C&S TMC NUMBER THREE
For a pt receiving NPPV, the IPAP is increased from 10 cm H2O to 14 cm H2O. This setting change should result in:
Normalized pH/PaCO2
Measurement of which of the following would be most useful in evaluating the effectiveness of fluid replacement therapy in a critically ill patient?
central venous pressure
While viewing the post-intubation chest x-ray of an orally intubated patient, the respiratory therapist notes that the distal tip of the endotracheal tube is parallel to T3. Which of the following actions would be appropriate?
no action is indicated, the endotracheal tube is properly placed.
Which of the following allows the easiest and most immediate determination of the correct placement of an endotracheal tube?
observing the rise and fall of the chest during inspiration and expiration.
An asthmatic patient is prescribed inhaled fluticasone (Flovent). Which of the following would the respiratory therapist do to determine the patient's optimal dose on inhaled fluticasone?
perform daily exhaled nitric oxide measurements
The simplest way of ensuring an open airway in an unconscious patient is?
performing a head-tilt/chin-lift maneuver.
During a spontaneous breathing trial (SBT), the patient's end-tidal CO2 increases from 43 mmHg to 55 mmHg, all of the following could have decreased EXCEPT:
physiological deadspace
The easiest to apply techniques to prevent ventilator-assoicated pneumonia (VAP) is?
positioning the patient in a semi upright position as much as possible.
A patient has just been admitted to the ED for severe smoke inhalation following a house fire. Which of the following would not be included in the assessment of this patient?
pulse oximetry
A respiratory therapist is reviewing the Levey Jennings control chart shown above for a blood gas analyzer. Which of the following best explains Sample Number 8 ?
random error
In which of the following situations would the respiratory therapist find the use of an orophraryngeal airway helpful?
to facilitate bag-mask ventilation in a comatose patient
In which of the following situations would the respiratory therapist use an obturator with a tracheostomy tube?
to facilitate tube insertion
The maximum inspiratory pressure (MIP) is used to determine?
ventilatory reserve
A 7 year old asthmatic child has been admitted to the ED in moderate respiratory distress. The child appears anxious and agitated. Vital signs are: pulse 146/min and respirations 34/min. Rectal temp is 39 degrees centigrade. There is dullness to percussion with absent sounds over the upper right upper lobe and generalized loud expiratory wheezes throughout both lungs. ABG on room air: pH 7.36, PaCO2 42, HCO3 24 and PaO2 71. Other physical findings are normal. The RT should recommend:
2 liters nasal O2, inhaled SAB, oral corticosteroids
Which of the following are acceptable alterations in a pt's status during weaning trials?
1 (An increase in the PaCO2 of 3 mmHg-YES, An increase in the pulse of 20/min-NO, An increase in the RR of 5/min-YES, the development of occasional PVCs- NO)
A standard 12- lead ECG uses
10 electrodes
Which of the following blood sodium (Na+) levels is most consistent with fluid loss (dehydration)?
156 mEq/L
The following data is recorded for a 22-year-old asthmatic male; Pre-bronchodilator: 421 L/min. Post-bronchodilator: 493 L/min. What percentage change has occurred in the PEFR following the bronchodilator?
17%
A pt with cardiovascular depression is being MV via a volume neb. Which of the following I:E ratios would most likely lead to further depression of this pt's cardiovascular system?
1:1
An intubated pt is being mechanically ventilated via a volume neb. The physician has asked the RT to begin weaning the pt. Which of the following modes would be appropriate?
2 (A/C-NO, SIMV-YES, IRV-NO PSV-YES)
A physician has ordered a PFT for a 44 year old female who presented with a complaint of dyspnea with mild exertion. She has a 21 year pack history of smoking a history of IV methylphenidate (Ritalin). The PFT results are as follows:
2. very obstructive-YES, Significant air-trapping-YES, Significant response to bronchodilator-NO
A patient who is being mechanically ventilated with an FIO2 of 1.0 has a PAO2 of 576 mmHg, a PAO2 of 180 mmHg, a PACO2 of 44 mmHG, and a C(a-v) O2 of 5% vol. The barometric pressure (PB) is 760 mmHg. On the basis of this information, the percent shunt (Qs/Qt) is approximately:
20%
A comatose pt who is being MV in the VC SIMV mode occasionally becomes restless and agitated. Which of the following alarms should the therapist set to ensure that an alarm sounds if the pt should become disconnected?
3 (Low exhaled Vt-YES, Apnea-NO, Low insp. Pressure-YES, I:E ratio-NO)
which of the following breathing patterns help optimize aerosol drug deposition to the deeper recesses of the lungs?
3 (MOUTH BREATHING-YES. RAPID DEEP INSPIRATION-NO. INSPIRATORY PAUSE-YES. PURSED-LIP BREATHING-YES)
The respiratory therapist monitoring an adult female patient who is receiving mechanical ventilation records a set tidal volume of 550 mL, a peak pressure of 25cmH2O, and a plateau pressure of 15 cmH2O. Which of the following best represents the static compliance?
37 ml cmH2O
Which of the following pathological conditions would cause tracheal deviation toward the diseased side:
4. Yes, Yes, Yes, No
All of the following would be important in the management of a trauma pt during air-transport except:
ABG sampling/analysis
A pt who is receiving an aerosol treatment with cromolyn sodium (Intal) becomes dyspneic and complains of chest tightness. Which of the following is an appropriate treatment for this pt's problem?
Add albuterol (Proventil) to the aerosol mixture
A pt with COPD is being MV in the SIMV mode with a rate of 7/min, Vt 425 mL, and an FiO2 of 0.45. ABG on these settings are pH: 7.37, PaCO2: 58, HCO3: 33, and PaO2 of 62. Breath sounds reveal expiratory wheezes, more on the left than the right. The RT should recommend:
Administering an in-line albuterol treatment
An RT is asked to assess a pt with history of CO2 retention & air trapping. The pt complains that he has become increasingly SOB and is having difficulty coughing up secretions. Upon auscultation, the therapist notes scattered coarse crackles and an occasional expiratory wheeze. Most appropriate?
Aerosol bronchodilator with PEP therapy
Over the last 3 months, a 14 year old home care pt with CF has had increasing difficulty with secretion retention and mucus plugging. The child's mother administers albuterol via SVN followed by CPT 4 times daily. Which of the following should the RT recommend?
Albuterol via IPV
Data obtained from an orally intubated, MV adult pt are as follows: 8:00 AM 10:00 AM Mode SIMV SIMV VT 470 mL 470 mL Rate 14/min 14/min PetCO2 36 mmHg 44 mmHg PaCO2 38 mmHg 46 mmHg Spo2 92% 91% SaO2 95% 95% Which of the following best explains these data:
Alveolar ventilation has decreased
2 mL (20 mg) cromolyn sodium (Intal) by neb. q4 has been ordered for a 7 year old asthmatic child. After verifying the order in the pt's medical record, the RT should:
Assess pt and administer therapy as ordered
An RT is discussing discharge orders with a pt who has a long standing history of chronic obstructive pulmonary disease and who has a 78 pack year smoking history. Important aspects of the discharge orders regarding the pt's pulmonary status include all of the following except:
Avoiding public restaurants that serve alcoholic beverages
A 69 year old female is receiving O2 via NC a 2 L/min. An ABG sample is drawn: pH: 7.29 PaCO2: 76 PaO2: 78 HCO3: 35 SaO2: 94% Most appropriate action:
Decrease the O2 flow to 1 L/min
An 80 kg (176 lb) male pt is being MV. Data below: Vent settings: ABG: Mode: VC-SIMV pH: 7.53 Rate: 14/min PaCO2: 27 Vt: 750 mL PaO2: 109 FIO2: 0.50 HCO3: 22 PEEP: 7 cm H2O Based on results, which of the following should the RT do FIRST?
Decrease the Vt
In the absence of pulmonary artery catheter monitoring, measurement of which of the following provides the best indicator of tissue pxygen transport?
C(a-v)O2
An effective respiratory care protocol would most likely result in which of the following?
Decrease the incidence of physician over-ordering and under-ordering
Which of the following is recommended for determining the presence of abnormal Hb in the blood?
CO-oximetry analysis
Measurement of which of the following would be most useful in evaluating the effectiveness of fluid replacement therapy in a critically ill pt?
CVP
An RT has been asked to initiate O2 therapy for a 33 year old female pt. While reviewing the physician's orders, the therapist notes that the physician ordered oxygen via simple mask at 3 L/m. Which of the following should the therapist do?
Clarify the order with the physician
A physician has written an order for a respiratory treatment that appears to contradict a hospital policy. The RT should:
Contact physician ask for clarification
A 96 kg (211 lb), 174 cm (5 ft 10 in) 86 year old male pt is receiving ventilatory support via a volume vent in the PSV mode. Vent settings and ABG results are as follows: Vent settings: ABG: PSV: 12 cm H2O pH: 7.41 FiO2: 0.45 PaCO2: 36 CPAP: 5 cm H2O PaO2: 72 HCO3: 22 The RT should recommend?
Continuing current therapy
A physician has ordered an apnea test for brain death determination on a 32-year-old female who is orally intubated and being mechanically ventilated. Which of the following prerequisites would need to be met before proceeding with the test?
Core Temperature > 97 deg F; yes, Euvolemia; no, Systolic BP > 90 mmhg; yes, Normal PACO2; no.
An RT is asked to evaluate and recommend care for a 79 yr old female who has end-stage COPD and who has just been brought to the ED by her daughter. Which of the following should the therapist consider first before recommending aggressive care for this pt?
DNR/DNI status
A pt in ICU requires aggressive fluid and electrolyte replacement therapy. Implementation of which of the following would be most appropriate to evaluate the effectiveness of therapy?
ECG monitoring
While assisting a physician during the bronch procedure, the RT notes blood streaked secretions in the suction container. Which of the following agents would be most helpful in controlling the bleeding?
Epi
A 34 week old neonate is receiving CPAP at 2 cm with an FiO2 of 0.30. ABG values are as follows: pH: 7.37 PaCO2: 40 PaO2: 76 HCO3: 22 Which should the therapist recommend?
Extubating and administration of 30% O2
A pt with a long standing history of COPD is receiving O2 via a 50% air entrainment mask. Prior to the initiation of O2 therapy, the pt was alert and oriented. 2 hours after the initiation of O2 therapy, the pt is barely responsive & lethargic. The RT should recommend a change of oxygen therapy because it is probable that the pt:
Has oxygen-induced hypoventilation
A respiratory therapist is asked by her shift supervisor to initiate nebulized bronchodilator therapy for a 57 - year old male patient. Which of the following should the therapist review prior to initiating therapy?
History; yes, Chest physical exam; yes, Physician orders; yes, Progress notes; yes.
A 51 year old female presents to the ED complaining of weakness, muscle cramps, fatigue, and palpations. An ECG is obtained. The RT should recommend:
IV potassium
The RT has positioned an adult post op pt with the head of the bed down for postural drainage to the left lateral basal segment. 3 minutes later, the RT notices a blood pressure of 168/90 mmHg on the cardiac monitor. The RT should:
Immediately have the pt sit up
The following ABG results are recorded for a neonatal pt who is receiving PC AC ventilation: pH: 7.31 PaCO2: 51 PaO2: 69 HCO3: 24 The RT should:
Increase the PIP
After initiating MV in the AC mode for an adult male pt, the RT observes that the pt is agitated and having difficulty cycling the vent. Which of the following should the RT do?
Increase the sensitivity setting
A 60 yr old 70 kg male pt is being MV via volume ventilator. Vent settings are: SIMV; rate 14/min; Vt 525 mL; FiO2 0.70; PEEP 10 cm H2O. ABG results on these settings are: pH 7.39, PaO2 82, PaCO2 43, HCO3 25. Over the last hours, the pt's BP has decreased from 120/76 mmHg to 100/60 mmHg. Respiratory mechanics has been initiated. The pressure and flow curves are shown on the right. The most appropriate action is:
Increasing the inspiratory flow rate
An RT is asked to assess a COPD pt is in a pulmonary rehab program. During the interview, the pt tells the therapist that he has been working with a resistive training device for 2 weeks and that he is able to tolerate the device for 15 mins. What should the therapist do?
Insert a smaller restrictive orifice in the device
28 week gestation neonate is being manually ventilated following delivery. Chest excursion is poor despite respiratory ventilation with high peak pressures. Most appropriate action?
Intubate the patient
2 hours after being admitted to the ICU, an asthmatic pt has become severely obtunded and cyanotic. SVT with frequent PVCs are noted on the cardiac monitor. Auscultation reveals markedly diminished air bilaterally. Which of the following is priority?
Intubation and MV with 100% O2.
All of the following are true regarding He/O2 therapy EXCEPT:
It has been shown to stimulate deep breathing
Following a traumatic nasal intubation, the pt begins to bleed profusely from the nasopharynx. The RT should:
Keep the NT tubes cuff inflated and suction pharynx as needed
While prepping a pt for a thoracentesis, the pt asks the RT why he must be sitting upright. The RT would explain to the pt that sitting upright
Lowers the diaphragm and reduces the possibility of its puncture.
An RT is assisting the physician with an elective cardioversion. During the procedure, the patient experiences a sudden attack of severe seizures. The 1st priority of the RT is:
Maintain a patent airway
70 kg (154 lb) male pt with COPD is being MV: Vent settings: ABG: Mode: SIMV pH: 7.36 Vt: 550 mL PaCO2: 61 mmHg Set rate: 10/min PaO2: 68 mmHg FiO2: 0.40 HCO3: 33 mmHg PEEP: 5 cm H2O The RT should recommend:
Maintain current settings
A 36 weeks gestation, 4 hour post-delivery neonate has the following ABG results while on a 35% oxyhood: pH: 7.34 PaCO2: 47 mmHg PaO2: 57 mmHg HCO3: 25 mmHg The RT should recommend:
Maintain current therapy and continue to monitor
A pt with a history of moderate COPD has an order for NPPV with IPAP 10, EPAP 5, backup rate 12/min, and FiO2 0.35. Prior to the initiation of NPPV, ABG results while breathing O2 via NC at 3 L/min showed a pH of 7.29, PaCO2 of 62, and PaO2 of 48. One hour after the initiative of NPPV, ABG results are obtained and the results are pH 7.36, PaCO2 51, and PaO2 74. The RT should recommend?
Maintaining preset settings
A pt with a nasal ET tube is exhibiting signs of severe respiratory distress with accessory muscle use. The RT's 1st action would be to:
Manually ventilate the patient
After performing ET suctioning on a pt who is being MV, the RT notices the vent has suddenly stopped cycling. The RT should do which of the following:
Manually ventilate the pt
Which of the following is true regarding the 4th heart sound (S4)?
May be a sign of diastolic heart failure
A pt with left lung consolidation has been receiving aerosol bronchodilator therapy for 2 days. Over the last 24 hrs, the pt has had increasing difficulty mobilizing secretions. Which of the flowing is indicated to help improve this pt's condition?
PEP therapy
If the airway resistance of a pt who is being MV via a volume ventilator increases, which of the following would also increase?
Peak pressure
A pt with AIDS is to be given treatment for the prevention of Pneumocystis carinii pneumonia. Which of the following is most appropriate therapy for this pt?
Pentamidine (NebuPent) via Respigard once every 4 weeks
At which of the following periods should the RT recommend the placement of a trach tube for an orally intubated pt?
Placement is individualized based on the pt's clinical situation
Following abdominal surgery, a pt has developed a productive cough and a temp of 103.3 degrees F (39.6 degrees Celcius) Auscultation of the chest reveals fine crackles throughout the left lower lung field. These findings are consistent with:
Pneumonia
The easiest way to apply technique to prevent VAP is:
Position the pt in a semi upright position as much as possible
An RT is assisting the physician with needle aspiration to relieve a tension pneumothorax. The procedure has been successful. Which of the following should be done next?
Proceed with chest tube placement
Which of the following represents a primary indication for ET instillment of surfactant?
Prophylactically for neonates <24 weeks gestational age
All of the following are true regarding respiratory care assess and treat (RCAT) protocols except:
RCAT protocols replace the Rapid Response Team
A pt's PaO2 measured by ABG is 255 mmHg. The analyzer on which the sample was analyzed is calibrated to a PaO2 of 150 mmHg. Most acceptable action?
Recalibrate the analyzer to accommodate this unusual value
A physician has requested that the RT instruct an outpatient who is enrolled in a pulmonary rehab program on the proper cleaning and disinfection of his RT equipment. The therapist should explain to the pt that the primary purpose for cleaning and disinfection is to:
Reduce the spread of infection
12 hours following a spontaneous breathing, orally intubated pt admitted for narcotic overdose regains consciousness, becomes extremely agitated and needs restraining. At this time, the RT should recommend which of the following?
Removal of ET
An adult pt is orally intubated and receiving continuous MV. While performing a routine cuff pressure measurement, the RT observes that the cuff pressure monometer's indicator needle continuously reads zero. No vent alarms are activated and the pt appears to be resting. The RT should do:
Replace cuff monometer
While attempting to suction a pt with a nasopharyngeal airway in place, the RT is experiencing difficulty in passing the suction catheter through the nasopharyngeal airway. The RT should do which of the following FIRST?
Reposition the nasopharyngeal airway and re attempt suctioning
Which of the following positions would be a contraindicated in a pt with left lung abscess.
Right lateral decubitus
An RT is asked to initiate MV on a 67 year old, 55 kg female pt who has a long standing history of COPD. The RT should suggest:
SIMV; rate 8/min, Vt 400 mL, FiO2 0.30
A 68 year old female presents to her physician with complaints of dyspnea on exertion and having to sleep with 2 pillows for breathing comfort. She has a 45 pack year history of smoking and is a retired cashier. The physician orders PFT and the results are as follows: FVC: 46 FEV1: 33 RV: 194 TLC: 106 Which of the following is consistent with these results:
Severe obstructive defect
To assess the degree of respiratory distress in a newborn, the respiratory therapist would evaluate the:
Silverman Anderson Index
The RT enters a pt's room as the pt is about to have a portable CXR done. The x-ray technician suddenly slumps to the floor, making a gurgling sound. The RT should do which of the following?
Speak loudly and gently shake the technician
Shortly after the initiation of a CPAP titration trial, the pt's BP decreases from 136/85 mmHg to 116/70 mmHg. The most appropriate action would be to:
Stop the titration and notify the physician
The RT has been called to assess a 42 year old male pt who is being mechanically ventilated via volume neb. Upon entering the room, the therapist finds an agitated pt in obvious respiratory distress. The therapist observes that the SpO2 is 89% and the end-tidal CO2 is 52 mmHg. The respiratory mechanics waveform is shown to the right. Which of the following do you recommend?
Suction the patient
A neonate pt is receiving supplemental O2 via NC. Over the last 12 hours the pt has had 3 episodes of epistaxis. The RT should recommend which of the following?
Switch the pt to oxyhood
During the administration of a nebulized treatment, the pt complains of tingling and numbing sensation in his fingers. The RT notices a slight trembling of his hands. The RT should:
Temporarily stop the treatment
Which of the following would activate the high pressure limit alarm on a volume vent?
The pt coughs during a mechanical breath
An orally intubated 18 yr old male was bought to the ED by EMS. A cuff pressure reading of 4 cmH2O was recorded at the time of initial assessment. The most likely finding of this cuff pressure is:
The pt is at high risk for aspiration
A premature infant is receiving O2 via 40% oxyhood. The results of a CBG and pulse ox measurement are as follows: pH: 7.38 PcCO2: 42 PcO2: 78 SpO2: 78 Which of the following would explain these results?
The pt is hyperoxic
A pt receiving sustained maximal inspiration (SMI) treatments with a volume oriented I.S. device begins to rapidly breathe through the device. Which of the following best explains this situation
The pt needs re instruction regarding SMI therapy
Which of the following are potential complications that might occur as a result of an overinflated endotracheal tube's cuff?
Tracheomalacia;yes, Tracheostenosis;yes, Gastric insufflation; no, Aspiration;no
A home care pt receiving continuous O2 via NC has become increasingly noncompliant in her O2 therapy and states she is concerned about appearance. Which of the following would be most appropriate for the RT to suggest?
Transtracheal oxygen catheter
An RT is attempting to suction a pt who has just been nasally intubated. The therapist is unable to pass the suction catheter through the nasotracheal tube. Which of the following should the RT do?
Use a smaller size suction catheter
An infant is being MV via HFJV. Which of the following would occur if PEEP were increased without a corresponding increase in PIP
Vt would decrease
Transillumination of the chest is performed on a neonatal pt for which of the following reasons?
When the pt's symptoms suggest a tension pneumothorax
In which of the following situations would it be appropriate for the RT to terminate a bronchodilator treatment?
Worsening of bronchospasm
A home care patient with a tracheostomy tube is receiving oxygen with aerosol via a tracheostomy collar. During a visit to the home, the respiratory therapist observes that there is very little aerosol mist exiting the tracheostomy collar. All of the following could be a potential source for this problem EXCEPT?
a loosely fitted tracheostomy collar
Which of the following may cause the FIO2 of a high-flow oxygen delivery device to decrease?
a malfunctioning air entrainment port
Which of the following would be indicated for a patient who requires frequent nasotracheal suctioning?
a nasopharyngeal airway.
Which of the following patients would benefit most from aerosol therapy?
a patient who has just had a tracheostomy tube placed
A 67-year-old female is admitted to the ED following a motor vehicle accident. The patient has severe facial lacerations including a broken nose and bilateral mandible fractures. There is blood in and round her mouth and ears. She is having difficulty breathing due to blood partially occluding her airway. She is currently receiving oxygen via nonrebreathing mask. Which of the following is most indicated for this patient?
a tracheostomy tube
While observing a patient use her metered dose inhaler (MDI), the respiratory therapist notes that the patient has difficulty in coordinating her inspiratory effort with actuation of the MDI. Which of the following would be beneficial for this patient?
addition of a holding chamber to the MDI
Following the successful placement of a pulmonary artery catheter, the following data are obtained: PAP; 20/6 mmHg, PCWP; 2 mmHg, CVP ; 0 mmHg, BP; 88/60 mmHg, Pulse; 138/ min. On the basis of this information, which of the following is indicated?
administration of intravascular fluid.
The effectiveness of infection control techniques is best monitored by obtaining random cultures from respiratory therapy equipment at which of the following times?
after 24 hours of patient use
Spontaneous "wedging" of the pulmonary artery (PA) catheter is the result of?
an inflated balloon
The results of an arterial blood gas are as follows; Ph: 7.48. Paco2: 43 mmHg. Pa02: 76 mmHg. Hc03: 17 mEq/L. The most correct interpretation is which of the following?
analytical error
A neonatal patient is being monitored via transcutaneous oxygen monitor with the electrode placed on the patient's chest. The electrode temperature is set at 44 deg C. The TcPO2 reading is 159 mmHg, but an arterial blood gas sample obtained concurrently with this reading indicates a Pao2 of 78 mmHg. Which of the following would correct this problem?
apply additional contact gel.
The respiratory therapist has just obtained an arterial blood gas sample from the radial artery of a patient on anticoagulant therapy. Which of the following would be the most beneficial to ensure there is no internal bleeding?
apply pressure to the puncture site until external bleeding has stopped.
During recovery from a cholecystectomy, a patient becomes disoriented and confused. He is afebrile with a respiratory rate of 28/min. The above ECG rhythm is observed on the cardiac monitor. The etiology of the patient's symptoms is most likely to be revealed from the results of which of the following?
arterial blood gas analysis.
Which of the following resuscitation devices is best suited for manually ventilating an adult patient?
bag-valve resuscitator that delivers a stroke volume of 1 liter.
The respiratory therapist has been called to evaluate a patient receiving nasal mask BiPAP. Upon entering the patient's room, the therapist observes that the estimated , exhaled tidal volume light is flashing. To correct this problem, the therapist could do all the following EXCEPT?
check the exhalation ports for leaks.
While reviewing a patient's medical chart, the respiratory therapist notes that over the last 24 hours, the patient's fluid intake totals 1,770 mL while the output total is 800 mL. The therapist should evaluate which of the following?
chest x-ray results
The chest x-ray shown to the right was taken immediately after an oral endotracheal tube was placed. Based on this chest x-ray, which of the following should the respiratory therapist recommend?
continue with therapy
Which of the following is NOT true regarding the use of high frequency jet ventilation?
cycling rates are generally less than 100 cycles per minute.
An adult pt being treated in the ED is receiving O2 by NC at 5 L/m. Over the last hour, the pt's respirations have become irregular and shallow. ABG's show: pH: 7.24 PaCO2: 86 mmHg PaO2: 89 mmHg HCO3: 36 The most appropriate recommendation:
decrease the O2 liter flow
A patient presenting with recurrent hemoptysis of no known origin would best be evaluated by performing which of the following?
diagnostic bronchoscopy.
When responding to a ventilator alarm, the respiratory therapist notes that the exhalation valve leak alarm has activated. Which of the following is the most correct action at this time ?
disconnect the patient from the ventilator and manually ventilate.
A physician has ordered an increase in the PEEP level of a mechanically ventilated patient. After increasing the PEEP to the ordered level, the respiratory therapist should evaluate which of the following to determine if the increase in PEEP is beneficial for this patient?
effective static compliance.
The capnogram tracing above was obtained from a mechanically ventilated patient. On the basis of this tracing, the respiratory therapist should?
ensure the endotracheal tube is patent.
An adult male head injury patient is intubated and being mechanically ventilated. To avoid secondary injury from accidental increased cerebral edema, which of the following should the respiratory therapist recommend?
etCO2 monitoring
Which of the following is consistent with the flow-volume curve shown to the right?
fixed large airway obstruction
A patient has just been admitted to the ED following a biking accident. While auscultating the patient's chest, the respiratory therapist notes near absent breath sounds on the left with the right side rising during inspiration. While the left side appears to cave in. Which of the following would be the most probable cause of this finding?
flail chest
Generally, chest tubes to drain air are placed:
high and directed anteriorly.
While performing an assessment of a patient, the respiratory therapist notes distended neck veins and peripheral edema. Which of the following conditions would be the most probable cause of this finding?
hypervolemia
Pertinent laboratory data for a 49-year-old post-operative patient are as follows: Ph: 7.52 PaCo2: 38 mmHg Pao2: 89 mmHg HC03: 30 mEq/L NA+: 144 mEq/L K+: 2.8 mEq/L Cl-: 95 mEq/L. These data are suggestive of which of the following?
hypokalemia
The respiratory therapist has positioned an adult postoperative patient with the head of the bed down drainage to the left lateral basal segment. Three minutes later, the therapist notices a blood pressure on the cardiac monitor. The respiratory therapist should do which of the following?
immediately have the patient sit up
A 37 yr old, 5'1" tall, 46 kg female with ARDS secondary to severe necrotizing pneumothorax is orally intubated and receiving VC/AC ventilation. Pertinent data are as follows: VT: 225 mL Rate: 16/min FiO2: 0.70 PEEP: 12 cmH2O PIP: 42 cmH2O Pplat: 22 cm H2O The RT should:
increase Vt in 1 mL/kg steps to a max of 6 mL/kg
While on CPAP of 12 cmh20 during a CPAP titration sleep procedure, an obstructive apnea is observed followed by loud snoring. Which of the following should be done?
increase the CPAP level by 1 cmh20 and continue to monitor.
The respiratory therapist is monitoring a hospitalized patient recently diagnosed with myasthenia gravis. Over the last 24 hours, the patient's vital capacity has decreased from 2.6 liters to 1.4 liters. On the basis of this information, which of the following should the therapist recommend?
increase the frequency of vital capacity monitoring
While checking the volume ventilator that is to be used for a coronary care patient, the respiratory therapist observes that the displayed exhaled tidal volume is 250 mL less than the preset tidal volume setting. Appropriate actions to correct this problem include all of the following EXCEPT?
increase the preset tidal volume setting by 250 mL
While inspecting the chest x-ray of an orally intubated patient, the respiratory therapist notes that the endotracheal tube has migrated into the left mainstem bronchus. Which of the following is LEAST LIKELY to occur as a result of this?
increased aeration on the right side
The respiratory therapist instructs a patient to exhale normally then inhale to a maximum breath. Which of the following is being measured during this process?
inspiratory capacity (IC)
The data below were obtained from a patient being weaned from mechanical ventilation via a 35% T-piece setup. The respiratory therapist should?
instruct the patient to relax and continue to closely monitor.
Hemodynamic monitoring is initiated for a patient with severe ARDS. Following an increase in PEEP, the SVO2 increases from 56% to 67%. Based on this change, the respiratory therapist should conclude that:
intrapulmonary shunt has decreased
A 28-year-old male has been admitted to the cmH20 for acute exacerbation of diabetes. Arterial blood gases are obtained and the results shown below: Ph: 7.29. Pac02: 26 mmHg. Pao2: 110 mmHg. HCO3: 12 mEq/L. These data indicate that the patient?
is hyperventilating because of an acid-base disturbance.
Which of the following is NOT true regarding of the nonrebreathing oxygen mask?
it has valves that direct inspired gases to the atmosphere.
Which of the following best explains the reason for extubating a patient at peak inspiration?
it reduces the occurrence of post-extubation aspiration
While examining a patient's chest, the respiratory therapist observes that the right chest excursion is greater than the left. Additionally, there is a dull percussion notes over the left lateral lung field with absent breath sounds in this area. The therapist should conclude that the patient most likely has
local bronchial obstruction
The quality control procedure useful for detecting and/or preventing malfunctions which could improve compliance and outcome of home mechanical ventilation is which of the following?
regularly assessing the actual performance of the ventilator at the patient's home.
During bronchoscopy of a pediatric patient admitted for aspiration pneumonitis secondary to the aspiration of peanuts, the tip of the bronchoscope continually becomes occluded with almond particles when vacuum is applied. Which of the following actions is most appropriate?
remove the bronchoscope from the lungs and wipe the tip with sterile gauze.
While caring for a patient with severe acute respiratory syndrome (SARS), the respiratory therapist's face shield becomes contaminated. When ready to leave the patient area, the therapist should do which of the following?
remove the face shield by handling the portion that secures it to the head and then dispose of it.
While a respiratory therapist is suctioning a nasally intubated patient, the nasotracheal tube becomes displaced out of the trachea. Which of the following should the therapist do?
remove the tube and manually ventilate as needed.
A premature infant is receiving an FIO2 of 0.30 via an oxyhood and blender setup. When analyzing the oxygen concentration, the respiratory therapist notes the FIO2 is 0.21. The blender is set at an FIO2 of 0.30, the flowmeter is set at 10 L/min, and the nebulizer's entrainment port is set at 100%. To correct this problem, the therapist should?
replace the oxygen analyzer.
While assessing a patient who is receiving supplemental oxygen at 28% via tracheostomy tube, the respiratory therapist notes pulsatile movement of the tube. Which of the following should the therapist do next?
reposition the tracheostomy tube
A 16-year-old female has been admitted to the ED with persistent cough, shortness of breath, chest pain, and unexplained fever. Auscultation reveals crackles with bronchial breath sounds. Which of the following should the respiratory therapist recommend?
sputum culture and sensitivity.
While palpating a patient's chest following the insertion of a central line, the respiratory therapist notes the development of fine crepitus surrounding the insertion site. Which of the following is most likely present?
subcutaneous emphysema
A 22-month-old toddler is brought to the ED by her mother. The mother states that the child started choking and gasping after taking a big gulp of milk. The respiratory therapist notes that the child looks dyspneic and with a wet sounding cry. When performing a clinical assessment of the patient, which of the following should the therapist expect to find?
tactile rhonchi
After calculating a patient's C(a-v)O2, the respiratory therapist notes that the value has significantly increased when compared to the previous measurement. Which of the following best explains this finding?
the cardiac output has decreased
Which of the following can be concluded by examining the flow volume curve shown to the right?
the patient coughed during exhalation.
While reviewing the medical record of a 56-year-old male, the respiratory therapist notes that the patient was orally intubated by EMS, then brought to the ED. This observation is most suggestive of which of the following?
the patient is unable to protect his own airway
Results of three spirometer test challenges made from 3.0 liter automated calibrated syringe are as follows: Measurement 1: 3.072. Measurement 2: 2.924 liters. Measurement 3: 3.055. Which of the following is true regarding these results?
the spirometer is accurate to within plus or minus 3%
An adult patient is receiving oxygen therapy via a 50% air entrainment mask operating at 8 L/min. If the flowmeter setting is decreased to 6 L/min, which of the following will occur?
the total flow of the system will decrease.
While interviewing a patient, the respiratory therapist observes a marked increase in the use of accessory muscles of ventilation. The respiratory therapist should conclude that:
there is an increase in the work of breathing.
While reviewing a patient's medical record, the respiratory therapist notes the following entry in the progress notes: "hyperresonance over the left lung". Which of the following best explains this finding?
there is an increased amount of air in the left lung
A slightly obese 30-year-old female has been admitted to the hospital after being seen in the outpatient clinic for recurrent symptoms of back pain. On physical exam the respiratory rate is 28/ min, while the rest of the vitals are normal. She is in moderate distress secondary to pain. She has a friction rub at the right base, but the remainder of her examination is unremarkable. Room air arterial blood gas values are PH: 7.41 Paco2 41 Pao2 91. The ECG is normal, and the chest x-ray shows infiltrates in the left lower lobe. The right side, where the rub is heard, is normal. Lower extremity dopplers are obtained and are normal. To further evaluate the patient's condition, the respiratory therapist should recommend which of the following?
ventilation/perfusion scan