TMC Practice

The respiratory therapist is in charge of transporting a patient with multiple trauma to a regional trauma center in a fixed wing aircraft. Which of the following should the therapist be most concerned about during the transport? A. Tissue oxygenation B. Pneumothorax C. Pulmonary embolus D. Humidification of the inspired gas

A. Tissue oxygenation

VD/VT Ratio

(PaCO2 - PECO2) / PaCO2

Minute Alveolar Ventilation equation

(Vt - deadspace) X RR

PAP (pulmonary artery pressure)

-Systolic: 15-26 -Diastolic: 5-15

A respiratory therapist calibrates a thermal conductivity helium analyzer. What should the analyzer read when exposed to room air?

0%

The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered?

0.50mL (2.5/5%=0.5)

Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? 1. FEV1 2. PEFR 3. FRC 4. RV

1 and 2

Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation? 1. Select a ventilator that uses demand valves rather than a reservoir IMV system. 2. Calculate oxygen cylinder duration of flow. 3. Selecting a ventilator that incorporates an internal air compressor.

1 and 2

Which of the following techniques measures total lung capacity? 1. Helium dilution 2. Bodyplethysmography 3. Single breath nitrogen elimination

1 and 2

A patient receives CPAP at 10 cm H2O and 0.30 FIO2 with the heated humidifier set at 40° C. As the gas is delivered to the patient through large bore tubing, which of the following will occur? 1. Excess water will rain out 2. Humidity deficit will occur 3. Relative humidity will decrease 4. Relative humidity will remain 100%

1 and 4

How long will a full E cylinder of oxygen last if run until empty with a flowrate of 10 L/min?

1 hour 2200x.3=660/10=66 66/60= 1.1

A patient on VC ventilation demonstrates auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 1. Tidal volume 2. Respiratory Rate 3. Inspiratory flow 4. Sensitivity

1, 2, and 3

After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include 1. bronchospasm. 2. pneumothorax. 3. pulmonary hemorrhage.

1, 2, and 3

A 7 year-old child suspected of having epiglottitis would exhibit which of the following signs? 1. Drooling 2.Hyper extended neck 3. Stridor 4. Unilateral wheeze

1,2, and 3

A pulse oximeter provides an accurate indication of a patient's oxygenation status in which of the following situations? 1. Polycythemia 2. Pulmonary hypertension 3. Congestive heart failure 4. Carbon monoxide poisoning

1. Polycythemia 2. Pulmonary hypertension 3. Congestive heart failure

Sleep apnea can be defined as repeated episodes of complete cessation of airflow for

10+ seconds

What increase in FEV1 during post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern?

12% and 200 mL

Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube?

12Fr 8/2(x3)=12

An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a nonrebreathing mask with an oxygen flowmeter set at 10 L/min. What is the actual flow being delivered to the mask?

16 L/min

Prior to performing a cardiopulmonary stress test on a 60-year-old patient, the respiratory therapist determines the incremental workloads to be used for test. What is the patient's maximum heart rate?

160 (220-age in years= max HR)

What is the air-to-oxygen ratio for an air entrainment device delivering 60% oxygen?

1:1

During review of the medical record prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm3. Based on this finding, what should the therapist do? 1. Perform ABG as normal. 2. Refuse to perform the ABG. 3. Hold pressure on the puncture site for a longer time after sample is collected. 4. Recommend that an ABG should be performed on the patient only if absolutely necessary.

2 and 4

CVP (central venous pressure)

2-6 mmHg

What is the normal range for central venous pressure in an adult?

2-6cm Hg CVP main monitor for fluids

Cuff pressure

20-25 mmHg 25-35 cmH2O

What is the normal VD/VT ratio for a patient breathing room air?

20-40%

The respiratory therapist prepares to administer inhaled nitric oxide to a neonate with respiratory distress syndrome. The most appropriate initial dose of iNO for this patient is

20ppm

How soon following hospital admission should medication reconciliation be carried out and documented in the medical record?

24 hours

pH7.41 PaCO240 torr PaO295 torr SaO296% HCO3-23 mEq/L BE+1 mEq/L PECO230 torr Hb15 g/dL What should the therapist report as the VD/VT ratio?

25%

Pulmonary artery pressure (PAP)

25/8 mmhg at rest, 14 mean 30 mmhg during exercise is a sign of HTN

A patient with bilateral pneumonia receives mechanical ventilation in the intensive care unit. The following data is obtained: ModePC, ACSet rate12 /minTotal rate12 /minVE8.6 LFIO20.60PIP31 cm H2OPEEP10 cm H2O pH7.41PaCO240 torrPaO295 torrSaO296%HCO3-23 mEq/LBE+1 mEq/LPAO2370 torrC(a-v)O23.5 vol% The respiratory therapist should report the A-aDO2 as

275 torr.

A patient being evaluated in the Pulmonary Clinic reports that he smoked a pack and a half of cigarettes (30 cigarettes) per day for 20 years. How should the respiratory therapist describe the patient's smoking history?

30 pack-years

The respiratory therapist reviews a patient's medical record prior to performing bedside assessment to determine readiness for weaning from ventilatory assistance. The patient weighs 60 kg (132 lb). The therapist would expect the patient to be able to achieve a spontaneous tidal volume of

300 - 480 mL

In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a

3L syringe

PCWP (pulmonary capillary wedge pressure)

4-12 mmHg

What is normal urine output in an adult patient?

40 mL/hr

While performing a 12-lead electrocardiograph on a 68-year-old male patient, the respiratory therapist notices a sudden increase in artifact on the ECG paper. Upon further investigation, the therapist discovers that the V2 electrode has fallen off the chest. Where on the patient should the therapist place this electrode?

4th intercostal space on the left side of the sternum.

Following cardiac surgery, a 55 year-old patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2.

5.0%

Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation?

50 torr

A patient on the general medical ward receives oxygen via 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient?

55L/min 28% = 10:1 10+1=11 x 5LPM= 55

At 1 minute post-delivery, a newborn has: blue extremities with a pink body heart rate is 90/min respiratory rate is 20/min a weak cry cough reflex is present some flexion of the extremities. 5 minutes post-delivery, the infant is: completely pink heart rate is 140/min respiratory rate is 40/min cough reflex is present baby is active with a strong cry. What APGAR scores should be assigned?

6 & 10

The respiratory therapist obtains a SpO2 reading of 90% on a patient receiving oxygen therapy via 50% venti-mask. This would indicate a PO2 value of approximately

60

A patient in the intensive care unit has the following hemodynamic measurements: CVP (mm Hg)5PAP (mm Hg)29/8PCWP (mm Hg)8BP (mm Hg) 130/70Cardiac output (L/min)5.1Cardiac index (L/min/m2)2.7 What is the pulse pressure?

60mmHg 130-70

What is the total flow delivered to a patient receiving oxygen via 28% Venturi mask with the oxygen flowmeter set at 6 L/min?

66L/min 28% = 10:1 6LPMx11=66

A 30-year-old male who weighs 68 kg (150 lb) has a minute ventilation of 9 L/min. and a respiratory rate of 20/min. What is his alveolar minute volume?

6L/min 9/.20=450VT 450-150=300 300x20=6,000 6.0L/min

What size endotracheal tube would be appropriate for an adult female patient?

7.0-7.5

An adult patient is intubated with a 7.0 mm ID endotracheal tube. What size suction catheter should be used to suction this patient?

7/2=3.5x3= 10.5 Round down 10 French

A healthy adult female can exhale what portion of her forced vital capacity in the first second?

70%

A capnograph used for continuous monitoring of a patient on mechanical ventilation should be recalibrated every

8 hours

Which of the following would modify the expiratory time and change the I:E ratio for a patient receiving PEP therapy? A. Expiratory resistance valve B. Inspiratory flow C. Rate control D. Volume control

A. Expiratory resistance valve

All of the following are goals of bronchial hygiene therapy EXCEPT A. reverse the underlying disease process. B. improve mobilization of retained secretions. C. improve pulmonary gas exchange. D. reduce the work of breathing.

A. reverse the underlying disease process.

A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient?

ABG

A patient develops ascites and shortness of breath. Where is tissue edema most likely to show up first?

Abdomen

Which of the following medications CANNOT be administered by metered dose inhaler? A. Acetylcysteine B. Fluticasone C. Salmeterol D. Tiotropium

Acetylcysteine

A 75 kg (165 lb) male is being mechanically ventilated at the following settings: ModeVC, SIMVSet Rate12 /minTotal Rate32 /minTidal Volume600 mLPIP35 cm H2OExhaled minute volume9.2 LFIO20.45PEEP 8 cm H2O The following patient information is available: pH7.36PaCO245 torrPaO289 torrHCO3-25 mEq/L The respiratory therapist should

Add pressure support

The following ABG results are reported for a patient in the ED on room air: pH 7.20 PaCO2 24 torr PaO2 95 torr HCO3 10 mEq/L SaO2 95% BE -15 mEq/L. The respiratory therapist should recommend

Administer Sodium Bicarbonate * HCO3 10 mEq/L

Thirty minutes after extubation, a patient exhibits moderate stridor. Which of the following should the respiratory therapist recommend?

Administer racemic epinephrine by small volume nebulizer.

While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices a change in PtcO2 from 60 to 142 torr and simultaneously the PtcCO2 changes from 37 to 2 torr. What is the most likely explanation for these changes?

Air leak around the sensor

A patient with a history of asthma presents to the ED in severe respiratory distress with increased accessory muscle use. Vital signs are: heart rate 110/min, respiratory rate 32/min and SpO2 of 88% on room air. Bilateral expiratory wheezes are heard on auscultation. The respiratory therapist should recommend initiating

Albuterol

A patient receiving high frequency oscillatory ventilation (HFOV) demonstrates excess CO2 retention on a recent arterial blood gas. Which of the following could be adjusted to correct this situation?

Amplitude (∆P)

Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend

Antibiotic therapy

A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist could recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT: A. coordinating coughing with pain medication. B. performing serial coughs. C. applying pressure to patient's abdomen during exhalation. D. "splinting" the incision area.

Applying pressure to patient's abdomen during exhalation.

Following thoracotomy, a patient receives incentive spirometry therapy Q2H. Her breath sounds are diminished in the bases of the lungs with scattered crackles. The patient's inspiratory capacity has decreased over the past 2 days. A chest radiograph indicates thin-layered basilar densities. Which of the following has most likely occurred?

Atelectasis

A 48 year-old woman is admitted to the coronary care unit for chest pain, dizziness and nausea. Her blood pressure is 60/40 mm Hg, respirations are 20/min. The cardiac monitor shows sinus rhythm at a rate of 50/minute with frequent multifocal PVC. The respiratory therapist should recommend administration of

Atropine

Which of the following patients would most likely benefit from pressure support ventilation? A. An intubated patient with an absent respiratory drive. B. A patient on SIMV with a mandatory rate of 12/min and total rate of 24/min. C. A patient with acute lung injury. D. A patient who requires short-term post-operative ventilatory support.

B. A patient on SIMV with a mandatory rate of 12/min and total rate of 24/min.

Which of the following values should the respiratory therapist report as indicative of pulmonary embolism in a patient with acute dyspnea? A. QS/QT of 10% B. VD/VT of 60% C. CL of 60 mL/cm H2O D. RAW of 2.4 cm H2O/L/sec

B. VD/VT of 60%

All of the following could cause a patient's right-hemidiaphragm to be elevated, EXCEPT A. right lower lobe atelectasis. B. right side hyperlucency, absent vascular markings. C. hepatomegaly. D. right lower lobe consolidation with air bronchograms.

B. right side hyperlucency, absent vascular markings

Which of the following assessments should the respiratory therapist recommend for a patient at high risk for post-operative complications?

Bedside Spirometery

A 2-year-old child with croup has been intubated for 4 days with a 4 mm ID uncuffed endotracheal tube. Heated aerosol at an FIO2 of 0.30 has been delivered to the patient. The physician asks the respiratory therapist to evaluate the patient for possible extubation. Which of the following would most likely indicate that the patient is ready for extubation?

Breath sounds are heard around the tube on auscultation.

A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend?

Bronchial Provocation

Which of the following is an indication for high frequency jet ventilation

Bronchopleural fistula

A 4-year-old girl is admitted to the Emergency Department with persistent dry coughing. Chest radiograph results reveal normal inspiration with the right lung remaining expanded on expiration. Which of the following should the respiratory therapist recommend at this time?

Bronchoscopic examination

Which of the following is a FALSE statement about self-inflating resuscitation devices? A. A reservoir is utilized to increase the delivered oxygen concentration. B. The respiratory therapist can sense changes in the patient's lung compliance and airway resistance. C. A compressed gas source is necessary for the device to operate. D. Excessive gas flow may cause the valve to malfunction.

C. A compressed gas source is necessary for the device to operate.

The respiratory therapist should recommend home apnea monitoring for infants with all of the following situations EXCEPT A. preterm infant with significant apnea periods. B. sibling of a SIDS baby. C. APGAR scores of 4 and 6 at delivery. D. a history of snoring.

C. APGAR scores of 4 and 6 at delivery.

Noninvasive Positive Pressure Ventilation (NPPV) is contraindicated for the management of which of the following conditions? A. Acute exacerbation of COPD B. Cardiogenic pulmonary edema C. Adult respiratory distress syndrome (ARDS) D. Premature extubation

C. Adult respiratory distress syndrome (ARDS)

Pressure-cycled ventilation would be LEAST appropriate for a patient with A. kyphosis. B. muscular dystrophy. C. acute respiratory distress syndrome. D. a drug overdose.

C. acute respiratory distress syndrome.

An acceptable level of PEEP therapy can be identified by all of the following EXCEPT A. the lower inflection point of a volume-pressure loop graphic. B. acceptable oxygenation without cardiovascular side effects. C. increasing oxygenation with increasing plateau pressure. D. increasing static compliance with acceptable oxygenation.

C. increasing oxygenation with increasing plateau pressure.

ll of the following statements regarding an oxygen concentrator are correct EXCEPT that it A. provides an unlimited supply of oxygen. B. increases alveolar oxygen tension. C. provides 100% oxygen at high flow rates. D. removes nitrogen from the room air.

C. provides 100% oxygen at high flow rates.

For a patient enrolled in a smoking cessation program, which of the following would indicate that the patient is non-compliant?

COHb level of 7%

Following a thoracotomy, a patient in the PACU receives 60% oxygen via a non-rebreather mask. A pulmonary diagnostic assessment reveals the following information: pH7.43PaCO234 torrPaO256 torrHCO3-22 mEq/LBE-1SaO290% f25/min.PAP49/28 mm HgPWP5 mm HgPVR400 dynesSVR1150 dynes To improve the patient's pulmonary status, the respiratory therapist should institute

CPAP

Which of the following physiologic values would be present in a patient who has proper fluid balance? A. PCWP of 22 mm Hg B. CVP between 3 and 6 mm Hg C. Urine output of 20 mL/hr D. PAP of 25/8 mm Hg

CVP between 3 and 6 mm Hg

If a patient's CvO2 decreased from 15 vol% to 10 vol%, which of the following should the respiratory therapist assess?

Cardiac Output

The following results are obtained from the pulmonary artery catheter of a patient who collapsed during a visit with a friend in the hospital: CVP10 cm H2OPAP33/27 mm HgPCWP20 mm HgBP108/72 mm Hg Which of the following conditions could be associated with these results?

Cardiogenic pulmonary edema

A 65 year-old female patient with advanced emphysema comes to the ED and is placed on a nasal cannula at 6 L/min. On inspection, the respiratory therapist finds that the patient has become drowsy and less responsive since the oxygen therapy was initiated an hour ago. ABG on 6 L/min are: pH 7.33, PaCO2 64 torr, PaO2 85 torr, HCO3 35 mEq/L. Which of the following should the therapist recommend?

Change to a 24% Venti-mask and repeat ABG.

A 60 kg (132 lb) patient is mechanically ventilated at the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure?

Change to airway pressure release ventilation.

A respiratory therapist enters a patient's room during oxygen rounds. The patient has end-stage emphysema and appears to be sleeping. The patient doesn't respond to questions and his pulse is 20 bpm. The therapist should immediately

Check DNR status

The respiratory therapist notices the low pressure alarm sounding from the ventilator for the patient in ICU Bed 1. As the therapist enters the room, she notes that during inspiration, the pressure manometer reads 6 cm H2O. The therapist's first action should be to

Check the exhalation valve

A 32-week gestational age infant is receiving mechanical ventilation for pulmonary interstitial emphysema. The respiratory therapist suspects that a pneumothorax has developed. Which of the following diagnostic procedures should the therapist recommend to confirm this diagnosis?

Chest radiograph

Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions?

Chronic bronchitis

Which of the following will give the most accurate measurement of volume and flow for spirometry?

Collins water-sealed spirometer

After a patient undergoes a thoracentesis, the respiratory therapist notes that the obtained pleural fluid is clear with a slight straw color. This fluid is most likely the result of

Congestive Heart Failure

A 2-year-old child recently diagnosed with laryngotracheobronchitis requires the administration of 40% oxygen. What is the most appropriate method for delivering the oxygen?

Cool aerosol mask

Which of the following would NOT cause a capnography reading to change from 36 torr to 30 torr? A. Tachypnea B. Hyperventilation C. Pulmonary emboli D. Endotracheal tube positioned in the right mainstem bronchus

D. Endotracheal tube positioned in the right mainstem bronchus

Which of the following devices would produce the greatest humidity output for a patient? A. Bubble humidifier B. Wick-type humidifier C. Large reservoir nebulizer D. Ultrasonic nebulizer

D. Ultrasonic nebulizer

While providing education to patients who will be discharged home on oxygen therapy, the respiratory therapist explains the hazards associated with oxygen delivery equipment in the home. This instruction should include all of the following EXCEPT A. liquid oxygen burns when refilling portable tanks. B. how to properly secure oxygen cylinders for transport. C. use of grounded 3-prong outlets for electrical equipment. D. emergency procedure to deal with gas explosions.

D. emergency procedure to deal with gas explosions.

A spontaneous breathing trial has been initiated for a 64-year-old, intubated, post-op patient. Oxygen is being administered by T-piece at an FIO2 of 0.50 via heated air-entrainment nebulizer at a flow of 12 L/min and a temperature of 37.0oC. The respiratory therapist notices that the aerosol mist disappears from the reservoir outlet during the patient's inspiration. The therapist should consider all the following EXCEPT A. lenghtening the reservoir tubing. B. adding an additional nebulizer. C. increasing the flow to 15 L/min. D. increasing the temperature to 39 celcius

D. increasing the temperature to 39 celcius

All of the following could be recommended to treat a patient with severely decreased static lung compliance, EXCEPT A. inverse ratio ventilation. B. appropriate PEEP therapy. C. airway pressure release ventilation. D. intrapulmonary percussive ventilation.

D. intrapulmonary percussive ventilation.

In order to reduce a patient's PaCO2 from 40 torr to 32 torr, all of the following could be increased EXCEPT A. tidal volume. B. alveolar ventilation. C. respiratory rate. D. physiologic deadspace.

D. physiologic deadspace.

The physician asks the respiratory therapist to select ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician's request?

Decelerating

During ventilator rounds in ICU, the respiratory therapist notes that the patient in Room 3 has the following waveform graphic displayed on her ventilator: What action should the therapist take?

Decrease inspiratory time.

A patient receives oxygen at home via nasal cannula at 1 L/min. He has 50 feet of extension tubing attached to his oxygen concentrator. The patient complains that there does not seem to be enough oxygen flow reaching the cannula. The respiratory therapist should recommend

Decrease the length of the extension tubing

During inline suctioning of a patient's endotracheal tube, 100% oxygen is being supplied via the ventilator. The respiratory therapist observes several premature ventricular contractions on the ECG monitor. The therapist should

Decrease the suctioning time per pass

A newborn infant has an APGAR score of 8 one minute after delivery. The most appropriate action at this time would be to

Dry and monitor the infant

During recovery from resection of an aortic aneurysm, a 65-year-old female patient suddenly develops severe substernal chest pain with grave dyspnea. The physician describes the bilateral breath sounds as basilar moist crepitant crackles. The patient appears pale, cool and diaphoretic. Which of the following should the respiratory therapist recommend as part of the initial assessment of this patient?

ECG

Following surgery to correct an abdominal aortic aneurysm, a 54-year-old female patient suddenly develops intense substernal chest pain with severe dyspnea. The pain does not appear to be aggravated by her respirations. Auscultation reveals bilateral, basilar, moist, crepitant rales. The patient appears pale, cold and clammy. Which of the following should the respiratory therapist recommend for initial assessment of this patient?

Electrocardiograph

A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem?

Elevated intracranial pressure

Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following?

Endobronchial intubation

A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff?

Enough to achieve a pressure of 25-35 cm H2O.

Hyperlucency

Extra pulmonary air COPD, asthma attack, pneumothorax

A spontaneous breathing term-71trial is initiated on an intubated, awake, and alert 70 kg (154 lb) patient. After 40 minutes on an FIO2 of 0.30, ABG results are as follows: pH 7.39 PaCO2 44 torr PaO2 85 torr HCO3- 24 mEq/L. The patient's vital signs remained stable throughout the trial. Which of the following is the most appropriate recommendation?

Extubate

A 25-year-old, 58 kg (130 lb) female is admitted to ICU after an emergency C-section and receives mechanical ventilation via volume-control ventilator. The current ventilator settings are: ModeVC, SIMVVT500 mLf12 bpmFIO20.50PEEP5 cm H2O The following laboratory data are available: pH7.36PaCO244 torrPaO250 torrHCO3-24 mEq/LSaO282%CVP7 cm H2OPAP13 mm Hg (mean)QT4.5 L/min. The respiratory therapist should recommend increasing which of the following?

FiO2

A patient receives 40% oxygen via a Venturi mask at 8 L/min. While performing oxygen rounds, the respiratory therapist notes that the flowmeter setting has been changed to 12 L/min. How would this affect the accuracy of this device?

FiO2 will remain unchanged

A patient with chronic bronchitis is seen in the pulmonary clinic with complaints of frequent cough and secretion production. Despite completing a round of antibiotics as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend?

Flexible bronchoscopy

Which of the following would be the most appropriate test to evaluate partial vocal cord paralysis in a patient complaining of difficulty swallowing?

Flow volume loop

A patient with end-stage pulmonary fibrosis receives oxygen at 2 L/min via transtracheal oxygen catheter. The patient complains of increased work of breathing and shortness of breath. The respiratory therapist should

Flush the transtracheal device with saline

A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position?

Head down, patient prone, with a pillow under the hips

A 36 year-old fireman was trapped and subsequently rescued from the collapse of a burning building. Which of the following devices would be appropriate to accurately assess his oxygenation status?

Hemoximeter

Following administration of oxygen, what additional therapy should the respiratory therapist recommend for a patient with decompression sickness?

Hyperbaric Oxygen Therapy

A firefighter is brought to the Emergency Department after being knocked unconscious in a burning office building. What is the best way to improve the oxygenation status of this patient?

Hyperbaric oxygen therapy

A patient who has significant decreases in airflow during sleep but does not have a complete cessation of breathing is having what type of episodes?

Hypopnea

A patient with chronic hypercapnia is brought to the ED after losing consciousness at home. A pulmonary artery catheter has been placed with the following measurements obtained: PAP25/10 mm HgBP76/50 mm HgPCWP4 mm HgSVR1360 dynesCVP0 mm HgCI1.8 L/min/m2 Which of the following is the most likely cause for his condition?

Hypovolemia

A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT A. hypoxemia. B. pneumothorax. C. pulmonary hemorrhage. D. bronchospasm/laryngospasm.

Hypoxemia

The peak inspiratory pressure on a pressure-cycled ventilator used for IPPB is 30 cm H2O. The respiratory therapist decreases the inspiratory flow. This change would affect the

I:E ratio

A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially?

IPPB

Which of the following pulmonary function capacities would have the smallest predicted normal value? 1. IRV 2. TLC 3. VC 4. IC

IRV

A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PCWP 4 mm Hg PAP (mean) 8 mm Hg CVP 2 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend

IV fluid challenge

A patient participated in Pulmonary Rehabilitation for the past 5 weeks. The patient recorded the results of his 6 minute walk test each week. The results indicate a steady increase in distance over the 5 week period. These results are consistent with

Improvement in exercise ability

During oral endotracheal intubation, the tip of the Macintosh laryngoscope blade should be placed

In the vallecula Miller- Under the epiglottis

A patient receives noninvasive positive pressure ventilation by mask. Current settings and arterial blood gas results are as follows: IPAP 10 cm H2O EPAP5 cm H2O Respiratory rate 12 /min pH 7.31 PaCO2 56 torr PaO2 63 torr HCO327 mEq/L BE+3 mEq/L Which of the following should the respiratory therapist recommend?

Increase IPAP to 15cm CO2 indicates lack of ventilation, increasing IPAP will increase ventilation and decrease CO2

Following abdominal surgery, a 70 year-old patient receives mechanical ventilation in the ICU at the following settings: VC, A/C VT 550 mL respiratory rate 14/min FIO2 0.50 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 torr and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend?

Increase the FIO2

A 2000 g neonate is breathing spontaneously on 28% oxygen via an oxyhood with the following arterial blood gas results: pH7.37PaCO237 torrPaO246 torrHCO3-22 mEq/L Based upon the above information, the respiratory therapist should recommend which of the following?

Increase the FIO2 to 0.35

A patient receives mechanical ventilation at the following settings: ModeVC, SIMVMandatory rate12 /minTotal rate12 /minFIO20.50VT500 mLPeak flow50 L/minPEEP5 cm H2O The respiratory therapist observes a lower inflection point at 8 cm H2O on the pressure-volume graph. Which of the following should the therapist recommend?

Increase the PEEP

A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation? 1. Increase the pressure limit 2. Increase the sensitivity 3. Increase the mandatory rate 4. Decrease the inspiratory time

Increase the pressure limit and Increase the mandatory rate

Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? A. Increased fremitus B. Decreased intensity of breath sounds C. Diminished diaphragmatic excursion D. Hyperresonance to percussion

Increased fremitus

The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should

Initiate an end expiratory hold just prior to the next ventilator breath

A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend?

Insert a nasopharyngeal airway after bleeding has been controlled

A 43-year-old female patient undergoes a total abdominal hysterectomy. The patient arrives in the Post Anesthesia Care Unit obtunded with minimal response to painful stimulus. What treatment should the respiratory therapist recommend for this patient?

Insert an OPA

A patient receives continuous mechanical ventilation through an oral endotracheal tube. The respiratory therapist notes that the high pressure alarm sounds continuously during inspiration and the patient appears to be biting down on the ET tube. Which of the following should the therapist recommend?

Insert an OPA

Adjusting the inspiratory flow during IPPB will primarily result in a change in

Inspiratory Time

A patient is in full cardiopulmonary arrest and after several attempts, the patient is orally intubated with a size 7 mm ID endotracheal tube. The nurse is unable to establish IV access and the ECG monitor shows sinus bradycardia. What is the most appropriate route to administer atropine to this patient?

Instill into endotracheal tube

While delivering IPPB therapy with a Bird Mark 7 ventilator, the respiratory therapist observes that the pressure does not rise consistently during inspiration. This is most likely the result of

Insufficient flow

A 28 year-old female has been admitted through the ED with suspected CO poisoning. She receives oxygen by non-rebreather mask at 10 L/min. Upon entering the patient's room, the respiratory therapist notes that the reservoir bag of the mask collapses during inspiration. This is most likely the result of

Insufficient flow to the reservoir bag

Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at frequencies of 100 to 250/min?

Intrapulmonary percussive ventilation

Which of the following statements is TRUE concerning positive expiratory pressure (PEP) therapy?

It may help improve secretion expectoration, decrease hyperinflation and improve airway maintenance

The respiratory therapist reviews the following laboratory data from a patient in the intensive care unit: pH7.54PaCO248 torrPaO278 torrCaO218.9 vol%K+2.1 mEq/LCl-82 mEq/LNa+142 mEq/L Based on these results, the therapist should recommend administration of

KCl

After performing spirometry on a patient in the pulmonary clinic, the respiratory therapist notes that both the inspiratory and expiratory flow portion of the flow-volume loop is flattened. The therapist should interpret the condition demonstrated on the flow-volume loop as a/an

Large airway obstructio

What is the most appropriate position for a female patient who is 5'3" tall, weighs 200 kg and complains of difficulty breathing?

Lateral Fowlers

A patient with a flail chest is intubated and mechanically ventilated with PEEP therapy. Pancuronium bromide has been administered. Which of the following ventilator alarms would be most important to set correctly for this patient?

Low Pressure Alarm

Heliox therapy is indicated for treatment of patients with post-extubation stridor because of the

Low density of the gas mixture

A 60 year-old male has just been extubated following coronary artery bypass grafting. His chest X-ray demonstrates platelike infiltrates with scattered densities and he is noted to have decreased chest expansion with an increased respiratory rate. Which of the following treatments should be recommended for this patient?

Lung expansion therapy

A 62-year-old patient with a history of emphysema (body weight 50 kg, 110 lb) requires mechanical ventilation because of acute respiratory failure. The respiratory therapist notes the following: Mode VC, SIMV Set rate10 /min. Total rate16 /min. VT 400 mL FIO2 0.28 Arterial blood gases are as follows: pH7.37 PCO2 56 torr PO2 65 torr HCO3-32 mEq/L

Maintain the current settings

A 44-week gestational age infant is delivered via C-section and is gasping, grunting, and has tachycardia and tachypnea. At one minute his Apgar score is 4 and at 5 minutes the score is 5. The infant is most likely suffering from

Meconium Aspiration

What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea?

Mild = 5-15

While reviewing the results of polysomnography on a 44-year-old patient, the respiratory therapist notes that the Apnea Hypopnea Index (AHI) is 25. This value should be reported as

Moderate <5 normal 5-15 Mild 15-30 Moderate >30 Severe

A 72 year-old female post stem cell transplant patient in the ICU complains of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B-type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition?

Moderate Heart Failure

A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from

Myocardial Infarction

The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor 1. electrocardiogram. 2. electroencephalogram. 3. nasal air flow. 4. chest wall impedance.

Nasal Airflow Chest Wall Impedance

The physician requests assistance in establishing a patent airway for a conscious patient who requires frequent nasotracheal suctioning. The respiratory therapist should recommend insertion of a/an

Nasopharyngeal airway

A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first?

Needle aspirate into the 2nd left intercostal space

A patient who suffered multiple trauma in a car accident receives oxygen via nasal cannula at 2 L/min. Vital signs are: heart rate 110/min, respiratory rate 32/min, blood pressure 90/60 mm Hg. The pulse oximeter reads 78%. Which of the following should the respiratory therapist recommend to maximize the patient's FIO2?

Non-rebreathing mask at 15 L/min

The respiratory therapist receives an order to administer a mixture of 80% helium/20% oxygen to a 40 year-old patient in an acute asthmatic episode. Which of the following devices would most effectively deliver the gas mixture to the patient?

Nonrebreathing mask

Airways resistance (Raw) of 1.8 cm H2O/L/sec is measured for a patient receiving mechanical ventilation. The respiratory therapist should suspect that the patient may have

Normal Airways

Airway Resistance (Raw)

Normal is 2-3 cmH2O/L/sec for intubated pts. Raw = PIP - Pplat / Flow in min/60 sec. Increase with Raw reflects issue with: - airways - bronchospam - secretion - edema

During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted FEF25-75 81% of predicted. How should the respiratory therapist interpret these results?

Normal lung function

A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes?

Obtain a sputum gram stain

A patient reports that he has difficulty breathing while lying in a supine position and prefers to sleep sitting in a chair. The respiratory therapist should record this complaint in the medical record as

Orthopnea

A 13 year-old patient in the ED complains of dyspnea, chest tightness, and a loose productive cough. The patient has a respiratory rate of 33 breaths/minute and bilateral wheezing in the lungs. What treatment should the respiratory therapist initiate?

Oxygen

While suctioning a patient being mechanically ventilated, the respiratory therapist notes the presence of multiple premature ventricular contractions on the ECG monitor. Suctioning is stopped and the patient is returned to the ventilator. Which of the following should the therapist recommend?

Oxygen

The physician asks the respiratory therapist to set an optimal PEEP level for a mechanically ventilated patient . The PEEP level is optimal when

Oxygen delivery to the tissues is maximal.

A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon deflated. Which of the following pressures will be measured by the distal lumen?

PAP

A patient in the intensive care unit has the following hemodynamic measurements: CVP: 12 mm Hg PAP: 48/16 mm Hg PCWP: 15 mm Hg MAP: 109 mm Hg Cardiac Output: 8.0 L/min. Cardiac Index: 4.7 L/min/m2 Which of the following should the respiratory therapist recommend?

PAP is rising and PCWP Furosemide-Lasix

A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon inflated. Which of the following pressures will be measured by the distal lumen?

PCWP

A 50 kg (110 lb) patient is mechanically ventilated with the following settings: VC, A/C VT 400 mL respiratory rate 14/min FIO2 0.60 10 cm H2O PEEP The chest radiograph demonstrates diffuse bilateral radiopacity. ABG results are: pH 7.36 PaCO2 47 torr PaO2 50 torr, HCO3- 26 mEq/L. The respiratory therapist should increase the

PEEP

A mechanically ventilated patient with a tracheostomy tube is on the following settings: PC, SIMV PIP 30 cm H2O f 20/min, FIO2 0.60 PEEP 5 cm H2O. The ventilator alarm suddenly begins to sound and on quick examination, the respiratory therapist notices a generalized decrease in breath sounds and a reduction in delivered tidal volume from 650 mL to 500 mL. Which of the following conditions is most likely?

Partial obstruction of the tracheostomy tube.

Over the last hour, a patient being ventilated with a volume-cycled ventilator has a decrease in urine output from 35 mL/hour to 10 mL/hour. The most likely cause of this change would be an increase in the

Peak Airway Pressure

A 10-year-old patient with asthma is asked to monitor his airflow improvement following each Beta-2 agonist treatment taken at home. Which of the following should the respiratory therapist provide for the patient?

Peak Flow Meter

All of the following could cause the high pressure alarm on a volume cycled ventilator to sound EXCEPT A. decrease in lung compliance. B. increase in airway resistance. C. peak flow setting of 60 L/min. D. acute bronchospasm.

Peak flow setting of 60 L/min

The patient in ICU Bed 6 is noted to have a meniscus in the left chest with a blunted left costophrenic angle on the morning chest radiograph. On physical exam, the respiratory therapist finds that the breath sounds are decreased on the left with a dull percussion note. What treatment should the therapist recommend?

Perform a left posterior thoracentesis

The respiratory therapist obtains a blood gas sample from the patient's radial artery and applies pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is

Placing in an ice bath

A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from

Pleural Effusion

Following coronary artery bypass surgery, a patient receives Incentive Spirometry QID. The patient's inspiratory capacity has diminished over the past several days and the patient is becoming increasingly short of breath. Chest radiograph shows left lower lobe consolidation with air bronchograms. The respiratory therapist would conclude that the patient has developed

Pneumonia

The most probable cause of air bronchograms and increased density on a chest x-ray is

Pneumonia

Transcutaneous monitoring of PO2 values will correlate well with arterial blood gas PO2 values in which of the following situations? 1. Hypotension 2. Hypothermia 3. Pneumonia

Pneumonia

While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding? 1. Pneumothorax 2. Pleural effusion 3. Pneumonia 4. Atelectasis

Pneumonia and Pneumothorax

A 150 kg (330 lb) patient is referred to a sleep center for evaluation of sleep apnea and daytime drowsiness. Which of the following is the most appropriate diagnostic procedure?

Polysomnography

While evaluating a patient who is in semi-Fowler position, the respiratory therapist finds that the patient's jugular vein extends approximately 7 cm above his sternal angle. The therapist should recommend initiation of which therapy?

Positive inotrope

The high pressure alarm sounds frequently on the ventilator of a 58 year-old patient who is being mechanically ventilated following major orthopedic surgery. The mandatory rate on the ventilator is 12/min and auscultation reveals bilateral vesicular breath sounds. Current vital signs include: heart rate 130/min, respiratory rate 36/min, blood pressure 125/88 mm Hg, temperature 37.1°C (98.8°F), and SpO2 96%. The patient appears quite agitated. The patient's respiratory pattern is most likely the result of

Post-operative pain

A patient with chronic bronchitis is to receive therapy to help remove a large amount of thick purulent secretions. Which of the following would be most helpful?

Postural drainage and percussion

A patient receiving a loop diuretic such as furosemide would most likely require replacement of

Potassium

The respiratory therapist instructs a postoperative abdominal surgery patient in how to perform incentive spirometry. The therapist should explain that the purpose of the treatment is to

Prevent areas of lung collapse

A sputum sample from an intubated patient with pneumonia has an offensive odor and is described as green and mucopurulent. The respiratory therapist should suspect that this condition is caused by

Pseudomonas aeruginosa.

Fine crepitant crackles are most commonly associated with which of the following conditions?

Pulmonary Edema

A 77-year-old male patient is admitted to the emergency room with shortness of breath, fine basilar crackles, +2 pitting edema and a chest radiogram with a butterfly pattern. These results are most consistent with which of the following?

Pulmonary Edema Butterfly/Batwing

All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT A. carbon monoxide poisoning. B. decompression sickness. C. anaerobic infections. D. pulmonary hypertension.

Pulmonary Hypertension

Qs/Qt

Pulmonary Shunt equation (CcO2-CaO2)/(CcO2-CvO2) 3-5%

Which of the following measurements is most indicative of congestive heart failure? A. Heart rate of 120/min B. Blood pressure of 92/72 mm Hg C. Pulmonary artery pressure of 25/10 mm Hg D. Pulmonary capillary wedge pressure of 30 mm Hg

Pulmonary capillary wedge pressure of 30 mm Hg

A patient is admitted to the Emergency Department via ambulance. The cardiac monitor indicates sinus tachycardia. The patient is orally intubated with a size 7.5 mm ID endotracheal tube and is being manually ventilated. What other point of care monitoring should the respiratory therapist recommend for this patient?

Pulse Oximetry

During cardioversion, the defibrillator will deliver the synchronized electrical shock on the

R wave

While administering 3.5 mg of albuterol to a patient with asthma in the ICU, the respiratory therapist notes that the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment for this patient?

Reduce the dose of albuterol

A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected pneumonia. The patient has no history of pulmonary disease. Auscultation reveal medium crackles throughout both lungs. Which of the following should be recommended for management of this patient?

Regular coughing and deep breathing

Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 76%. Which of the following would be most appropriate at this time?

Reintubation

A pediatric patient on high-flow oxygen therapy is monitored with a finger pulse oximetry probe. There are frequent and repeated false low SpO2 alarms (less than 90%). Which of the following should the respiratory therapist recommend in this situation?

Relocate the sensor to the forehead or ear lobe.

While making oxygen rounds, the respiratory therapist hears a high-pitched sound coming from a bubble humidifier. The patient is receiving oxygen by air-entrainment mask at 28% and the oxygen flowmeter is set at 12 L/min. The therapist should

Remove the bubble humidifier

The respiratory therapist assists with elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST?

Replace the manual resuscitation bag.

While weaning a patient from inhaled nitric oxide therapy, the respiratory therapist notes an increase in pulmonary artery pressure following a decrease in dosage. The therapist should

Return the iNO dose to the previous level

A 64-year-old, 70 kg (154 lb) man with severe COPD receives independent (differential) lung ventilation following thoracotomy and right lower lobectomy. Which of the following setting combinations would be most appropriate for this patient?

Right lung 150 mL; left lung 350 mL

he following measurements were obtained from a patient with a pulmonary artery catheter in place: CVP1 mm HgPAP10 mm Hg (mean)PCWP8 mm HgCI1.6 L/min/m2BP110/90 mm Hg Based on the above information, all of the following values would be decreased EXCEPT

SVR

Following a cholecystectomy, a 45 year-old patient receives intermittent positive pressure breathing therapy to treat post-operative atelectasis. The respiratory therapist determines that the ventilator self-cycles between the patient-initiated breaths. The therapist should adjust the

Sensitivity

The physician asks the respiratory therapist to monitor the effectiveness of bronchodilator therapy in a patient with asthma. What is the most appropriate parameter to monitor?

Serial peak flow measurement

A patient is seen in the Emergency Department for complaints of nausea and vomiting. A nasogastric tube has been inserted and the patient is started on lasix. Which of the following should the respiratory therapist monitor?

Serum Electrolytes

Which of the following should the respiratory therapist utilize in order to determine the severity of respiratory distress in a newborn?

Silverman Score

The respiratory therapist provides education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will

Slow the growth of bacteria

The respiratory therapist instructs a patient to take a maximal inspiration followed by a maximal exhalation without force. Which of the following values are being measured?

Slow vital capacity

Which of the following would be most important to evaluate for a patient who is entering a smoking cessation program? -Height -Smoking History -Weight -Diet

Smoking History

The respiratory therapist calibrates a spirometer and checks the volume with a 3.0 liter super syringe. The volumes recorded are: 2.85 L, 2.8 L, and 2.8 L. Based upon the information obtained which of the following is a correct statement?

Spirometer may have a leak

What determines cardiac output?

Stroke Volume X Heart Rate

Which of the following would NOT be required to perform a nasal intubation?

Stylet

The respiratory therapist prepares to assist with the intubation of an adult male patient. The anesthesia resident wishes to administer a neuromuscular blocker that has a fast onset and short duration. Which of the following should the therapist recommend?

Succinylcholine

The respiratory therapist receives an order for postural drainage and vibration. With the bed flat, the therapist places the patient in a prone position with pillows under his hips. Which lung segments are being treated with this position?

Superior segments of the lower lobes

A patient receiving oxygen therapy at home calls in the middle of the night and reports that the oxygen supply tubing will not stay attached to her transtracheal catheter. The flow rate to the transtracheal catheter is set at 0.5 L/min. The patient has attempted to flush the catheter with saline and push a cleaning rod through it without success. The respiratory therapist should instruct the patient to

Switch to a nasal cannula

A hyperresonant percussion note is associated with which of the following pathologies? 1. Hemothorax 2. Pleural effusion 3. Tension pneumothorax 4. Chronic bronchitis

Tension Pneumothorax Chronic Bronchitis

A 55 year-old male patient is evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should

Terminate the procedure

A patient performs both a forced vital capacity and a slow vital capacity maneuver with the following results: FVC 2.40 L SVC 2.18 L Which of the following statements is TRUE regarding these results?

The SVC shows poor effort and should be repeated.

A 2100 g neonate in the NICU is monitored with a TcPO2 monitor. The TcPO2 reads 53 torr with the temperature set at 40oC. The arterial PO2 is 73 torr. Which of the following would best explain the difference in TcPO2 levels?

The TcPO2 temperature setting is too low

A patient has been intubated with a naso-tracheal tube and is being manually ventilated. As the respiratory therapist ventilates the patient, he notices that there is no chest movement, minimal breath sounds and air escaping from the mouth as the bag is squeezed. A chest x-ray has determined that the endotracheal tube is in the correct position. What is the most likely cause of this situation?

The cuff ruptured during intubation

A patient has a tracheostomy tube in place. The measured cuff pressure is 24 mm Hg. Which of the following statements is true of this situation?

The pressure is appropriate

An ICU patient's blood pressure is continuously monitored via an arterial catheter in the left radial artery. The respiratory therapist places the patient in Trendelenburg position for bronchial hygiene therapy and the blood pressure monitor begins to alarm. When the patient is returned to the original position, the blood pressure normalizes. What is the most likely reason for the variation in blood pressure?

The tip of the catheter was below the transducer.

Upon review of the chest radiograph after an elective intubation, the respiratory therapist notes that the distal tip of the endotracheal tube is 3 cm above the carina. How should the therapist interpret this finding?

The tube is in the proper position

A sudden decrease in end-tidal CO2 occurs in a mechanically ventilated patient. A repeat analysis yields the same results. Which of the following situations might account for these readings?

The ventilator circuit has become disconnected.

What is the correct formula to calculate the static lung compliance of a patient receiving mechanical ventilation?

Tidal volume ÷ (plateau pressure - PEEP)

A 68 year-old patient with advanced emphysema is receiving oxygen by nasal cannula at 1 L/min. The physician has ordered that the patient's SpO2 be maintained at 90%. ABG on 1 L/min are pH 7.34, PaCO2 65 torr, PaO2 55 torr, HCO3 35 mEq/L. What should the respiratory therapist recommend FIRST?

Titrate the oxygen flow to the nasal cannula

Which of the following is utilized with a pulmonary artery catheter to convert the pressure in the blood vessel into an electrical signal?

Transducer

A heat moisture exchanger is indicated for humidification in which of the following situations?

Transport to a tertiary care center.

A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to achieve a minimal occluding volume. This would indicate that the

Tube is not the appropriate size

A 58 year-old male patient receives mechanical ventilation in the ICU on the following settings: VC,SIMV, VT 650 mL, f 12/min, FIO2 0.65, PEEP 10 cm H2O. He has a large amount of thick, yellow secretions. How should the respiratory therapist suction this patient?

Use a closed-system suction catheter.

An oxygen-dependent patient uses a nasal cannula at 3 L/min continuously at home. He complains that his liquid oxygen portable device runs out too quickly when he attends church services and prevents him from dining out in restaurants afterwards. Which of the following devices should the respiratory therapist recommend to resolve the issue?

Use a pulse-dose oxygen delivery system.

The respiratory therapist receives an order to administer bronchodilator therapy with albuterol. To reduce the chance of cross contamination, the therapist should

Use an MDI

patient receives 60% oxygen via large volume nebulizer and aerosol mask at a flow of 8 L/min. The patient's inspiratory flowrate is 35 LPM. Which of the following should the respiratory therapist recommend?

Use two nebulizers at a flow of 10 L/min each

What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation?

VC provides a constant minute ventilation

A patient is suspected of having developed a pulmonary embolus. Which of the following tests should the therapist recommend to confirm the diagnosis?

VD/VT

A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance?

VT/Plat-PEEP

An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is

Ventilation/Perfusion Mismatch

A patient with a size 8.5 mm ID oral endotracheal tube is transported from the Emergency Department to the Intensive Care Unit. The respiratory therapist suspects the tube has changed position during transport. Which of the following is the first step to assess the tube position?

Verify symmetrical chest movement

A well-penetrated chest X-ray has which of the following qualities?

Vertebrae are just visible behind the heart

A 16 year-old patient with cystic fibrosis attends high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient?

Vibratory/Oscillatory PEP

After completing oxygen rounds, the respiratory therapist must clean flowmeters that were removed from rooms where no patients were receiving oxygen therapy. Which of the following methods is most appropriate for disinfection of the flowmeters?

Wipe with alcohol

The respiratory therapist works with a patient with COPD in a smoking cessation program. The patient complains of recent weight gain. The therapist should explain that this is not unusual and is a result of

a decrease in the patients metabolism

A 30 year-old male with bronchitis has coarse bilateral rales with a SpO2 of 90%. Despite a good cough effort, he has great difficulty in removing his thick secretions. The respiratory therapist should initiate

a heated humidifier and oxygen therapy.

Fremitus

a palpable vibration from the spoken voice felt over the chest wall

Following thoracotomy, a patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as

a persistent bronchopleural fistula.

A patient recently underwent a thoracotomy and receives IPPB QID. The patient's inspiratory capacity has diminished over the past several days and the patient is becoming increasingly short of breath. Chest radiograph shows left lower lobe radiodensity with a concave upper border. The respiratory therapist would conclude that the patient has developed

a pleural effusion

Ascites

abnormal accumulation of fluid in the abdomen

bronchial breath sounds

abnormal breath sounds when heard in locations that vesicular sounds are normally present. pneumonia may produce these sounds

A patient involved in an automobile accident is brought to the ED with tachypnea, tracheal deviation to the right, splinting, asymmetrical chest movement, and decreased breath sounds on the left side. The respiratory therapist should initially

administer 100% oxygen via mask.

A 55 year-old patient admitted to the Emergency Department has a history of hypertension. The patient is conscious, diaphoretic and complaining of chest pain. The respiratory therapist's first response should be to

administer oxygen

A patient involved in a motor vehicle accident several days ago sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain and develops tachypnea and tachycardia. The respiratory therapist should

administer oxygen

While suctioning an adult patient, the respiratory therapist observes evidence of hypoxemia on the bedside heart monitor. Which of the following are acceptable forms of treatment for the therapist to recommend?

administer oxygen

While examining the chest drainage system of a mechanically-ventilated patient following thoracotomy, the respiratory therapist observes bubbling in the water-seal chamber during inspiration. This would indicate

air leaving the pleural space

A patient receives mechanical ventilation via high frequency oscillation. The results of an arterial blood gas analysis are as follows: pH 7.18 PaCO2 68 torr PaO2 73 torr HCO3-26 mEq/L BE+2 mEq/L The respiratory therapist should increase the

amplitude

A patient's cardiac output is increased and his QS/QT is calculated to be 20%. Based upon this information, the respiratory therapist would inform the physician this patient has

an elevated shunt

Adverse effects of inhaled NO include all of the following EXCEPT A. methemoglobinemia. B. aplastic anemia. C. rebound pulmonary hypertension. D. nitrogen dioxide toxicity.

aplastic anemia

The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to

apply pressure to the site

During mechanical ventilation, a patient initiates the breath and then the ventilator controls the remaining variables for that breath. This describes a/an

assisted breath

A patient with a history of cardiovascular disease is brought to the Emergency Department. He is intubated and manually ventilated. The ECG monitor shows sinus rhythm with a rate of 50 beats/min and the patient's pulse is weak and irregular. The nurse has been unable to place a central or peripheral venous catheter. The respiratory therapist should recommend endotracheal instillation of

atropine

During bedside monitoring, the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first

attempt to draw blood from the arterial line

hemothorax

blood in the pleural cavity

Indirect calorimetry is performed on a 65-year-old patient to evaluate his nutritional status. It is determined that the patient's RQ is 1.00. This would indicate that the patient's diet consists mostly of

carbohydrates

Following CABG surgery, a 59 year-old patient's C(a-v)O2 increases from 5 mL/dL to 8 mL/dL. The respiratory therapist should report to the physician that the patient's

cardiac output is increasing

A patient admitted to the ED is noted to have pulse and blood pressure variations with respirations. This is most indicative of

cardiac tamponade

A patient has 2 mediastinal chest tubes following a thoracotomy. The respiratory therapist notes that there is continuous bubbling in the water seal chamber of the chest drainage system. The therapist should

check for a leak in the system.

After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist documents a need to change the patient's treatment regimen in the Progress Notes. The respiratory therapist should

check the medical record for new physician orders.

A patient reports to the pulmonary function clinic for evaluation of disability as a result of pneumoconiosis. Pulse oximetry is performed with a result of 97% on room air. Arterial blood gases are obtained and the measured SaO2 is 85%. These results are most consistent with

cigarette smoking

During a cardiopulmonary stress test on a 55-year-old man, the respiratory therapist notes the following changes: Heart rate increases Blood pressure increases VD/VT ratio decreases Respiratory rate increases The therapist should _______

continue the test

A 58 year-old male patient is hypoxic on volume control ventilation and is receiving 15 cm H2O of PEEP FIO2 0.60. Shortly after increasing the PEEP therapy to 18 cm H2O, the respiratory therapist notes that the systemic blood pressure has fallen from 110/72 mm Hg to 94/50 mm Hg and the cardiac output has fallen from 4.3 L/min. to 2.5 L/min. The most appropriate action at this time would be to

decrease the PEEP to 15 cm H2O and increase the FIO2 to 0.70.

A patient in the ICU is ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. The respiratory therapist notes that the patient's SpO2 is 92% and PETCO2 is 25 torr. The pressure-volume waveform reveals over-distension. The therapist should

decrease the inspiratory pressure.

A 62-year-old female who weighs 60 kg (132 lb) is on mechanical ventilation following hip replacement surgery.Ventilator settings are as follows:ModeVC, SIMVFIO20.35Set rate12 /min.Total rate12 /min.VT500 mLArterial blood gas results are as follows:pH7.50PaCO230 torrPaO2105 torrHCO3-24 mEq/LThe respiratory therapist should

decrease the minute volume.

A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend

deep breathing and coughing to clear secretions.

A patient is diagnosed with unilateral lung disease. The physician has requested that the affected lung be ventilated at a pressure 10 cm H2O lower than the normal lung. The respiratory therapist should recommend providing this type of ventilation via

double-lumen endobronchial tube

When initiating mechanical ventilation for a patient with chronic CO2 retention, the respiratory therapist must assure adequate inspiratory flow in order to prevent

dynamic hyperinflation

The respiratory therapist completes oxygen rounds and checking oxygen saturations on a number of patients. What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients?

ethyl alcohol

A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with

heart failure

A patient receiving warfarin (Coumadin®) has a prothrombin time (PT) of 20 seconds. These findings indicate a

high likelihood of excessive bleeding.

A 60 kg (132 lb) female patient with congestive heart failure receives NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40 PaCO2 42 torr PaO2 145 torr HCO3 26 mEq/L SaO2 99% CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as

hyperoxygenation

A 75 kg (165 lb) patient with acute lung injury is mechanically ventilated at the following settings: VC, A/C; VT 300 mL, respiratory rate 16/min, FIO2 0.50 and PEEP +5 cm H2O. The following arterial blood gas results are obtained: pH 7.30 PaCO2 58 torr PaO2 79 torr HCO3- 28 mEq/L. The patient's condition should be described as

hypoventilation

An optimal PEEP study is initiated for a patient receiving mechanical ventilation. The respiratory therapist initiates PEEP of 10 cm H2O for 20 minutes with no adverse effects. The PEEP is increased to 15 cm H2O and the patient's heart rate rises significantly with a severe fall in the blood pressure. Based upon the above information, the therapist should conclude that the patient is suffering from

hypovolemia

The most serious complication associated with airway suctioning is

hypoxemia

The respiratory therapist is called to ICU to evaluate a patient on continuous flow CPAP (8 cm H2O, FIO2 0.30) who is showing signs of respiratory distress. The patient's SpO2 has changed from 94% to 90%. The therapist observes that the CPAP pressure manometer displays negative pressure during inspiration. The therapist should

increase inspiratory flow to the CPAP system.

A 1600 g neonate receives oxygen by oxyhood at an FIO2 of 0.60. The flowmeter is set at 5 L/min. While analyzing the oxygen, the respiratory therapist notices varying FIO2 readings at different locations inside the oxyhood. The therapist should

increase the flow to the oxyhood

While instructing a patient prior to a vital capacity maneuver, the respiratory therapist should direct the patient to

inhale to total lung capacity then exhale to residual volume

Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right?

insert a chest tube

Evaluation of a spontaneously breathing patient reveals tachypnea, tracheal deviation to the right and an absence of breath sounds on the left. The most likely etiology would be

left tension pneumothorax

Hyperresonance

lower-pitched, booming sound found when too much air is present such as in emphysema or pneumothorax

Bronchial breath sounds heard over the lung periphery indicate

lung consolidation

A 72-year-old male patient who is 5' 10" tall and weighs 75 kg (165 lb) receives mechanical ventilation. The respiratory therapist notes diminished breath sounds in the bases of both lungs. The patient is on the following ventilator settings: Mode VC, A/C VT 600 mL Set rate10 /min PEEP 10 cm H2O FIO20.50 Arterial blood gases show: pH7.42 PaO2 82 torr PaCO2 38 torr SaO2 97% Based on this information, the respiratory therapist should

maintain the current settings.

A patient receives mechanical ventilation with a PEEP of 10 cm H2O and requires a MRI scan. Before transporting the patient, the respiratory therapist should obtain a

manual resuscitation bag with a non-ferrous PEEP valve assembly.

The most common complication associated with fiberoptic bronchoscopy via the nasal route is

mild epitaxis

All of the following statements are TRUE with regard to cuff inflation techniques EXCEPT: A. minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring. B. minimal leak technique allows a small leak at the end of inspiration. C. at minimal occlusion volume, air leakage around the tube cuff should cease. D. cuff pressure should not exceed 35 cm H2O in order to allow circulation to tracheal mucosa.

minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring.

Elevated ST segment

myocardial infarction

Inverted T wave indicates:

myocardial ischemia

While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the

peak flow meter is clogged.

The respiratory therapist performs the quality control procedures for the blood gas analyzer in the NICU and notices a single data point that is 3 standard deviations from the mean value for the pH electrode. The therapist should

perform another control run

Which of the following would indicate that the lung compliance of a patient on a volume-cycled ventilator is increasing?

plateau pressure begins to decrease

A 17 year-old patient receives 40% oxygen via a Venturi mask following a motor vehicle accident. He suddenly develops acute shortness of breath, is diaphoretic and SpO2 is 85%. Breath sounds are vesicular on the right and extremely diminished on the left. The respiratory therapist should evaluate the patient for the presence of

pneumothorax

The primary source of infection in the health care setting is

poor handwashing by the personnel

A mixed venous blood sample is needed to determine the oxygen consumption of the tissues. The mixed venous blood sample should be obtained from the

pulmonary artery. (PAP)

A patient in the intensive care unit has the following hemodynamic measurements: CVP 4 mm Hg PAP 48/16 mm Hg PCWP 8 mm Hg MAP 92 mm Hg Cardiac Output5 L/min. Cardiac Index2.5 L/min/m2 These results are most consistent with

pulmonary hypertension.

A 70-kg (154 lb) patient with emphysema receives mechanical ventilation. Current ventilator settings are as follows: VC, SIMV; VT 550 mL, respiratory rate 12/min, FIO2 0.30. The patient is awake and alert and does not appear to be in any distress. The total respiratory rate is 14/min. ABG results are as follows: pH 7.35, PaCO2 58 torr; PaO2 65 torr; HCO3 30 mEq/L. His SpO2 is 94% and MIP is -30 cm H2O. This patient is most likely

ready for a spontaneous breathing trial.

A patient receiving mechanical ventilation has a capnometer in-line at the Y-connector of the vent circuit for continuous monitoring of exhaled CO2. The capnogram suddenly indicates an abrupt decrease in the PETCO2 from 5.3% to 0.0%. The respiratory therapist should

reattach the patient to the circuit

A nasally intubated patient receives mechanical ventilation via volume-cycled ventilator. While performing a patient-ventilator system check, the respiratory therapist notices that the high pressure alarm is sounding. The patient appears cyanotic and his heart rate is 48 beats per minute. The therapist is unable to pass a suction catheter through the nasotracheal tube. The therapist should

remove the tube and manually ventilate

While attempting to calibrate a polarographic oxygen analyzer, the respiratory therapist notices that the analyzer reads 21% when exposed to room air but only reads 64% when exposed to 100% oxygen. The most appropriate action at this time would be to

replace the battery

A 44 year-old patient who suffered a cerebral vascular accident has been moved from Neuro-ICU to the step-down unit. He becomes diaphoretic and his SpO2 suddenly drops from 95% to 88% on a 32% tracheostomy collar. His heart rate is 115/min, respiratory rate is 42/min and his breath sounds are very diminished. The respiratory therapist is unsuccessful in attempting to pass a 12 Fr suction catheter. The therapist should

replace the tracheostomy tube.

A spontaneously breathing post-CVA patient has developed right lower lobe infiltrates on chest x-ray and has coarse breath sounds. When the respiratory therapist attempts to suction the patient by the nasotracheal route, a gag reflex is present but the patient does not cough. Watery secretions are aspirated through the suction catheter. The therapist should

reposition the patient to a sniffing position.

A tracheostomy tube has just been changed on a patient receiving continuous volume-cycled ventilation. The patient suddenly becomes dyspneic and develops crepitus around the tracheostomy stoma. The respiratory therapist should

reposition the tracheostomy tube

A patient receives IPPB therapy with a Bird Mark-7 ventilator. The respiratory therapist notes that the patient is generating negative pressure at the beginning of inspiration although the machine does not switch into the inspiratory phase. The respiratory therapist should adjust the

sensitivity

The respiratory therapist assisted the pulmonologist with a bedside fiberoptic bronchoscopy procedure in the ICU. In order to clean and disinfect the bronchoscope, the therapist should

soak in alkaline glutaraldehyde for 10 hours.

The primary reason for the use of respiratory care protocols is to

standardize provision of care.

A 19-year-old patient has a size 7 mm ID nasotracheal tube placed through the right nare. While attempting to suction the patient with a size 12 Fr catheter, resistance is met as the catheter is introduced into the endotracheal tube. The respiratory therapist should

switch to a 10 Fr suction catheter. 7/2=3.5 x 3 =10.5

The following measurements were obtained from a patient being monitored with a balloon tipped, flow directed catheter: CVP 2 cm H2O PAP 12 torr (mean) PCWP 3 torr CI 1.2 L/min/m2 BP 110/90 mm Hg Based on the above information, all of the following parameters would be decreased EXCEPT A. right ventricular end diastolic pressure. B. left atrial filling pressure. C. systemic vascular resistance. D. cardiac output.

systemic vascular resistance.

A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted to the left. The most likely explanation for the problem is that

the endotracheal tube has slipped into the right main stem bronchus.

A patient receives oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37 PaCO2 42 torr PaO2 80 torr HCO3 38 mEq/L. The most likely explanation for these results is that

the numbers were not reported correctly

The respiratory therapist prepares to assist with bronchoscopy for a patient in the ICU currently receiving mechanical ventilation in the VC,AC mode. The therapist should anticipate addressing all of the following considerations EXCEPT

the patient's extrinsic PEEP levels will increase.

The physician informs the patient that the results of his polysomnogram indicate obstructive sleep apnea. Treatment for this disorder might include

tracheostomy

The FRC measured by body plethysmography is 30% larger than that measured by helium dilution. This difference is best explained by

trapped thoracic gas

A patient who had his chest tube clamped for 18 hours with no apparent respiratory distress is now tachypneic, diaphoretic and complaining of dyspnea and general uneasiness. The respiratory therapist should

unclamp the chest tube

A patient has mild stridor immediately after extubation. This finding is most often associated with

upper airway obstruction.

All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT: -maintaining cuff pressures between 20 and 25 mm Hg. - using the minimal leak technique for inflation. - using a low-residual-volume, low-compliance cuff. - monitoring intracuff pressures.

using a low-residual-volume, low-compliance cuff.