TMC EXAM 2

Arterial blood gases on a patient in the cardiac intensive care unit are as follows: pH 7.31 PaCO2 50 mmHg PaO2 81 mmHg HCO3- 24 mEq/L BE 0 mEq/L Which of the following represents an accurate interpretation of these results? A. respiratory acidosis with no hypoxemia B. partially compensated metabolic acidosis C. metabolic acidosis D. left ventricular heart failure

The correct answer is : A Explanation : A CO2 of 50 mmHg is above its normal range and therefore presents acidosis. A quick glance at the pH shows no compensation. Therefore respiratory acidosis is present. Further, the patient's PO2 is normal so hypoxemia is not present. The correct interpretation is respiratory acidosis with no hypoxemia.

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 35 seconds. Based on this result the respiratory therapist should A. perform an Allen's test on the left radial artery B. perform a femoral artery puncture C. proceed with the puncture of the right radial artery D. perform a right brachial artery puncture

The correct answer is : A Explanation : A modified 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. This is done by including 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. This should occur in a few seconds. In this case, color fails to return in a timely manner. This indicates that the right radial artery should NOT be used because the ulnar artery does not have good back-up circulation. The left ulnar artery should be checked for collateral circulation to determine if a puncture of the left radial artery is safe.

Which of the following is an important strategy when caring for a patient with adult respiratory distress syndrome? A. keep mean airway pressures as low as possible B. promote AutoPEEP C. keep FIO2 higher than 0.60 D. ventilate in Control mode with paralytics

The correct answer is : A Explanation : A patient with adult respiratory distress syndrome has decreased pulmonary compliance. This places the patient at risk for barotrauma because of the high ventilatory pressures required during mechanical ventilation. Therefore, keeping mean airway pressures as low as possible is of primary concern.

A respiratory therapist notes a pressure-volume loop on a patient receiving mechanical ventilation has a pronounced beak. What strategy is useful in this case? A. decreasing tidal volume B. increasing flow C. increasing PEEP D. decreasing flow

The correct answer is : A Explanation : A pressure volume loop on a ventilator that shows a significant beak indicates inappropriate ventilation. It indicates that a massive increase in pressure is required to deliver the final part of a tidal volume. This is undesirable because an increase in mean airway pressure has many negative affects on the patient, including decreased venous return, among other things. The solution is to sacrifice some of the tidal volume and therefore reduce pressure. A proper pressure volume loop will show a very tiny beak. This beak indicates the point of over distention of the lung and is a good indicator that we are filling the lung properly. Achieving this small beak will help to increase alveolar recruitment, aerate distal parts of the lungs, and help mobilize and remove secretions.

A 75-kg (165-lb) patient with mycoplasma pneumonia is receiving mechanical ventilator support by a PB 840 ventilator on the following settings with corresponding arterial blood gas values: Mode assist/control Mandatory rate 10/min VT 525 mL FIO2 0.6 pH 7.29 PaCO2 51 mmHg PaO2 78 mmHg HCO3- 23 mEq/L BE -1 mEq/L Which of the following actions is most appropriate? A. increase mandatory rate B. increase FIO2 C. increase VT D. institute PEEP

The correct answer is : A Explanation : An examination of the arterial blood gas reveals that this patient is under-ventilating and is under-oxygenating. In such a case, ventilation should be addressed prior to oxygenation. Since carbon dioxide is too high and is off by more than 4 mmHg from the target, the most suitable action is to increase the rate. Increasing the tidal volume may also be helpful but the patient's current tidal volume is already near the top of the range. Additionally, adjustment of tidal volume should be reserved for changes of CO2 that are less than 4 mmHg.

An infant born 24 hours prior is experiencing frequent periods of apnea lasting more than 60 seconds. Which of the following medications would be helpful in stimulating the infant's respiratory drive? A. Aminophylline B. Fluticasone C. hormone D. Exosurf

The correct answer is : A Explanation : An infant who experiences apnea periods greater than 60 seconds may need respiratory stimulation. This may be accomplished by administering the medication Aminophylline. Aminophlylline is only intended for ventilatory stimulation in infants. The same medication is used for long-term bronchodilation in adults.

Which of the following patients would benefit most from an inverse I:E ratio ventilation? A. ARDS B. chronic bronchitis C. kyphoscoliosis D. COPD

The correct answer is : A Explanation : An inverse I:E ratio is a term that indicates a longer inspiratory time than expiratory time. The patient with adult respiratory distress syndrom is an example of a patient who can benefit from an inverse I:E ratio. Their lungs are noncompliant and therefore require more inspiratory time to allow for better gas distribution.

After two aerosolized Albuterol treatments by small volume jet nebulizer, the patient's breath sounds have changed from diminished to profuse wheezing bilaterally. Respiratory rate has decreased from 32 to 26. The respiratory therapist should A. continue with bronchodilator therapy B. discontinue current therapy C. administer 80/20% Heliox gas mixture D. intubate the patient

The correct answer is : A Explanation : When breath sounds change from absent or diminished to a more audible sound, such as wheezing, it can be concluded that there is more air flow in the bronchials. This indicates the patient has improved from bronchodilator therapy. The therapy should be continued.

A 75-kg (165-lb) male is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: Mandatory rate 12/min VT 500 mL FIO2 0.6 PEEP 8 cm H2O Arterial blood gas results: pH 7.30 PaCO2 52 mm Hg PO2 65 mm Hg HCO3- 27 mEq/L BE +3 mEq/L Which of the following represents the most appropriate action? A. increase rate to 14 B. increase tidal volume to 600 mL C. increase PEEP to 10 cmH2O D. increase FIO2 to 1.0

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

While performing routine oxygen rounds, the respiratory therapist notes a COPD patient who is receiving supplemental oxygen at 2 L/min is markedly cyanotic and has a heart rate of 30/min. The therapist should FIRST A. switch to FIO2 1.0 B. increase flow to 4 L/min by nasal cannula C. obtain an arterial blood gas D. go get help

The correct answer is : A Explanation : Even though a COPD patient should rarely receive more than 2 L/min oxygen, there are emergency circumstances that would dictate more supplemental oxygen. The use of the word "markedly" is an indication of an emergency. In this case the patient is markedly cyanotic and therefore has an oxygenation emergency. Switching to 100% oxygen is appropriate.

Which of the following parameters is NOT consistent with weaning from mechanical ventilation? A. A-aDO2 of 320 mmHg B. VT to 500 mL C. VD/VT of 0.50 D. RSBI of 86

The correct answer is : A Explanation : In order to wean from a ventilator, the patient's dead space-tidal volume ratio must be below 60% or .60. The rapid shallow breathing index must be below 106. Spontaneous tidal volume must be greater than 5 mL per kilogram. The alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this case, the dead space-tidal volume ratio is too high and the alveoli-arterial oxygen difference is too wide. These are the two criteria that indicate the patient is not ready to wean from the ventilator.

An adult patient is intubated with an 8.0 mm endotracheal tube. The high-pressure alarm is sounding. The tube is noted to be positioned at 28-cm at the lips. Chest rise is asymmetrical. What procedure should the respiratory therapist recommend? A. stat chest radiograph B. extubation C. arterial blood gas D. suction with a directional-tip catheter

The correct answer is : A Explanation : In this scenario, one may become anxious to choose an option that corrects the problem, with is likely to be an endotracheal tube that is advanced too far into the trachea. However, because there is no response like this, the respiratory therapist should confirm the concern with a chest X-ray, STAT.

A patient is in the emergency room (ER) with paradoxical chest movement on the right side. The trachea is deviated from mid-line. Which of the following should the respiratory therapist suspect? A. fractured ribs and a pneumothorax B. pleural effusion C. pulmonary embolism D. pulmonary edema

The correct answer is : A Explanation : Paradoxical chest movement on the right side is an indication of the presence of broken ribs. Deviation of the trachea indicates the presence of a pneumothorax.

A patient with ARDS is receiving mechanical ventilatory support. An end-tidal CO2 monitor shows a PetCO2 of 59 torr. The therapist should A. increase minute ventilation B. continue current therapy and ventilator settings C. recalibrate the capnography D. obtain an arterial blood gas

The correct answer is : A Explanation : Remember that the end-tidal CO2 data from a capnometer is usually 10 mmHg less than the corresponding arterial CO2 level. Thus, an end-tidal CO2 of 59 mmHg is consistent with an arterial CO2 of about 69 mmHg. The best solution to correct this problem is to increase ventilation.

Three hours after endotracheal extubation, a patient demonstrates moderate stridor. Which of the following should the therapist administer? A. racemic epinephrine B. viscous Xylocaine C. topical Lidocaine D. Albuterol sulfate

The correct answer is : A Explanation : Stridor is produced by inflammation in the upper airway and may be seen occasionally post extubation. The solution is dependent upon the degree of the stridor. Mild stridor may be treated by cool mist or racemic epinephrine. Moderate stridor requires racemic epinephrine at a minimum. Marked or severe stridor requires immediate intubation or other airway protection procedures.

Which of the following is considered subjective information? A. dyspnea B. breath sounds C. chest movement symmetry D. vital capacity

The correct answer is : A Explanation : Subjective information are those data that must be reported by the patient. This kind of data is also known as symptoms. Data that can be observed independent of the patient's input is known as objective information, otherwise called signs. Of the options here, dyspnea must be reported by the patient and therefore is the only subjective information offered.

A respiratory therapist notices the cuff pressure on an endotracheal tube is 10 cm H2O. After introducing 10.0 mL of air, the cuff pressure is 5 cm H2O. The patient is receiving positive pressure ventilation. The therapist should recommend A. replacing the ET tube B. clamping the pilot tube C. monitoring the patient D. initiating high frequency jet ventilation

The correct answer is : A Explanation : The ET tube cuff that fails to increase in pressure after introducing additional air is most likely damaged. When a part of an ET tube is damaged, the only acceptable option is to replace it.

The respiratory therapist should respond to the following graph (wave form shows a sudden fall to Zero end-tidal CO2) by checking for which of the following? A. disconnection in the patient-ventilator interface B. poor alveolar perfusion C. hypercarbia D. hypercapnia

The correct answer is : A Explanation : The capnograph wave form shows a sudden fall to Zero end-tidal CO2. This is most likely caused from a disconnection of the ventilator circuit.

A radiology report of a chest x-ray indicates the end of the radio-opaque line on an oral endotracheal tube is resting 1-cm above the carina. The respiratory therapist should suggest A. withdraw the ET tube 2 cm B. withdraw the ET tube 5 cm C. advance the ET tube 1 cm D. advance the ET tube 2 cm

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

An 81-kg (178-lb) adult male is orally intubated with a 6.5-mm endotracheal tube. The therapist reports difficulty removing secretions with the suction pressure set to 120 mmHg. The respiratory therapist will FIRST A. switch to an 8.0-mm ET tube B. increase suction pressure to 130 mmHg C. instill Albuterol down the ET tube D. decrease suction pressure to 100 mmHg

The correct answer is : A Explanation : The first problem that should be recognized is that the patient's endotracheal tube is too small for their ideal body weight. And 81 kg male should have an endotracheal tube size of 8 mm to 8.5 mm. Having the proper endotracheal tube size will permit a larger suction catheter to be used. This will drastically improve the efficiency of suctioning.

The following flow volume loop (loop is tall and skinny) is obtained from a 62-year-old factory worker. Which of the following could represent the patient's diagnosis? A. pulmonary fibrosis B. emphysema C. cystic fibrosis D. chronic bronchitis

The correct answer is : A Explanation : The flow volume loop is tall and skinny, indicating normal flows but abnormal volumes. This is consistent with a restrictive lung defect. The best answer is the disease that is restrictive in nature. In this case, only pulmonary fibrosis qualifies.

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

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

Which of the following can be done to most effectively increase the efficiency of suctioning through an endotracheal tube? A. increase suction catheter diameter (size) B. apply intermittent suction pressure during withdrawal of the catheter C. increase suction time D. increase suction pressure

The correct answer is : A Explanation : The proper way to increase suctioning effectiveness to an endotracheal tube is to first increase suction catheter size or diameter followed by increasing suction pressure and then increasing suction time. Therefore, the best answer is to increase the suction catheter diameter or size.

A patient receiving volume-controlled ventilation has a balloon-tipped pulmonary artery catheter in place. The respiratory therapist notices the PA waveform is ascending and descending with inflection points at 25 and 2 mmHg. Based on this information, the therapist should recommend A. advancing the catheter B. monitoring the patient closely C. rotating the catheter D. deflating the catheter balloon

The correct answer is : A Explanation : The pulmonary artery catheter waveform that has a high inflection point of 25 and a low inflection point of 0-2 mmHg is an indication that the tip of the catheter is in the right ventricle of the heart. The proper placement of this catheter is in the pulmonary artery. Therefore, advancing the catheter is indicated. This is done by inflating the balloon and allowing the catheter to sail into a proper position in the pulmonary artery.

A patient is being weaned from mechanical ventilation after being placed on the ventilator 3 days prior due to complications from a pulmonary infection. Which of the following would be most helpful in determining the status of the infection prior to weaning? A. CBC B. evaluate color of sputum C. temperature D. ABG

The correct answer is : A Explanation : To confirm the correction of an infection a complete blood count must be obtained. The complete blood count consists of a white blood cell count, among other data, that will show conclusive evidence regarding the presence and/or resolution of an infection. If the patient has an elevated white blood cell count ventilator weaning may not continue.

A patient is receiving 28% aerosol with the oxygen flow meter running at 6 L/min. What is the total flow of gas to the patient? A. 66 L/min B. 24 L/min C. 44 L/min D. 18 L/min

The correct answer is : A Explanation : To determine the answer to this question, one must have memorized the air-oxygen ratios. For 28%, the ratio is 10:1. This means that the Venturi mechanism will incorporate 10 parts air for every 1 part oxygen. One way to solve this problem is to add the ratio numbers together. (10+1= 11). Then, multiply that total by the indicated flow on the oxygen flow meter. In this case, we multiply 6 L per minute by 11. We get a total flow of 66 L/min.

A patient is receiving volume-controlled mechanical ventilation. Which of the following adjustments are appropriate to reduce autoPEEP? A. increase inspiratory flow rate B. decrease expiratory time C. increase tidal volume D. increase PEEP

The correct answer is : A Explanation : To reduce autoPEEP, expiratory time must be increased. This may be done by decreasing inspiratory time, which is accomplished by increasing inspiratory flow rate.

Which of the following would be most helpful in evaluating partial paralysis of the vocal cords? A. flow volume loop B. forced vital capacity C. infrared end-tidal CO2 detector D. ventilatory response to CO2

The correct answer is : A Explanation : Vocal cord paralysis and other fixed upper airway obstructions are best diagnosed by doing a flow-volume loop pulmonary function test. If present, the flow-volume loop will be described as "round" in shape. This is because a fixed obstruction causes an equal amount of resistance on both inhalation and exhalation.

Which of the following is associated with hypokalemia? A. flattened T waves B. inverted P waves C. significant Q waves D. respiratory acidosis

The correct answer is : A Explanation : When a patient has hypokalemia the ECG waveform will show flattened T waves. Conversely, if the patient has hyperkalemia, spiked T waves may be observed.

A patient is breathing rapidly and deeply while receiving oxygen by Venturi mask at 60% with a flowrate to 6 L/min. SpO2 is 88%. The therapist should A. increase the flow B. increase to 80% by Venturi mask C. decrease FIO2 to 0.4, flow rate 8 L/min D. intubate and mechanically ventilate

The correct answer is : A Explanation : When a patient is receiving oxygen by Venturi mask or any Venturi device, the respiratory therapist must ensure the total flow of gas going to the patient is meeting or exceeding the patient's inspiratory demand. This is especially true on high oxygen percentages. At 60% the air-oxygen ratio is 1:1. This would give us a total flow of 12 L per minute. A patient who is breathing deeply and rapidly is very likely exceeding 12 L per minute.

Which of the following may be helpful at relieving upper airway inflammation following endotracheal extubation? A. Albuterol B. racemic epinephrine C. Azmacort (Triamcinolone acetonide) D. methylprednisolone

The correct answer is : B Explanation : Upper airway inflammation may be treated with cool aerosol therapy or racemic epinephrine. If severe, intubation may be required. Other medications listed are not appropriate to reduce upper airway swelling.

A patient with a confirmed pulmonary embolism is receiving oxygen by non-rebreathing mask. When oxygen therapy was initiated, the reservoir collapsed completely with each breath. Thirty minutes later the reservoir bag collapses only partially with each breath. Respiratory rate has fallen from 28/min to 10/min. The therapist should respond by A. continuing current therapy B. beginning mechanical ventilation C. assisting ventilation with a manual resuscitator D. increasing flow to the NRB mask

The correct answer is : A Explanation : When the reservoir on a non-rereading mask collapses completely, one must suspect that the inspiratory flow the patient is producing is exceeding the total flow to the patient from the flow meter. The solution to this is to increase the flow. However, in this case after a few moments, the bag begins to collapse only partially which is normal. This indicates that the patient has become less distressed and that the oxygen therapy has been effective. Continuing current therapy is most appropriate.

A decreasing A-aDO2 is most closely related to which of the following? A. Increased pulmonary shunting B. decreasing atelectasis C. increasing venous admixture D. refractory hypoxemia

The correct answer is : B Explanation : A decrease in the oxygen tension gap between the alveoli and the artery (A-a gradient) indicates the patient is improving. The best interpretation, of the options given, is decreasing atelectasis. We do not acutally know that it is decreasing atelectasis specifically, but this option is the only one that would result in improvement of the patient and that can affect the alveolar-arterial oxygen gradient. An increase in venous admixture and an increase in pulmonary shunting would result in an increased A-aDO2 which is opposite of what is actually happening.

What is the primary purpose for a nitrogen washout test? A. determine closing volume B. determine FRC C. evaluate evenness of pulmonary gas distribution D. directly measure TLC

The correct answer is : B Explanation : A nitrogen washout test is used to determine three different lung volumes: TLC, RV, and FRC. For the NBCR exam the most important of those volumes is the FRC. Thus, when asked what a nitrogen washout test is for (or helium dilution test), the correct answer is FRC.

A patient with cystic fibrosis complains of shortness of breath during a postural drainage and percussion treatment after the head of bed is down for 10 minutes. A bronchogram has revealed consolidation of secretions in the lateral basal segment of the left lower lobe. The respiratory therapist should modify the therapy in which way? A. Use a pneumatic precursor B. Reduce the time in Trendelenburg position C. Switch to IPPB therapy D. Utilize reverse Trendelenburg position

The correct answer is : B Explanation : A patient who experiences difficulty tolerating the head of bed down during postural drainage and percussion may benefit from decreasing the duration of the treatment.

Which of the following most effectively makes up the humidity deficit for a patient who is orally intubated and receiving mechanical ventilation? A. bubble humidifier B. heated humidity C. HME D. centrifugal nebulizer

The correct answer is : B Explanation : A patient who is intubated cannot provide 100% humidity to their lungs because the ET tube bypasses the natural humidification processes of the body. In such case a humidification device is needed to make up the entire humidity deficit. Of the devices listed in the options, only a heated humidifier can accomplish this. A bubble humidifier is used with a nasal cannula and an HME device does not provide sufficient humidity. A centrifugal nebulizer is not used in conjunction with a mechanical ventilator.

A spiral CT scan would best evaluate which of the following? A. pneumonia B. pulmonary embolism C. sarcoidosis D. atelectasis

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

A 32-year-old 81-kg (178-lb) adult male is receiving mechanical ventilatory support. Settings are as follows: Mode Assist/control Mandatory rate 10 Total rate 18 Tidal volume 450 mL FIO2 0.6 PEEP 5 cm H2O The patient is cyanotic and anxious. The respiratory therapist will recommend which of the following? A. decrease mandatory rate B. increase tidal volume C. increase inspiratory flow rate D. increase FIO2

The correct answer is : B Explanation : All of the answers offered indicate a change in the ventilator settings. However, the question shows no evidence of arterial blood gas analysis. This is because a close examination of the ventilator settings will show that there is something wrong. The patient weighs 81 kg which would suggest a minimum tidal volume of 500 mL. (6 x 81 kg = 486 mL). The patient's set tidal volume is only 450 mL. This should be corrected.

Which pH level is expected for a COPD patient having an acute on chronic exacerbation? A. 7.35 B. 7.44 C. 7.49 D. 7.30

The correct answer is : B Explanation : An acute on chronic episode occurs when a COPD patient with compensated respiratory acidosis experiences an exacerbation, which causes their respiratory rate or overall minute ventilation 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 very high level to a new 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.

Pulmonary function results of a 22 year old patient who began smoking 1 year prior shows an airway resistance (Raw) of 1.7 cm H2O/L/sec. Which of the following represents an accurate interpretation of the measurement? A. neuromuscular disease B. normal C. acute asthma D. chronic asthma

The correct answer is : B Explanation : An airway resistance of 1.7 cmH2O/L/sec is considered normal. Elevated airway resistance is associated with asthma.

The respiratory therapist notes the following results of an arterial blood gas: pH 7.40 PaCO2 41 torr PaO2 46 torr HCO3 -24 mEq/L BE 0 mEq/L The patient reports no symptoms. Pulse rate, blood pressure and color are within normal limits. Which of the following can the therapist appropriately conclude? A. hemoglobin level is low B. results are consistent with a venous blood sample C. the analysis did not correct for temperature D. the patient has sickle cell anemia

The correct answer is : B Explanation : An asymptomatic patient with a PaO2 of 46 mmHg is not normal. The arterial blood gas data should be questioned for its validity. Of the answers offered, the most likely cause of these results is an accidental analysis of venous blood rather than arterial blood. These values are consistent with a venous blood gas sample.

A patient has a balloon-tipped, flow-directed catheter in place in the pulmonary artery. Which pressure can the respiratory therapist expect to obtain from the distal lumen? A. CVP B. PAP C. MAP D. SVR

The correct answer is : B Explanation : Because the distal lumen of a pulmonary artery catheter is in the pulmonary artery, the pressure monitored through that lumen is called the pulmonary artery pressure or PAP.

Which of the following do NOT contribute to total airway resistance for a mechanically ventilated patient with an endotracheal tube? A. bronchoconstriction B. upper half of the trachea C. endotracheal tube D. main bronchi

The correct answer is : B Explanation : Because the upper half the trachea is not communicating with the airway when an endotracheal tube is in place, it does not contribute to total airway resistance. The endotracheal tube cuff is inflated in the lower half of the trachea.

Which of the following equations would determine cardiac index? A. C.O. / ejection fraction B. C.O. / BSA C. C.O. x BSA D. stroke volume x heart rate

The correct answer is : B Explanation : Cardiac index can be calculated by dividing the cardiac output by the body surface area. The body surface area is given in units of millimeters squared. Body surface area rarely deviates from about 2 m², regardless of the size of the patient. So essentially, we could take cardiac output and divide it by two to get cardiac index. This can be done even if the body surface area of the patient is unknown. For example, if the cardiac output is 4 L/min, the cardiac index is about 2. Conversely, if cardiac index is 1.8, cardiac output could be estimated to be 3.6 L/min.

The following graphic (shows fluttering expiratory flow) from an orally intubated patient receiving mechanical ventilation is most likely caused by A. vocal cord paralysis B. condensate in the tubing C. fixed upper airway obstruction D. PEP therapy

The correct answer is : B Explanation : Condensate in the tubing will show up as a fluttering expiratory flow.

A patient receiving mechanical ventilator support is on the following settings and has the following clinical data: Mode SIMV Mandatory rate 14VT 500 mLFIO2 0.65PEEP 20 cm H2O Arterial blood gas results pH 7.38 PaCO2 43 torr PaO2 68 torr HCO3- 26 mEq/L BE +2 mEq/L Which of the following should the respiratory therapist recommend? A. increase FIO2 to 0.8 B. increase PEEP to 22 cm H2O C. decrease PEEP to 18 cm H2O, increase FIO2 to 1.0 D. increase FIO2 to 1.0

The correct answer is : B Explanation : Examination of the arterial blood gas reveals adequate ventilation with hypoxemia. To correct the PaO2, FIO2 or PEEP should be increased. When we look at these two parameters we see FIO2 is already at or above 60%. In this case, PEEP should be increased next.

A 31-week-gestional age infant has a respiratory rate of 30/min and a heart rate of 70/min while breathing room air. Five minutes after birth, the infant is acrocyanotic and has a weak cry. Following suctioning of the oropharynx the respiratory therapist should A. administer Atropine sulfate B. provide manual ventilation with the bag-valve C. begin chest compressions D. place the infant in an oxyhood at FIO2 0.40

The correct answer is : B Explanation : Five minutes after birth this infant is still showing signs of significant respiratory distress. Supporting ventilation with a bag-valve is appropriate.

What would most likely be indicated by an elevated CVP? A. pulmonary embolism B. fluid overload C. left heart failure D. increased pulmonary vascular resistance

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

A patient who is receiving volume-controlled ventilation has the following arterial blood gas and clinical data: Mode Assist/control Rate 14/min FIO2 0.50 (analyzed) VT 500 mL Arterial blood gas analysis was done at standard temperature and pressure (STP). Pressure (H2O) is 47 cm H2O pH 7.40 PaCO2 41 torr PaO2 358 torr HCO3- 25 mEq/L BE +1 mEq/L The respiratory therapist can conclude which of the following? A. The patient has a significant shunt B. The PaO2 result is erroroneous C. There is a fault in the Sanz electrode D. There is increased permeability in the alveolar capillary membrane

The correct answer is : B Explanation : If the patient is receiving 50% oxygen, the maximum oxygen tension in the alveoli is about 300 mmHg. This patient has a blood gas that shows the arterial oxygen level of 358 mmHg, which is impossible. It is impossible for the arterial oxygen level to be greater than the maximum alveolar oxygen tension level. Therefore, this blood gas represents an analyzer error.

Which of following parameters indicate a patient is ready to wean? A. MIP of -18 cm H2O B. pulmonary shunt of 16% C. PEEP of 10 cm H2O D. A-aDO2 of 410 mm Hg

The correct answer is : B Explanation : In order for a patient to be considered for ventilator weaning pulmonary shunting must be less than 20%, spontaneous respiratory rate must be less than 20 per minute, tidal volume must be at least 5 mL per kilogram or above 350 mL, and MIP must be greater than -28 cmH2O. The question is asking which of those parameters indicate the patient is ready to wean. All of them meet weaning criteria.

Which of the following is NOT normally part of a smoking cessation program? A. source of emotional support B. information on the cost of cigarettes and tobacco products C. education on the hazards of smoking D. nicotine replacement therapy

The correct answer is : B Explanation : In preparation to help the patient stop smoking, the healthcare giver may assess the emotional support required, evaluate the appropriateness of nicotine replacement therapy, and educate the patient on the hazards of smoking. Discussing the cost of cigarettes and other tobacco products will not be helpful.

Refractory hypoxemia is associated with which of the following diseases? A. Pleural effusion B. ARDS C. Chronic bronchitis D. Rocky Mountain Spotted Fever

The correct answer is : B Explanation : Of the options listed, the disease that is most closely associated with refractory hypoxemia is ARDS. Refractory hypoxemia is a condition where arterial oxygenation does not increase in spite of elevated FIO2.

An 18-year-old male patient is admitted to the emergency department (ED) after being rescued from an area lake in the middle of the winter. Core body temperature is 32 deg C. (90 deg F) He has the following blood gas values on room air. The blood gas values are not corrected for temperature: pH 7.33 PaCO2 46 mmHg PaO2 60 mmHg HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should A. provide a warming blanket to the patient B. start a heated aerosol by mask set at 45% C. provide manual resuscitation D. place the patient on mechanical ventilation

The correct answer is : B Explanation : One effective way to raise core body temperature is to administer heated aerosol.

A patient receives postural drainage and percussion. During the treatment, the patient develops rhonchi. The respiratory therapist should NEXT A. administer an IPPB treatment B. perform nasal tracheal suctioning C. discontinue treatment D. switch to PEP therapy

The correct answer is : B Explanation : The development of rhonchi during postural drainage and percussion is an indication that the therapy is working - is mobilizing secretions effectively and moving them upward where they can be expectorated or suctioned.

Which of the following transdermal nicotine preparations might the respiratory therapist recommend to help a patient stop smoking? A. gum B. patch C. MDI D. spray

The correct answer is : B Explanation : The question is asking for a transdermal nicotine preparation. "Transdermal" means "through-the-skin". A patch is the appropriate preparation were looking for.

A respiratory therapist is monitoring the volume of gas a patient can inhale after a passive exhalation of tidal volume. The therapist is attempting to observe which of the following? A. vital capacity B. inspiratory capacity C. inspiratory reserve volume D. total lung capacity

The correct answer is : B Explanation : The volume achieved when the patient inhales maximally after a passive exhalation of tidal volume is called inspiratory capacity. Comparatively, the maximum volume inhaled after complete active exhalation is called vital capacity.

A physician orders a chest radiograph on an ambulatory patient in the emergency department (ED) in response to a suspicion of pneumonia. Which of the following should be ordered? A. series of oblique-angle radiographs B. PA radiograph C. apical lordotic D. AP radiograph

The correct answer is : B Explanation : There are two types of chest x-rays that can be used - a PA x-ray and an AP x-ray. The PA x-ray is more accurate but requires the patient to be mobile. An AP x-ray is used for patients who are bedridden. In this case the patient is clearly ambulatory so A PA radiograph is most appropriate.

Quality control material has published values for pH of 7.30, PO2 of 85 mm Hg. Documentation indicates the range of pH is 0.5% and is 3% for PO2. Machine results are as follows: pH PO2 (mmHg) Run 1 7.33 83 Run 2 7.25 86 Run 3 7.29 80 Which quality control runs indicate the machine is out of control? A. 1 and 3 B. 2 and 3 C. 1 and 2 D. 1, 2, and 3

The correct answer is : B Explanation : This question is just a matter of math. It takes a few minutes to figure this one out. You must take each result and add and subtract 0.5% and 3% to the pH and PO2, respectively. You're looking for the Runs that are out of control. Runs two and three are the only ones out-of-control.

Which of the following values are required to determine a patient's inspiratory capacity (IC)? A. VC and RV B. VT and IRV C. RV and ERV D. ERV and IRV

The correct answer is : B Explanation : To answer this question, one must look at every option and mentally determine if the desired result can be reached. In this case, tidal volume can be added to inspiratory reserve volume (VT + IRV) to achieve inspiratory capacity (IC).

Which of the following is NOT used to determine the optimum level of PEEP for a patient receiving mechanical ventilation? A. steady QT of 4.4 L/min B. VD/VT ratio C. inflection point of a volume-pressure loop graphic D. sufficient oxygenation with no hemodynamic instability

The correct answer is : B Explanation : To determine optimal PEEP, the pressure which may be found at the upper inflection point of a flow pressure ventilator graphic, hemodynamic stability, and cardiac output are needed. Deadspace-tidal volume ratio is NOT helpful in determining optimal PEEP.

A respiratory therapist notices an increasing high-pitched noise coming from the upper airway of a child receiving 30% oxygen by heated aerosol. Which of the following would be most appropriate for further evaluation? A. MRI of the upper airway B. lateral neck radiograph C. CT scan of the upper airway D. bedside pulmonary function test with flow volume loop

The correct answer is : B Explanation : To evaluate the source of upper airway inflammation, a neck x-ray is most appropriate. This allows direct visualization of the tissue which can be helpful in determining the source and location of the inflammation.

Several hours after oral endotracheal extubation of an 8.0-mm tube, an adult patient begins to demonstrate inspiratory stridor. Which of the following would be most helpful to the patient? A. heated aerosol by mask B. racemic epinephrine C. Atropine sulfate D. Albuterol

The correct answer is : B Explanation : When a patient is extubated and has swelling of the upper airway tissues as demonstrated by stridor, racemic epinephrine is an appropriate medication to reduce swelling quickly. Another, less effective option, is to provide a cool mist. In extreme cases, such as marked stridor, reintubation or an emergency tracheotomy may be indicated.

A patient in the intensive care unit has an arterial catheter in place. The respiratory therapist notices the blood pressure from the arterial line is 95/70 mmHg. Blood pressure taken by a sphygmomanometer reads 110/78 mmHg. The patient is asymptomatic. The therapist should A. record the arterial line blood pressure B. record the sphygmomanometer blood pressure C. discard the blood pressure cuff D. calibrate the blood pressure cuff

The correct answer is : B Explanation : When blood pressure by sphygmomanometer (cuff) differs from the blood pressure obtained from an indwelling arterial line, the blood pressure taken by cuff is considered more accurate and reliable. Problems that may occur in the yard line include a clots in the line or bubbles in the transducer dome.

Which of the following should be looked at FIRST to assess for proper placement of an oral endotracheal tube? A. lateral neck radiograph B. left chest symmetry C. chest radiograph D. breath sounds

The correct answer is : B Explanation : When examining for proper placement of an endotracheal tube the first actions that should be taken should be those that are less time-consuming. Three of these options are all suitable for determining proper positioning of the endotracheal tube. However, the quickest way to determine positioning would be to examine the left chest symmetry. Breath sounds is appropriate but takes a little more time. Obtaining a chest radiograph will definitely help to confirm positioning but will take significant time. So, if asked "what is the first step one would take", the answer would be whatever is the quickest. But, if asked what is the best way to determine the position of the endotracheal tube, the best answer would be a chest x-ray.

A respiratory therapist is having difficulty advancing a suction catheter down a fenestrated tracheostomy tube while the inner cannula is removed. The cannula appears to meet resistance within a few inches from insertion. The therapist should A. remove the tracheostomy tube B. twist the catheter while attempting to advance C. inflate the cuff D. obtain a smaller suction catheter

The correct answer is : B Explanation : When suctioning somebody with a fenestrated tracheostomy tube, it must be remembered that the suction catheters can sometimes get stuck on the fenestration hole inside the tube. The best remedy for this is to twist the suction catheter until the end is clear of the hole.

An oxygen-dependent COPD patient is brought to the emergency room on 4 L/min oxygen by nasal cannula. From the paramedic documentation it is observed that respiratory rate has changed from 30 to 18 bpm. Heart rate has decreased from 120 to 90. Saturation is 92% and the patient's color has also improved. The therapist should do which of the following? A. discontinue oxygen therapy B. decrease flow to 1 lpm C. maintain current therapy D. switch to a partial rebreathing mask

The correct answer is : B Explanation : When the COPD patient receives more than 2 L/min. oxygen by nasal cannula, or more than 28% by any other means, it is possible to suppress their hypoxic drive and reduce their total ventilation. In this question the patient has a decreased respiratory rate from 30 to 18. The solution is to lower the supplemental oxygen. An oxygen flow rate of 1 to 2 L/min. by nasal cannula is most appropriate.

A pulmonary function study reveals a forced vital capacity (FVC) that is greater than a slow vital capacity (SVC). To which of the following can this be attributed? A. partial diaphragmatic paralysis B. poor patient effort on the SVC maneuver C. chronic air-trapping D. excessive effort on the FVC maneuver

The correct answer is : B Explanation : When the patient exhales slowly they are able to breathe out more air than if they were to exhale quickly. For this reason, and FVC should always be less than an SVC. If FVC is noted to be higher than the SVC, this is clear evidence that the patient's effort during the SVC maneuver was poor or insufficient.

The respiratory therapist notices the PtcO2 value on a transcutaneous monitor has suddenly jumped within the last minute. The therapist should suspect a problem with A. Insufficient heating of the electrode B. Adherence of the electrode to the skin C. Development of skin burns D. Overheating of the electrode

The correct answer is : B Explanation : When the transcutaneous PO2 value suddenly increases, the most likely cause is an electrode that is become dislodged from the skin and is reading the oxygen tension of the ambient air.

Which of the following parameters could be used to calculate tidal volume? A. PetCO2 and alveolar ventilation B. minute ventilation and alveolar ventilation C. minute ventilation and respiratory rate D. PECO2 and VD/VT

The correct answer is : C Explanation : If you take a minute ventilation and divide it by the respiratory rate you get tidal volume.

A patient with cystic fibrosis is receiving routine postural drainage and percussion. Which of the following may be used to determine the effectiveness of therapy? A. Sputum analysis B. DLCO measurements C. Chest radiograph D. Arterial blood gas analysis

The correct answer is : C Explanation : A chest radiograph, or x-ray, would be most helpful at determining the effectiveness of the postural drainage and percussion therapy. Arterial blood gas assessment and sputum analysis are too indirect to assess effectiveness. DLCO measurement is not related and not helpful.

A respiratory therapist is alerted by a low-volume ventilator alarm on a patient who has a chest tube drainage system in place. Set tidal volume is 600 mL while return tidal volume is 190 mL. The therapist should FIRST A. increase tidal volume to compensate B. insert an additional chest tube C. clamp the chest tube near the patient D. disconnect the chest tube from wall suction pressure

The correct answer is : C Explanation : A patient who is receiving mechanical ventilation, and has a chest tube drainage system in place, must be monitored carefully for lost volume through the lung through the chest tube drainage system. The clinical evidence of this is found in the return tidal volumes. If the volume administered is far greater than the return volume, volume must be being lost in the system somewhere. A loss of volume may be noticed by the excessive bubbling in the water seal compartment. To determine how it is being lost, the first step would be to clamp the chest tube near the patient. If bubbling in the water seal compartment stops, the volume being lost is most likely coming from a perforation in the lung. The patient requires surgery to repair this.

Which of the following laboratory examinations would be helpful in further assessing a patient with diabetic ketoacidosis? A. creatinine B. PD50 C. glucose level D. P50

The correct answer is : C Explanation : A patient with diabetic ketoacidosis primarily has a problem with the blood glucose level. Further assessment therefore can be done by examining the glucose level.

A patient with adult respiratory distress syndrome is receiving mechanical ventilation with a pressure-cycled ventilator. Which of the following alarms is most important? A. low pressure alarm B. high pressure alarm C. low-volume alarm D. I:E ratio alarm

The correct answer is : C Explanation : A pressure-cycled ventilator delivers a breath at a specific set pressure in spite of the volume achieved. The machines focuses on pressure without regard to delivered volume. Therefore, the respiratory therapist should be focused on volume. The most important alarm on a pressure-cycled ventilator is a low return volume alarm.

Which of the following data, if observed, would indicate improper positioning of an oral endotracheal tube? A. symmetrical chest rise B. radiologist reports the ET tube is level with the aortic arch C. ET tube markings at 29 cm D. chest radiograph shows tube 2 cm above the carina

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

A patient is undergoing a full cardiopulmonary arrest. The patient is intubated and is being monitored with an infrared capnographic device. PetCO2 data is showing 3%. Which of the following best explains this value? A. decreased C(a-v)O2 B. poor systemic perfusion C. poor alveolar perfusion D. increased PAO2

The correct answer is : C Explanation : An end-tidal CO2 of only 3% is low. This indicates poor ventilation. In looking at the answers the best one is poor alveolar perfusion. Poor systemic perfusion does not relate and increased alveolar oxygen tension does not relate to low alveolar CO2.

A patient with Status Asthmaticus has an airway resistance (Raw) of 3.2 cmH2O/L/sec. The patient's respiratory rate is 28/min and tidal volume is gradually falling. Saturation is 94% on 3 L/min. Which of the following would be most beneficial to the patient? A. mechanical ventilation with pressure support B. helium/oxygen mixture 80%/20% C. helium/oxygen mixture 70%/30% D. increase oxygen to 4 L/min

The correct answer is : C Explanation : Asthma is often associated with high airway resistance. When unable to lower airway resistance through bronchodilation, such as is seen with status asthmaticus, the use of helium-oxygen mixtures may be helpful. 70-30% Heliox therapy is appropriate because the 30% oxygen is closest to the 3 L/min. oxygen the patient is receiving by nasal cannula.

Quality control data for an arterial blood gas analyzer is plotted on a graph that has a range of 4 standard deviations (2 SD up and 2 SD down). Points on the graph show a gradual rise from below the mean to above the mean. All points are within 2 SD of the mean. The respiratory supervisor should A. replace the electrodes B. remove this machine from service C. monitor this machine closely D. call the medical director for direction

The correct answer is : C Explanation : Because all points on the blood gas graphs are within two standard deviations of the mean, the blood gas machine is technically in control. But the use of the word gradual rise means that there is a trend upward. Whenever there's a trend you need to monitor that machine because the trend may ultimately rise above the two standard deviations. You do not need to remove the machine from service or perform any kind of maintenance when a trend is observed - only monitor.

The supply of flu vaccination is limited as a result of short supply. The respiratory therapist would suggest prioritizing administration of the vaccine to which of the following groups of people? A. hospital administrators B. children C. healthcare workers D. teachers

The correct answer is : C Explanation : Because healthcare workers are important in helping others who are sick, vaccinations and other healthcare should be provided to healthcare workers first.

After performing minimum seal technique on an 80-kg (175-lb) patient who is orally intubated with an 8.0-mm ET tube, the cuff pressure is measured by manometer and found to be 36 cmH2O. Which of the following can best explain this? A. tracheomalacia B. ruptured cuff C. transesophageal fistula D. tracheal stenosis

The correct answer is : C Explanation : Because the minimum seal technique was used (also called minimum occluding volume), we know that the cuff is touching the tracheal tissues. However, the pressure required to do so is far above the normal pressure. This would indicate that the space inside the trachea is larger than normal. The cause of this is most likely a transesophageal fistula.

A postoperative patient is not progressing with sustained maximal inspiration therapy and refuses to cough because of pain along the incision site when doing so. The respiratory therapist should instruct the patient to A. pause at the top of each inspiration B. attempt coughing 1 hour after pain medication has been administered C. press a pillow against the incision site when coughing D. avoid coughing until pain subsides

The correct answer is : C Explanation : Explosive coughing by a postoperative patient can inadvertently open incision sites. To prevent this, splinting the site with a pillow is an appropriate option.

A patient with a history of hyper-reactive airway disease is having difficulty expectorating because the sputum is thick and tenacious. Which of the following medications should the respiratory therapist recommend? A. Solu-Mederol B. Beclamethasone (Beclovent) C. Acetylcysteine (mucomyst) D. Spiriva (tiotropium bromide)

The correct answer is : C Explanation : Hyperactive airway disease is associated with diseases such as asthma and consist of bronchoconstriction and inflammation. This patient appears to have difficulty with bronchoconstriction and thick secretions. Therefore, a mucolytic, such as acetylcysteine, and Solu-Medrol are appropriate.

A respiratory therapist begins manual resuscitation on a patient who is found apneic for several minutes. Capnography with an infrared device is instituted. The therapist will expect to see which of the following initial capnographic trends? A. gradual decrease in end-tidal CO2 B. steady hypocapnia C. rise in end-tidal CO2 D. steady hypercapnia

The correct answer is : C Explanation : If the patient is found not to be breathing for several minutes but then receives manual resuscitation, the initial end-tidal CO2 reading will be low but will be followed by a steady rise in the end-tidal CO2. This is because once ventilation begins CO2 begins crossing the alveolar capillary membrane and filling up the alveoli, and ulimately shows up on the capnograph.

A female patient who is morbidly obese has an 8.0 mm tracheostomy tube. She has been placed on an ulcer prevention mattress in the Intensive Care Unit. Following transport to the new bed, the nurse calls a respiratory therapist to assess her because she is complaining of air hunger. Diffuse dry crackles are auscultated with crepitus noted upon palpation. These findings are most closely associated with A. atelectasis B. pneumothorax C. subcutaneous emphysema D. secretions in the airway

The correct answer is : C Explanation : In this case, the respiratory therapist should assume that the tracheostomy tube has become dislodged due to the patient transfer. Positive pressure ventilation through the tube while it was dislodged has resulted in subcutaneous emphysema, or air under the skin outside of the lung. Auscultation usually reveals dry crackles and palpation reveals a crepitus sensation.

The following data is available for a patient receiving volume-controlled mechanical ventilation: 6 am 9 am Ppeak (cm H2O) 25 32 Pplat (cm H2O) 15 17 Set VT (L) 0.6 0.6 PEEP (cm H2O) 5 5 Which of the following is most consistent with these data? A. the patient has atelectasis B. the patient has ARDS C. the patient is in need of endotracheal suctioning D. the patient's pulmonary compliance is significantly decreasing

The correct answer is : C Explanation : In this problem, peak pressures are rising but plateau pressures are generally static. This indicates a decrease in dynamic compliance and is caused by a temporary condition such as a kinked ET tube, excess water in the circuit, bronchoconstriction, or secretions in the airway. Three of the options would cause a decrease in static compliance. Only endotracheal suctioning relates to dynamic compliance.

A post-op adult patient achieved an inspiratory capacity of 1800 cc with an incentive spirometer prior to surgery. After the surgery, the patient appears to be confused on how to use the incentive spirometer. The therapist notes the patient is having difficulty getting the balls to rise. The therapist should A. coach the patient more diligently B. administer oxygen at 5 L/min nasal cannula C. switch to a volume-type device D. assess the patient for the cause of the confusion

The correct answer is : C Explanation : Incentive spirometry comes in two types: a flow type, which requires keeping balls floating, and the volume type, which simply measures inspiratory capacity. The volume type of incentive spirometer is considered to be the easiest. It is appropriate to switch to a volume spirometer when the patient is having difficulty with a flow type spirometer.

A written teaching plan for a pediatric patient with chronic asthma should include A. proper titration of bronchodilator dosage B. titration of oxygen C. PEFR monitoring and proper MDI use D. determination of oxygen saturation

The correct answer is : C Explanation : Monitoring one's peak flow, using a metered-dose inhaler correctly, and learning to detect early symptoms of oncoming bronchoconstriction are all important aspects of a teaching plan for a pediatric asthma patient. A patient should never be encouraged or instructed to adjust their prescribed frequency for any type of therapy by the respiratory therapist.

While transporting a patient from a helicopter landing pad to the emergency department (ED), the respiratory therapist notices the ET tube has become unsecured. To best confirm to location of the ET tube, the therapist should recommend A. observe chest rise B. palpate the trachea C. chest radiograph D. auscultate breath sounds

The correct answer is : C Explanation : One may quickly determine the location of an endotracheal tube by observing chest rise and auscultating breath sounds. However, neither of these methods are conclusive. The only way to confirm proper placement is through a chest x-ray.

For which of the following conditions is PEP therapy most beneficial? A. Postoperative recovery B. ARDS C. pneumonia D. myasthenia gravis

The correct answer is : C Explanation : PEP therapy is beneficial at removing secretions. Of the options given, only pneumonia is a disease where secretions are a primary concern.

Following abdominal surgery, a patient is attempting to perform sustained maximal inhalation (incentive spirometry) but repeatedly falls asleep during the procedure. The therapist should modify the therapy in which of the following ways? A. intubate and begin mechanical ventilation B. administer Narcan C. switch to IPPB with face mask D. hold therapy until the patient becomes more alert

The correct answer is : C Explanation : Patients often receive incentive spirometry after surgery. This therapy is considered to be most effective at preventing postoperative complications. However, some patients come out of surgery heavily sedated and sleepy and are unable to comply with the demands of incentive spirometry. In this case, a modification in therapy that accomplishes the same objective must be made. One appropriate modification is to use IPPB. A face mask is appropriate because the patient is not alert enough to use a mouthpiece.

A 35-year-old female patient presents to the emergency room with droopy eyelids and facial muscles. She complains of frequent fatigue that improves with rest, but then returns. Which of the following diagnostic procedures are not indicated? A. basic spirometry B. arterial blood gases C. nitrogen washout D. Tensilon challenge

The correct answer is : C Explanation : The patient is showing signs of myasthenia gravis for which basic spirometry, a Tensilon challenge, and an arterial blood gas are indicated. A nitrogen washout would detect lung volume changes associated with chronic obstructive pulmonary disease, but has little to no value for a patient with myasthenia gravis.

A 62-year-old man admitted to the emergency room with chest pain complains of shortness of breath after a bronchodilator treatment. Further examination reveals the patient is diaphoretic. The ECG wave form shows occasional PVCs. Which of the following would be most helpful in further determining the cause of the patient's condition? A. arterial blood gas analysis B. cardiac catheterization with fluoroscopy C. 12-lead ECG D. cardiac stress test with Adenosine

The correct answer is : C Explanation : The presence of chest pain, diaphoresis, and PVCs are all indicators of cardiac distress. A 12-lead ECG will help to further evaluate the level of distress and potentially the cause of the problem. The concern would be myocardial infarction.

The sudden sounding of a high-pressure ventilator alarm is noted on a patient receiving volume controlled mechanical ventilation. The respiratory therapist notes the endotracheal tube is at 27 cm at the teeth and that breath sounds are absent when auscultating the left hemithorax. The therapist should immediately A. advance the endotracheal tube until breath sounds can be auscultated over the left chest B. prepare for insertion of chest tubes in the left thorax C. withdraw the endotracheal tube until breath sounds are bilateral D. check the air pressure of the tube cuff

The correct answer is : C Explanation : The proper placement of an oral endotracheal tube is when the teeth or lip line matches with markings on the tube somewhere in the low 20s. This endotracheal tube is 27 cm at the teeth, indicating the tube is advanced too far. In this case, it is likely the tube has advanced into the right mainstem bronchus, which would cause a high-pressure alarm to occur. The appropriate action is to withdraw the endotracheal tube until breath sounds are bilateral.

A patient is receiving an initial pulmonary rehabilitation visit to the clinic. To orient the patient which of the following should be taught to the patient concerning the goals and benefits of pulmonary rehabilitation? A. return to normal life B. achieve normal pulmonary function C. increase exercise tolerance and improve performance of ADLs D. reduce the need for oxygen

The correct answer is : C Explanation : The purpose of a pulmonary rehabilitation program for a patient with COPD relates to improving their life from their point of view. Legitimate goals include recognizing signs of infection, reducing hospitalizations, increasing their ability to perform activities of daily living, and generally increasing exercise tolerance. Because lung disease cannot be reversed it is unreasonable to think that we can return the patient to normal life or reduce their need for oxygen.

Which of the following is needed to calculate minute alveolar ventilation? A. PAO2 and tidal volume B. VD/VT and PAO2 C. tidal volume, weight, respiratory rate D. C(a-v)O2 and VT

The correct answer is : C Explanation : There are three items you need to calculate a patient's minute alveolar ventilation- tidal volume, respiratory rate, and the patient's weight in pounds. If the tidal volume is not given you may need to calculate the tidal volume by looking at minute ventilation and dividing it by the rate first.

Which of the following ventilator circuit change frequencies is important to minimize nosocomial infections among patients receiving mechanical ventilation? A. monthly B. daily C. every 7 days D. when soiled

The correct answer is : C Explanation : This question is about infection control and requires you to memorize that ventilator circuits must be changed every seven days. It may occur differently in your hospital, but you must memorize seven days for the exam.

A patient in the intensive care unit has the following clinical and laboratory data: PB 747 mm Hg PH2O 47 mm Hg pH 7.28 PaCO2 52 mm Hg PaO2 70 mm Hg HCO3- 27 mEq/L BE +2 mEq/L FIO2 0.6 SaO2 1.0 CvO2 12 vol% CaO2 17 vol% Hb 15 gm/dL Which of the following represents the C(a-v)O2? A. 25 vol% B. 2 vol% C. 5 vol% D. 200 vol%

The correct answer is : C Explanation : To answer this question, one must complete two calculations. First, CaO2 and CvO2 must be determined. Once CvO2 is subtracted from CaO2, 5 vol% is the closest answer.

A physician suspects a patient has a restrictive pulmonary defect. Which of the follow tests would be most helpful at determining this? A. Forced vital capacity B. Fev1.0/FVC% C. Slow vital capacity D. Fev1.0

The correct answer is : C Explanation : To determine if the patient has a restrictive pulmonary defect, pulmonary function volumes must be obtained. Specifically, slow vital capacity (SVC) or forced vital capacity (FVC) are used for this evaluation. An SVC is more accurate than a FVC. SVC should be chosen first if given the option.

A physician suspects a patient has a cancerous mass in the right lobe as identified by a PA chest radiography. Which of the following should the therapist recommend to examine the nature and size of the mass? A. pulmonary angiography B. A-P chest radiograph C. series of oblique chest radiographs D. V/Q scan

The correct answer is : C Explanation : When a large round-shaped infiltrate is observed on a PA or AP x-ray, more information should be gathered. The suspicion would be that the patient has a cancerous mass in the lungs. This can, in part, be confirmed by doing another x-ray from a different perspective. A series of x-rays taken from different angles will help reveal the three-dimensional shape of the infiltrate. If the infiltrate is round shaped from other perspectives as well, the infiltrate is likely a mass of some sort. A biopsy would be indicated to determine if the mass is cancerous or benign.

A patient is on 80%/20% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min? A. 14 L/min B. 8 L/min C. 18 L/min D. 16 L/min

The correct answer is : C Explanation : When helium-oxygen mixtures are run through flow meters that are intended for oxygen only, the indicated flow on the flow meter is inaccurate. This is because the helium-oxygen mixture is less viscous and does not push the indicator ball up as much as does oxygen. In this case, a correction factor must be used depending upon the mixture percentages. For an 80/20% mixture a correction factor of 1.8 must be used. A 70/30% mixture has a correction factor of 1.6 and a 60/40% mixture has a correction factor of 1.4. In this problem the 80/20% mixture factor of 1.8 must be multiplied by the indicated flow on the oxygen flow meter to calculate actual total gas flow. When we do this we get a total gas flow of 18 L/min.

Which of the following is an important element of instruction to a home care patient who will be receiving continuous oxygen therapy at 2 L/min by nasal cannula? A. check oxygen concentrator flow rate once a week B. run a flow calibration check once monthly C. do not change flow rate without a physician order D. increase flow rate during exercise

The correct answer is : C Explanation : When instructing a home care patient on the use of their oxygen concentrator, and using oxygen in general, the respiratory therapist must include those things that are appropriate for the patient. In this question no open flames, use of grounded plugs only, and a restriction on changing the flow rate without a physician order are appropriate instructions. It is inappropriate to ask the patient to check or calibrate the concentrator's flow rate once a week. This sort of maintenance should be done by a respiratory therapist.

While running quality control material through a blood gas analyzer, the therapist notes that 4 consecutive data points are beyond 2 SD from the mean. The therapist will A. monitor the machine closely for several days B. report the problem to the medical director C. remove the machine from service D. continue running quality control material until corrected

The correct answer is : C Explanation : When monitoring the quality control data for an arterial blood gas machine the points on the graph, which show the actual values of the quality control material, should be between the upper control limit and the lower control limit (two standard deviations above and below the mean for a total of a 4 standard deviation range). In this case there are several consecutive points that are beyond the two standard deviations and therefore the machine is considered out of control and should not be placed in service but removed. Blood gases should not be run on that machine until the problem has been resolved. More importantly, blood gas data should not be reported as part of the patient's medical record because they are likely inaccurate.

A COPD patient is in the emergency room. A quick assessment reveals a respiratory rate of 28, spontaneous tidal volume of 200 mL, use of accessory muscles, and venous distension. The patient is receiving oxygen by nasal cannula at 2 L/min and oxygen saturation by pulse oximetry is 88%. Which of the following would provide most help to the patient at this time? A. flutter valve therapy B. non-rebreathing mask C. NIPPV D. adult mechanical ventilation

The correct answer is : C Explanation : When the COPD patient has ventilatory difficulty beyond and above their baseline, managing their work of breathing is paramount. If not managed, the COPD patient can end up on a mechanical ventilator quite easily. The key modality used to decrease work of breathing is bilevel therapy, or noninvasive positive pressure ventilation. This allows time for the patient to breathe easier while other processes in the body are corrected. For instance, a COPD patient with an infection and consequent ventilatory difficulty may benefit from bilevel therapy until antibiotics have taken affect.

A patient receiving oxygen at home via a molecular sieve device complains that he is not feeling any oxygen coming from the cannula. The respiratory therapist should A. instruct the patient to do a flow check/calibration of the concentrator B. inform the patient that this finding is normal C. have the patient utilize portable oxygen until the oxygen concentrator is examined D. instruct the patient to call the manufacturer of the concentrator

The correct answer is : C Explanation : When the patient complains of not receiving enough oxygen or when the function of oxygen delivery device is a question, the first best option is to ensure adequate oxygenation of the patient by switching to another modality that is known to be functioning properly.

An adult patient with asthma is receiving Xopenex by small volume nebulizer T.I.D. at a dosage of 1.25 mg. The patient complains of dizziness, tingling in his fingers, and anxiety with each treatment. The therapist should A. switch to Pulmicort 0.5 mg B. decrease frequency to BID C. change dose to 0.63 mg D. increase dose to 1.88 mg

The correct answer is : C Explanation : When the patient has an adverse reaction to a specific medication, the therapist must modify the therapy. Modifying therapy means to change to a different method or modality that accomplishes the same objective. In this case, the best option is to reduce the dose of Xopenex to 0.63 mg. Xopenex comes in 2 dosages that are appropriate for adults - 1.25 mg and 0.63 mg. If a patient is having adverse reaction at the higher dose, the lower dose may be attempted. Although not offered here, it would also be appropriate to change medications to another bronchodilator such as albuterol or Atrovent.

A patient who requires 10 cmH2O of PEEP when mechanically ventilated is being transported. A spring PEEP valve will be used in conjunction with the resuscitation bag. Where should the PEEP valve be placed? A. proximal to the inlet valve B. distal end of the reservoir C. distal to the outlet valve D. between the bag and patient interface

The correct answer is : C Explanation : When using a resuscitation bag for a patient who requires contant PEEP, a PEEP valve may be placed at the distal end of the outlet valve. Placing the valve anywhere else will not provide positive end-expiratory pressure.

Which of the following chest radiograph observations is most closely associated with pleural effusion? A. tree-in-winter pattern B. reticulogranular pattern C. complete opacification D. concave interface border

The correct answer is : D Explanation : A concave interface border is associated with the pleural effusion. A reticulogranular pattern is associated with adult respiratory distress syndrome. Complete opacification of the lung is related to pneumonia.

A patient with congestive heart failure, who is demonstrating moist crepitant rales upon auscultation, would benefit most from A. administration of aminoglycocide medication B. postural drainage and percussion C. PEP therapy D. Lasix

The correct answer is : D Explanation : A patient with congestive heart failure who is demonstrating moist crepitant rales is most likely in a state of fluid overload. The administration of Lasix is most appropriate in order to diurese the patient.

A pulmonary rehabilitation patient is having difficulty complying with a smoking cessation program. A physical and psychological screen reveals a heavy physiological dependence and a low psychological dependence on smoking. Which of the following is appropriate? A. Valium B. psychological counseling C. Versed D. nicotine replacement therapy

The correct answer is : D Explanation : A physiological dependence on nicotine can be overcome slowly by having the patient use nicotine replacement therapy. This may include chewing gum with nicotine or transdermal preparations.

The following pulmonary function data is obtained from a 65-year-old adult male who is 5 ft 2 in (157-cm) tall and weighs 120-lbs (55-kg). Percent (%) of Predicted SVC 75 FVC 72 FEV1.0 39 FEF25-75 52 FEF200-1200 76 DLCO 89 Which of the following most accurately represents the patient's condition? A. moderate obstructive defect B. normal spirometry C. severe restrictive defect only D. mild restriction with severe obstructive defect

The correct answer is : D Explanation : A slow vital capacity of 75% indicates a mild restriction. An FEV1 of 39% of predicted indicates a severe obstruction.

The respiratory therapist working in a clinic receives a call from a patient who has asthma and is only able to achieve 60% of their normal baseline peak flow measurement. The therapist should advise the patient to A. check flows again in one hour, call if less than 50%of expected B. take a rescue medication every 15 minutes for 2 hours, recheck flows C. take a rescue medication, check flows in one hour D. call the doctor immediately

The correct answer is : D Explanation : According to national asthma guidelines a peak flow measurement of 60% of baseline is a direct indication to seek additional medical help.

Which of the following should be monitored for a ventilator-dependent newborn with IRDS? A. gas distribution (SBN2) in the lungs B. urine specific gravity C. pH D. fluid input and output

The correct answer is : D Explanation : All choices are indicated while monitoring a critically ill neonate receiving mechanical ventilation. I & O fluid monitoring is essential. Managing acid-base balance and the artificial airway are also essential.

In which of the following situations should an HME be replaced with heated humidity? A. afebrile conditions B. patient has asthma C. patient is hyperthermic D. presence of thick secretions

The correct answer is : D Explanation : An HME should be changed if the patient has thick secretions or is hypothermic. If the patient is hypothermic he or she cannot breathe out enough heat into the exchanger to capture and rebreathe. In that case the device should not be used.

A COPD patient is receiving oxygen at 2 L/min by a pulse-dose oxygen delivery device. The patient complains of shortness of breath and feels she is not getting enough oxygen. The home care respiratory therapist should A. increase the flow rate B. switch to a Venturi mask at 40% C. encourage the patient to relax and call her physician D. switch to a continuous oxygen regulator and normal nasal cannula

The correct answer is : D Explanation : Any time a patient is having difficulty or complains that they are not receiving enough oxygen through their oxygen delivery device, the first step is to ensure that they are receiving enough oxygen by changing or replacing the device immediately. In this case the patient is using a pulse dose oxygen delivery device. On these devices there is an option to switch to continuous flow. That is the best option until the problem can be determined and solved. Another good option would be to have the patient use a standard oxygen cylinder while the respiratory therapist troubleshoots and solves the problem.

An infant is delivered and has a one-minute APGAR score of 5. The infant is placed on the radiant warmer. What other equipment would be most helpful at this time? A. non-rebreathing mask B. croup tent C. nasal cannula D. oxygen hood

The correct answer is : D Explanation : From examining Apgar scores one can determine the best therapy for the patient. An Apgar score of 1 to 3 requires CPR. An Apgar score of 4 to 6 necessitates supplemental oxygen and general stimulation. An Apgar score of 7 to 10 requires only routine care of the infant. No supplemental oxygen is required in this case, one must know that an oxygen hood is the most desirable method to deliver supplemental oxygen to the patient who has an Apgar score of five.

Hypervolemia would first be manifested in which of the following values? A. SVR B. mPAP C. wedge pressure D. CVP

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

A patient is in the intensive care unit following the repair of a hip fracture. Within 2 hours after surgery, the patient is hypotensive and is increasingly short of breath. Heart rate has risen from 90 to 110 bpm. Which of the following test results would be most helpful at this time? A. COHb B. Creatinine C. Arterial blood gases D. Hb and HCT

The correct answer is : D Explanation : Immediately following surgery a patient that is hypotensive is most likely hemorrhaging from a leaky vessel from the operation. To confirm the loss of blood an Hb and HCT may be done to examine hemoglobin level. If low, the patient should be sent back to surgery to explore for a leak but not before blood is adminisitered, if the is an option.

A febrile patient has the following blood gas results: (results are not corrected for temperature) pH 7.35 PaCO2 44 mmHg PaO2 28 mmHg HCO3- 24 mEq/L BE 0 mEq/LO2 Sat 90% Which of the following requires attention? A. Severinghaus electrode B. Sanz electrode C. spectrophotometer D. Clark electrode

The correct answer is : D Explanation : In this arterial blood gas a PaO2 of 28 mmHg is reported. That is too low for the patient to still be alive and therefore this data is probably faulty. The question is essentially asking which electrode would you suspect is not working properly. The Clark electrode is another name for the PO2 electrode. The Sanz electrode is another name for the pH electrode and the Severinghaus electrode is called the CO2 electrode.

An infant remains cyanotic after the administration of high level supplemental oxygen. The physician is concerned about the presence of a condition, patent ductus arteriosis, and asks the respiratory therapist to gather data to confirm or rule out that condition. Which of the following data will the therapist require? A. blood glucose B. chest radiography C. CT scan with contrast D. blood gases from the umbilical and radial arteries

The correct answer is : D Explanation : Patent ductus arteriosus (PDA) is a congenital abnormality that may be found in some infants. If found, the correction is surgery. To diagnose PDA, the PO2 is analyzed from the right brachial artery and the umbilical artery. If PO2 differs by more than 15 mmHg then PDA is present.

Which of the following could result from the application of positive end-expiratory pressure? A. increased A-aDO2 B. reduced intra-thoracic pressure C. reduced alveolar ventilation D. reduced cardiac index

The correct answer is : D Explanation : Positive end expiratory pressure, like all positive pressure ventilation techniques, leads to decreased venous return, decreased cardiac output, and decreased cardiac index.

A respiratory therapist is preparing for defibrillation on a patient with pulseless ventricular tachycardia. Which of the following should NOT be part of that preparation? A. set the defibrillator to deliver 360 joules B. prepare to administer supplemental oxygen C. set up for manual ventilation with a bag/valve D. set the defibrillator's synchronization to ON

The correct answer is : D Explanation : Pulseless ventricular tachycardia should be treated with defibrillation. When defibrillating a deadly cardiac rhythm, the synchronization setting on the defibrillator should be set to "off".

A patient with lobular pneumonia is receiving supplemental oxygen at 40% by Venturi mask. The following clinical and laboratory data is available: VT (spont) 600 mL RR 18/min pH 7.48 PaCO2 33 mmHg PaO2 49 mmHg HCO3- 23 mEq/L BE -1 mEq/L The respiratory therapist should recommend A. increase oxygen to 50% B. switch to nasal cannula at 2 L/min C. sedate the patient D. switch to a non-rebreathing mask

The correct answer is : D Explanation : The degree of hypoxemia indicates a need for maximum oxygen percentage. In this case a non-rebreather mask is most appropriate. All other options would either be insufficient, increase hypoxemia, or are unrelated.

A patient with a history of asthma reports to the emergency department after self-treating bronchoconstriction for the past 3 days. Periodic relief has been achieved but the patient is in current distress and is wheezing bilaterally. Which of the following treatment actions would be most appropriate? A. sildenafil, IV B. administer Sublimaze, PO C. full pulmonary function testing with DLCO measurement D. continuous aerosolized bronchodilator at 7 mg/hr

The correct answer is : D Explanation : The patient shown in this question obviously demonstrates lack of response to bronchodilator therapy. Of the options offer, IV methylprednisolone and continuous aerosolized bronchodilators are appropriate.

A patient reports to the emergency department with shortness of breath, bilateral wheezing, and a low-grade fever. This condition has persisted for several days. The patient has had multiple breathing treatments with only temporary relief. Which of the following is appropriate to recommend? A. IV Sublimaze B. oral antibiotics C. IV Doxapram (Dopram) D. continuous bronchodilator therapy

The correct answer is : D Explanation : The patient who has persistent bilateral wheezing but who is responding somewhat to bronchodilator therapy should continue that therapy. Of the options offered continuous bronchodilator therapy is most appropriate.

A physician has ordered administration of 80% / 20% heliox therapy to a spontaneously breathing patient. Which of the following gas delivery devices should the respiratory therapist plan on using? A. air-entrainment mask B. simple mask C. nasal cannula D. nonrebreathing mask

The correct answer is : D Explanation : The proper modality to administer Heliox therapy is a non-rebreathing mask.

The expired air over one minute that participates in active gas exchange is one's A. anatomical gas exchange. B. respiratory quotient. C. minute ventilation. D. alveolar ventilation.

The correct answer is : D Explanation : The total expired air over 1 minute is known as minute ventilation. Not all of this air participates in gas exchange due to anatomical dead space. Once anatomical deadspace is removed, the remaining ventilation is known as alveolar minute ventilation or simply alveolar ventilation.

A 62-year-old male has ventricular tachycardia. The patient is not alert and will not respond to verbal stimuli. A pulse is palpable. The respiratory therapist will respond by A. administering methyl prednisone, IV B. administering Isuprel (Isoproterenol) C. defibrillating the patient D. performing cardioversion

The correct answer is : D Explanation : The treatment for ventricular tachycardia without a pulse is defibrillation at 300-360 W. Cardioversion, however, is used with atrial arrhythmias and ventricular tachycardia where there is a pulse present.

A respiratory therapist is measuring the gas volume from a patient who exhales maximally after inhaling to inspiratory reserve volume. Which of the following volumes is the respiratory therapist attempting to observe? A. inspiratory reserve volume B. expiratory reserve volume C. total lung capacity D. vital capacity

The correct answer is : D Explanation : The volume exhaled maximally after a maximum inhalation is called vital capacity.

Which of the following is an appropriate strategy when caring for a patient with ARDS who is receiving mechanical ventilation? A. strive for C.I. values less than 2.0 L/min/m2 B. keep the patient in reverse trendelenburg position C. keep PEEP as high as possible D. keep FIO2 at 60% or below if possible

The correct answer is : D Explanation : There are two primary strategies for patients who have adult respiratory distress syndrome and are receiving mechanical ventilatory support - keep mean and peak airway pressures as low as possible and keep FIO2 below 60% as much as possible.

The respiratory therapist is making a plan of care for a patient with mycoplasma pneumonia who needs assistance with airway clearance of secretions. In which order should therapy be performed? A. coach coughing, bronchodilator, percussion, postural drainage B. postural drainage, percussion, bronchodilator, coach coughing C. percussion, postural drainage, bronchodilator, coach coughing D. bronchodilator, percussion, postural drainage, coach coughing

The correct answer is : D Explanation : There is an oder at which procedures should be done to mobilize and remove secretions. The first steps are to open the airway, dislodge the sputum, move dispute into the upper airway, and then remove the sputum through coughing or suctioning.

A patient with CHF has the following input/output history Yesterday Today IN 1900 mL 2100 mL OUT 1000 mL 1100 mL Which of the following clinical findings is most likely to be observed? A. bronchial wheezing B. friction rub C. decreased egophony D. moist crepitant rales

The correct answer is : D Explanation : This CHF patient is obviously retaining fluid because he is receiving more fluid in that he is putting out. The clinical finding most associated with fluid retention is moist crepitant rales. Fine rales are associated with atelectasis but moist rales is associated with fluid retention, especially congestive heart failure (CHF).

A patient receiving volume-controlled ventilation weighs 75 kg (165 lb) and is 5 ft, 7 in (170 cm) tall and within ideal body weight. The following clinical data is available: Mode SIMV Mandatory rate 12 Total rate 32 FIO2 0.40 VT 500 mL Exhaled minute volume 9.6 L pH 7.44 PaCO2 32 torr PaO2 97 torr HCO3- 22 mEq/L BE +1 mEq/L The respiratory therapist should recommend which of the following changes? A. Administer sedative medication B. Add inspiratory pause C. Reduce mandatory rate to 6 D. Institute pressure support of 5 cm H2O

The correct answer is : D Explanation : This patient has reduced spontaneous tidal volumes. This may be determined by taking minute ventilation and dividing it by rate. This calculation reveals a tidal volume of 300 mL, which is far below the minimum 5 mL/kg tidal volume needed to sustain life. The elevated respiratory rate, in conjunction with a low tidal volume, is an indication that the patient is in need of pressure support. Pressure support will help by increasing the size of spontaneous tidal volumes, which will help naturally lower rate and decrease work of breathing.

A patient shows signs of hypoxemia while on a heated aerosol set at 40% with the flow rate set to 8 L/min. The patient's minute ventilation is 38.0 L. Which of the following changes should be made? A. decrease FIO2 to 28%, maintain flow rate B. increase FIO2 to 0.5, maintain flow rate C. increase to FIO2 to 1.0 with a flow rate to 15 L/min D. increase flow rate to 10 L/min

The correct answer is : D Explanation : This question requires one to recognize that the flow rate is not meeting the patient's ventilatory demand. It requires a little math to determine how much total flow the patient is receiving. In this case the ratio for 40% is 3:1. If you add 3+1, you get 4. Then, if you multiply 4 times 8 L/min. you get a total flow of 32 L per minute. The patient's reported minute ventilation is 38 L per minute. This would cause the patient to entrain extra air and would ultimately lower FIO2, resulting in an increase in hypoxemia.

Which of the following data is needed to calculate minute alveolar ventilation? A. IBW, VD/VT B. PECO2, VT C. RSBI, VD/VT D. RR, VT, weight in lbs

The correct answer is : D Explanation : To calculate minute alveolar ventilation, three values must be known: the patient's weight in pounds, tidal volume, and respiratory rate. Respiratory rate multiplied by tidal volume is equal to minute ventilation. However, this question asks about minute ALVEOLAR ventilation. To determine alveolar ventilation one must first take tidal volume and subtract the dead space portion of each breath. That portion is estimated to be 1 mL per pound of ideal body weight. Once the dead space is removed from the tidal volume the remaining value may be multiplied by the rate to get the minute alveolar ventilation.

Which of the following exams provides the best diagnostic information for an obstructive defect in a COPD patient? A. DLCO B. SVC C. FEF200-1200 D. Fev1/FVC%

The correct answer is : D Explanation : To determine if the patient has an obstructive defect, as would be seen with a COPD patient, the best pulmonary function test would be the Fev1/FVC%. The second best test would be the Fev1.0 by itself. In order to determine if a patient is obstructive you must examine the flows. Slow vital capacity is a volume and therefore would be helpful in determining if the patient is restrictive. DLCO helps determine the diffusion capacity of the alveoli and will not differentiate between obstruction and restriction.

Which of the following devices would be used to obtain a PCWP measurement? A. indwelling arterial catheter B. central venous catheter C. double lumen catheter D. pulmonary artery catheter

The correct answer is : D Explanation : To measure pulmonary capillary wedge pressure, a pulmonary artery catheter must be in place.

A patient in the emergency room has a blood pressure of 90/60 mmHg and a palpated heart rate of 110 bpm. Pulse oximetry shows a saturation of 70% and a heart rate of 60 bpm. The respiratory therapist should A. record the pulse ox saturation in the medical record B. change the pulse oximeter sensor C. recalibrate the pulse oximeter D. move the pulse ox electrode to different location

The correct answer is : D Explanation : When a pulse oximeter is reading a low oxygen saturation but has a different heart rate compared to that which can be palpated, the oxygen saturation reading is in error and should not be reported. The cause for this is likely poor peripheral perfusion. An appropriate response is to first move the pulse ox probe to a different location on the body. A secondary option is to replace the probe.

While administering aerosolized bronchodilator with IPPB, the therapist notices the pressure manometer has a significant negative deflection with each breath. The patient appears to be showing signs of fatigue. The respiratory therapist should A. decrease pressure B. increase pressure C. increase inspiratory flow rate D. increase sensitivity

The correct answer is : D Explanation : When delivering an IPPB treatment, the respiratory therapist should monitor the pressure manometer to see how much effort the patient must produce to trigger the machine to cycle into inhalation. If a significant negative deflection of the needle is observed, the machine is not as sensitive as it needs to be. Increasing sensitivity is appropriate.

Over the last 2 hours, the respiratory therapist notices the peak pressure of a patient receiving volume controlled mechanical ventilatory support has risen from 22 to 31 cm H2O. Plateau pressures have remained steady at 14 cmH2O. Which of the following is the most likely explanation for these changes? A. reticulogranular changes on the chest radiograph B. ARDS C. pulmonary fibrosis D. secretions in the airway

The correct answer is : D Explanation : When peak pressures increase while plateau pressures remain virtually unchanged, the most likely cause is a temporary condition such as secretions in the airway, bronchoconstriction, occlusion of the endotracheal tube, etc. Pulmonary fibrosis and ARDS would cause a decrease in pulmonary compliance manifested by an increase in plateau pressures.

A 30-weeks of gestation infant is receiving mechanical ventilatory support with a time-cycled, pressure limited ventilator at the following settings: PIP 35 cm H2O Rate 28 FIO2 0.4 PEEP 4 cm H2O I-time 0.75 sec The respiratory therapist notices the pressure manometer is not rising to the set pressure during each inspiration. Which of the following is the mostly likely cause? A. internal flow rate is too high B. rate is insufficient C. set pressure exceeds the pressure capability of the ventilator D. the pressure-limiting pop-off valve is set to low

The correct answer is : D Explanation : When the pressure manometer is not rising to the set pressure, the cause may be one of two sources. First, the problem may be that the operational flow in the ventilator is too low. Next, there is a possibility the pressure-limiting pop off valve is set too low. This is the most likely answer, of the options given.

A patient is receiving heliox therapy with a mixture of 80% / 20% by nonrebreathing mask to reduce airway resistance during an asthmatic episode. The respiratory therapist notes the patient seems to be experiencing moderate respiratory distress. The therapist also observes the reservoir bag completely collapses with each inspiration. The therapist should A. discontinue heliox therapy B. switch to a 60%/40% heliox mixture C. switch to a Venturi mask set at the highest possible FIO2 setting D. increase total flow of gas mixture to the mask

The correct answer is : D Explanation : When the reservoir bag of a non-rebreathing mask collapses completely, which each breath, and this problem persists beyond a few minutes, the flow to the reservoir bag should be increased.