100 g neonate in the NICU is monitored with a TcPO2 monitor. The TcPO2 reads 53 torr with the temperature set at 40oC. The arterial PO2 is 73 torr. Which of the following would best explain the difference in TcPO2 levels?
A.There was an error in the arterial blood gas analysis.B.The TcPO2 monitor needs to be repositioned on the neonate.C.The TcPO2 temperature setting is too low.D.The TcPO2 monitor has come off the skin.
An ICU patient's blood pressure is continuously monitored via an arterial catheter in the left radial artery. The respiratory therapist places the patient in Trendelenburg position for bronchial hygiene therapy and the blood pressure monitor begins to alarm. When the patient is returned to the original position, the blood pressure normalizes. What is the most likely reason for the variation in blood pressure?
A.Trendelenburg position causes an elevation in blood pressure.B.The tip of the catheter was below the transducer.C.The catheter needed flushing.D.The catheter was kinked.
The following results are obtained from the pulmonary artery catheter of a patient who collapsed during a visit with a friend in the hospital: CVP10 cm H2OPAP33/27 mm HgPCWP20 mm HgBP108/72 mm Hg Which of the following conditions could be associated with these results?
A.Tricuspid valve stenosisB.Right ventricular failureC.Cardiogenic pulmonary edemaD.Fluid overload
While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is the most likely explanation for these changes?
A.Upper airway obstructionB.Poor peripheral perfusionC.Air leak around the sensorD.Device is out of range
An oxygen-dependent patient uses a nasal cannula at 3 L/min continuously at home. He complains that his liquid oxygen portable device runs out too quickly when he attends church services and prevents him from dining out in restaurants afterwards. Which of the following devices should the respiratory therapist recommend to resolve the issue?
A.Use a pulse-dose oxygen delivery system.B.Take a backup E-size oxygen cylinder.C.Reduce the oxygen flow to 2 L/min during church.D.Insertion of a transtracheal oxygen catheter.
What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation?
A.VC limits and controls PIP.B.VC provides a constant minute ventilation.C.VC ensures better patient-ventilator synchrony.D.VC delivers a decelerating flow pattern.
While examining the chest drainage system of a mechanically-ventilated patient following thoracotomy, the respiratory therapist observes bubbling in the water-seal chamber during inspiration. This would indicate
A.a leak in the chest drainage system.B.air leaving the pleural space.C.excessive pressure from the suction regulator.D.inadequate water level in the water-seal chamber.
Following thoracotomy, a patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as
A.a persistent bronchopleural fistula.B.a resolved pneumothorax.C.back-pressure from the suction chamber.D.normal function of the water seal chamber.
A patient's cardiac output is increased and his QS/QT is calculated to be 20%. Based upon this information, the respiratory therapist would inform the physician this patient has
A.an elevated shunt.B.a reduced cardiac index.C.increased pulmonary vascular resistance.D.normal lung mechanics.
The physician informs the patient that the results of his polysomnogram indicate obstructive sleep apnea. Treatment for this disorder might include
A.bronchial hygiene therapy.B.respiratory stimulants.C.tracheostomy.D.negative pressure ventilation.
All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT
A.carbon monoxide poisoning.B.decompression sickness.C.anaerobic infections.D.pulmonary hypertension
A respiratory therapist enters a patient's room during oxygen rounds. The patient has end-stage emphysema and appears to be sleeping. The patient doesn't respond to questions and his pulse is 20 bpm. The therapist should immediately
A.confirm DNR status.B.go get help.C.begin rescue ventilation.D.begin chest compressions.
A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend
A.continuing the therapy until breath sounds improve. B.administering dornase alpha. C.administering albuterol therapy. D.deep breathing and coughing to clear secretions.
A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist could recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT:
A.coordinating coughing with pain medication.B.performing serial coughs.C.applying pressure to patient's abdomen during exhalation.D."splinting" the incision area.
A patient receives oxygen at home via nasal cannula at 1 L/min. He has 50 feet of extension tubing attached to his oxygen concentrator. The patient complains that there does not seem to be enough oxygen flow reaching the cannula. The respiratory therapist should recommend
A.decreasing the length of the extension tubing.B.increasing the concentrator flow.C.changing to a liquid system.D.analyzing the FIO2.
While instructing a patient prior to a vital capacity maneuver, the respiratory therapist should direct the patient to
A.exhale to residual volume and inhale to inspiratory capacity.B.inhale to total lung capacity then exhale to residual volume.C.exhale normally then inhale to total lung capacity.D.inhale normally then exhale to functional residual capacity.
Indirect calorimetry is performed on a 65-year-old patient to evaluate his nutritional status. It is determined that the patient's RQ is 1.00. This would indicate that the patient's diet consists mostly of
A.fats.B.proteins.C.sugars.D.carbohydrates.
A patient receives IPPB therapy with a Bird Mark-7 ventilator. The respiratory therapist notes that the patient is generating negative pressure at the beginning of inspiration although the machine does not switch into the inspiratory phase. The respiratory therapist should adjust the
A.flow.B.sensitivity.C.apnea timer.D.inspiratory pressure.
A patient receiving warfarin (Coumadin®) has a prothrombin time (PT) of 20 seconds. These findings indicate a
A.high likelihood of excessive bleeding.B.normal clotting ability.C.propensity for increased clotting.D.decrease in bone marrow function.
A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT
A.hypoxemia.B.pneumothorax.C.pulmonary hemorrhage.D.bronchospasm/laryngospasm.
A 44 year-old patient who suffered a cerebral vascular accident has been moved from Neuro-ICU to the step-down unit. He becomes diaphoretic and his SpO2 suddenly drops from 95% to 88% on a 32% tracheostomy collar. His heart rate is 115/min, respiratory rate is 42/min and his breath sounds are very diminished. The respiratory therapist is unsuccessful in attempting to pass a 12 Fr suction catheter. The therapist should
A.increase the suction pressure to 120 mm Hg.B.change to a 10 Fr suction catheter.C.replace the tracheostomy tube.D.orally intubate the patient.
The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should
A.initiate an inspiratory hold just after the next ventilator-delivered breath.B.initiate an expiratory hold just prior to the next ventilator-delivered breath.C.subtract Pplat from Pdyn.D.subtract set PEEP from the measured Pplat.
A spontaneously breathing post-CVA patient has developed right lower lobe infiltrates on chest x-ray and has coarse breath sounds. When the respiratory therapist attempts to suction the patient by the nasotracheal route, a gag reflex is present but the patient does not cough. Watery secretions are aspirated through the suction catheter. The therapist should
A.insert an oral endotracheal tube.B.reposition the patient to a sniffing position.C.change to a larger suction catheter.D.insert an oropharyngeal airway.
Pressure-cycled ventilation would be LEAST appropriate for a patient with
A.kyphosis.B.muscular dystrophy.C.acute respiratory distress syndrome.D.a drug overdose.
A mixed venous blood sample is needed to determine the oxygen consumption of the tissues. The mixed venous blood sample should be obtained from the
A.left atrium.B.pulmonary vein.C.pulmonary artery.D.superior vena cava.
While providing education to patients who will be discharged home on oxygen therapy, the respiratory therapist explains the hazards associated with oxygen delivery equipment in the home. This instruction should include all of the following EXCEPT
A.liquid oxygen burns when refilling portable tanks.B.how to properly secure oxygen cylinders for transport.C.use of grounded 3-prong outlets for electrical equipment.D.emergency procedure to deal with gas explosions.
The FRC measured by body plethysmography is 30% larger than that measured by helium dilution. This difference is best explained by
A.maldistribution of ventilation.B.increased diffusing capacity.C.trapped thoracic gas.D.reduced lung compliance.
A patient with end-stage pulmonary fibrosis receives oxygen at 2 L/min via transtracheal oxygen catheter. The patient complains of increased work of breathing and shortness of breath. The respiratory therapist should
A.manually ventilate the patient with a resuscitation bag.B.increase the flow to the transtracheal catheter to 6 L/min.C.evaluate the SpO2 with a pulse oximeter.D.flush the transtracheal device with saline.
All of the following statements are TRUE with regard to cuff inflation techniques EXCEPT
A.minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring.B.minimal leak technique allows a small leak at the end of inspiration.C.at minimal occlusion volume, air leakage around the tube cuff should cease.D.cuff pressure should not exceed 35 cm H2O in order to allow circulation to tracheal mucosa.
CVP4 mm HgPAP48/16 mm HgPCWP8 mm HgMAP92 mm HgCardiac Output5 L/min.Cardiac Index2.5 L/min/m2 These results are most consistent with
A.normal cardiac function.B.pulmonary hypertension.C.left heart failure.D.hypovolemia.
The results of a patient's spirometry are recorded as follows: PredictedObservedFVC (L)3.52.1FEV1 (L)2.72.6FRC (L)2.51.7TLC (L)5.64.2 These results are indicative of
A.normal lung function.B.sarcoidosis.C.acute bronchitis.D.cystic fibrosis.
After performing spirometry on a patient in the pulmonary clinic, the respiratory therapist notes that both the inspiratory and expiratory flow portion of the flow-volume loop is flattened. The therapist should interpret the condition demonstrated on the flow-volume loop as a/an
A.normal tracing.B.obstructive pattern.C.restrictive pattern.D.large airway obstruction.
The respiratory therapist performs the quality control procedures for the blood gas analyzer in the NICU and notices a single data point that is 3 standard deviations from the mean value for the pH electrode. The therapist should
A.perform another control run.B.contact the quality control supervisor.C.recalibrate the electrode.D.replace the electrode.
The respiratory therapist is called to ICU to evaluate a patient on continuous flow CPAP (8 cm H2O, FIO2 0.30) who is showing signs of respiratory distress. The patient's SpO2 has changed from 94% to 90%. The therapist observes that the CPAP pressure manometer displays negative pressure during inspiration. The therapist should
A.place the patient back on the ventilator at the previous settings.B.increase inspiratory flow to the CPAP system.C.assess the patient for excess secretions.D.increase the CPAP to 10 cm H2O.
A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from
A.pneumonia.B.pulmonary embolism.C.pleural effusion.D.bronchiolitis.
While delivering IPPB therapy with a Bird Mark 7 ventilator, the respiratory therapist observes that the pressure does not rise consistently during inspiration. This is most likely the result of
A.poor patient effort.B.improper trigger setting.C.bronchial secretions.D.insufficient flow.
All of the following statements regarding an oxygen concentrator are correct EXCEPT that it
A.provides an unlimited supply of oxygen.B.increases alveolar oxygen tension.C.provides 100% oxygen at high flow rates.D.removes nitrogen from the room air.
A 1600 g neonate receives oxygen by oxyhood at an FIO2 of 0.60. The flowmeter is set at 5 L/min. While analyzing the oxygen, the respiratory therapist notices varying FIO2 readings at different locations inside the oxyhood. The therapist should
A.re-calibrate the oxygen analyzing device.B.increase the flow to the oxyhood.C.place the neonate in an isolette at an FIO2 of 0.60.D.check the water level of the humidifier.
A 55 year-old male patient is evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should
A.reduce the speed of the bike.B.administer supplemental oxygen.C.gradually reduce the workload and monitor closely.D.terminate the procedure immediately.
A patient receiving mechanical ventilation has a capnometer in-line at the Y-connector of the vent circuit for continuous monitoring of exhaled CO2. The capnogram suddenly indicates an abrupt decrease in the PETCO2 from 5.3% to 0.0%. The respiratory therapist should
A.replace the exhalation valve.B.decrease the humidifier temperature setting.C.remove the inline medication nebulizer.D.reattach the patient to the circuit.
While attempting to calibrate a polarographic oxygen analyzer, the respiratory therapist notices that the analyzer reads 21% when exposed to room air but only reads 64% when exposed to 100% oxygen. The most appropriate action at this time would be to
A.reset the zero point.B.replace the battery.C.replace the fuel cell.D.add electrolyte solution.
Over the last hour, a patient being ventilated with a volume-cycled ventilator has a decrease in urine output from 35 mL/hour to 10 mL/hour. The most likely cause of this change would be an increase in the
A.respiratory rate.B.delivered FIO2 .C.peak airway pressure.D.inspiratory flow.
Adjusting the inspiratory flow during IPPB will primarily result in a change in
A.respiratory rate.B.peak pressure.C.tidal volume.D.inspiratory time.
All of the following could cause a patient's right-hemidiaphragm to be elevated, EXCEPT
A.right lower lobe atelectasis.B.right side hyperlucency, absent vascular markings.C.hepatomegaly.D.right lower lobe consolidation with air bronchograms.
The following measurements were obtained from a patient being monitored with a balloon tipped, flow directed catheter: CVP2 cm H2OPAP12 torr (mean)PCWP3 torrCI1.2 L/min/m2BP110/90 mm Hg Based on the above information, all of the following parameters would be decreased EXCEPT
A.right ventricular end diastolic pressure.B.left atrial filling pressure.C.systemic vascular resistance.D.cardiac output.
In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a
A.rotameter.B.3.0 L syringe.C.Wright respirometer.D.pneumotachometer.
A 60 kg (132 lb) female patient with congestive heart failure receives NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40, PaCO2 42 torr; PaO2 145 torr; HCO3 26 mEq/L, SaO2 99%, CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as
A.shunting.B.hypoventilation.C.hyperoxygenation.D.fluid overload.
A tracheostomy tube has just been changed on a patient receiving continuous volume-cycled ventilation. The patient suddenly becomes dyspneic and develops crepitus around the tracheostomy stoma. The respiratory therapist should
A.suction the patient.B.insert a larger tracheostomy tube.C.reposition the tracheostomy tube.D.recommend an antihistamine.
A 62-year-old female who weighs 60 kg (132 lb) is on mechanical ventilation following hip replacement surgery.Ventilator settings are as follows: ModeVC, SIMVFIO20.35Set rate12 /min.Total rate12 /min.VT500 mL Arterial blood gas results are as follows: pH7.50PaCO230 torrPaO2105 torrHCO3-24 mEq/L The respiratory therapist should
A.switch to pressure control mode.B.institute pressure support.C.decrease the minute volume.D.decrease the FIO2.
A patient receiving oxygen therapy at home calls in the middle of the night and reports that the oxygen supply tubing will not stay attached to her transtracheal catheter. The flow rate to the transtracheal catheter is set at 0.5 L/min. The patient has attempted to flush the catheter with saline and push a cleaning rod through it without success. The respiratory therapist should instruct the patient to
A.tape the connection securely.B.increase the flow to the catheter.C.decrease the flow to the catheter.D.switch to a nasal cannula.
A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted to the left. The most likely explanation for the problem is that
A.the patient is disconnected from the ventilator.B.the patient is experiencing diffuse bronchospasm.C.the endotracheal tube has slipped into the right main stem bronchus.D.the patient has developed a left tension pneumothorax.
A patient receives oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80 torr, HCO3 38 mEq/L. The most likely explanation for these results is that
A.the sample was not iced properly.B.there was excess heparin in the syringe.C.the numbers were not reported correctly.D.the sample contains venous blood.
In order to reduce a patient's PaCO2 from 40 torr to 32 torr, all of the following could be increased EXCEPT
A.tidal volume.B.alveolar ventilation.C.respiratory rate.D.physiologic deadspace.
A 44-week gestational age infant is delivered via C-section and is gasping, grunting, and has tachycardia and tachypnea. At one minute his Apgar score is 4 and at 5 minutes the score is 5. The infant is most likely suffering from
A.transient tachypnea of the newborn.B.meconium aspiration.C.bronchopulmonary dysplasia.D.apnea of prematurity.
A 75 kg (165 lb) patient with acute lung injury is mechanically ventilated at the following settings: VC, A/C; VT 300 mL, respiratory rate 16/min, FIO2 0.50 and PEEP +5 cm H2O. The following arterial blood gas results are obtained: pH 7.30, PaCO2 58 torr, PaO2 79 torr, HCO3- 28 mEq/L. The patient's condition should be described as
A.venous admixture.B.ventilation/perfusion mismatching.C.hypoventilation.D.refractory hypoxemia.
During bedside monitoring, the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first
A.verify the position of the transducer.B.check the transducer dome for air bubbles.C.flush the catheter with heparin solution.D.attempt to draw blood from the arterial line.
Following a thoracotomy, a patient in the PACU receives 60% oxygen via a non-rebreather mask. A pulmonary diagnostic assessment reveals the following information: pH7.43PaCO234 torrPaO256 torrHCO3-22 mEq/LBE-1SaO290% f25/min.PAP49/28 mm HgPWP5 mm HgPVR400 dynesSVR1150 dynes To improve the patient's pulmonary status, the respiratory therapist should institute
cpap
A 7 year-old child suspected of having epiglottitis would exhibit which of the following signs?
drooling,hyperextension of the neck, stridor. no unilateral wheeze
Which of the following techniques measures total lung capacity?
helium dilution test and body box, but not nitrogen test
The most serious complication associated with airway suctioning is
hypoxemia
A hyperresonant percussion note is associated with which of the following pathologies?
no hemothorax or pleural effusion, yes to tension pneumo and chronic bronchitis
Airways resistance (Raw) of 1.8 cm H2O/L/sec is measured for a patient receiving mechanical ventilation. The respiratory therapist should suspect that the patient may have
normal airways
Fine crepitant crackles are most commonly associated with which of the following conditions?
pulmonary edema
Which of the following devices would produce the greatest humidity output for a patient?
ultrasonic neb
