Procedures Final

Compared with the nasal route, the advantages of oral intubation include which of the following? 1. Reduced risk of kinking 2. Less retching and gagging 3. Easier suctioning 4. Less traumatic insertion

1 AND 3

A 17-year-old patient is receiving mechanical ventilation because of apnea resulting from a drug overdose. While the patient is breathing 25% oxygen, the following ABG values are analyzed. Pao2, 155 torr Sao2, 100% pH, 7.42 Paco2, 41 torr HCO3-, 26 mEq/L BE, +2 mEq/L What action should now be taken? Question options: A) Recheck the blood gas analyzer B) Increase the tidal volume to hyperventilate the patient C) Maintain the patient on present settings D) Reduce the patient to 21% oxygen

A

A 21 year-old woman in the emergency room is displaying rapid and deep, labored breathing. Her room ABG reveals a pH of 7.25, PaCO2 of 28, HCO3- of 14 mEq/L, and a base excess of -14 mEq/L. How would the respiratory therapist assess her acid-base condition? 1. severe hyperventilation 2. partially compensated metabolic acidosis 3. compensatory response to the metabolic acidosis 4. severe hypoventilation Question options: A) 1, 2, and 3 B) 1 and 3 C) 3 only D) 2, 3, and 4

A

A heat-moisture exchanger (HME) should be avoided in which of the following circumstances? 1. Patients with excessive secretions 2. Patients with a high FiO2 3. Patients with low body temperature A) 1 only B) 1 and 2 only C) 1 and 3 only D) 1, 2, and 3

A

A patient is receiving continuous mandatory ventilation in the control mode at a rate of 10/min. The inspiratory time control is set at 25%. What is the I:E ratio? A) 1:3 B) 1:2 C) 1:4 D) 1:1

A

A patient is receiving continuous mandatory ventilation in the control mode at a rate of 15/min. The expiratory time is 2.9 sec. What is the inspiratory time? A) 1.1 sec B) 1.3 sec C) 1.5 sec D) 1.7 sec

A

A patient who just suffered severe closed-head injury and has a high ICP is about to be placed on ventilatory support. Which of the following strategies could help to lower the ICP? A) Maintain a PaCO2 from 25-30 mm Hg (deliberate hyperventilation) B) Allow as much spontaneous breathing as possible (SIMV) C) Maintain a high mean pressure using PEEP levels of 10 to 15 cm H2O D) Maintain a PaCO2 of 50-60 mm Hg (deliberate hypoventilation)

A

A practitioner forgets to ice an ABG sample and leaves it at room temperature for 45 minutes. Which of the following parameters can you predict will increase in this sample during that period? I. PCO2 II. pH III. PO2 Question options: A) I only B) I and II C) II and III D) I, II, and III

A

Absolute contraindication for nasotracheal suctioning includes which of the following? 1. Epiglottitis 2. Croup 3. Irritable airway A) 1 and 2 only B) 1 and 3 only C) 2 and 3 only D) 1, 2, and 3

A

After obtaining an arterial blood sample from an arterial line, yo would do all of the following except: A) Flush the line and stopcock with the heparinized intravenous solution B) Aspirate at least 5 mL of fluid or blood (dead space or waste) C) Confirm stopcock port open to intravenous bag solution and catheter D) Confirm undamped pulse pressure wave form on monitor

A

At the very beginning of exhalation, the PETCO2 normally should be at what level? Question options: A) 0 mm Hg B) 15 mm Hg C) 25 mm Hg D) 40 mm Hg

A

During oral intubation of an adult, the endotracheal tube should be advanced into the trachea about how far? A) until its cuff has passed the cords B) just far enough so that the tube cuff is no longer visible C) until its cuff has passed the cords by 2 to 3 inches D) until its tip has passed the cords by 2 to 3 cm

A

If a combitube is placed in the trachea, the distal balloon will seal the? A) esophagus B) nasal pharynx C) oral pharyn D) trachea

A

If the patient is being ventilated via a mechanical ventilatory via intermittent mandatory ventilation with partial ventilatory support, what would probably happen to PaCO2 if the patient suddenly had no spontaneous breathing? A) Increase B) Decrease C) Stay the same D) Change according to FiO2

A

In patients suffering from acute respiratory acidosis, below what pH level are intubation and ventilatory support generally considered? Question options: A) 7.2 B) 7.3 C) 7.1 D) 7.0

A

In which mode does flow asynchrony most commonly occur? A) volume ventilation B) Pressure ventilation C) CPAP D) No more is more susceptible

A

Patient A is having an asthma attack with loud wheezing, paradoxical pulse, and normal sensorium. Patient B is also having an asthma attack but has no audible wheezing, no paradoxical pulse, but is confused and slow to respond. Which patient(s) should be treated more aggressively? A) patient A B) Patient B C) Both patients D) Neither patient

A

Physiological goals of artificial ventilatory support include which of the following? 1. Support or manipulate gas exchange 2. Reduce or manipulate the work of breathing 3. Increase lung volume A) 1 and 2 only B) 2 and 3 only C) 1 and 3 only D) 1, 2, and 3

A

To avoid thermal injury with transcutaneous blood gas monitor sensors, what should you do? 1. Carefully monitor the sensor temperature. 2. Apply hydrocortisone cream under the sensor. 3. Regularly rotate the sensor site. Question options: A) 1 and 2 B) 1 and 3 C) 2 and 3 D) 1, 2, and 3

A

What is the normal range for PaO2/FiO2? A) 350 to 450 B) 250 to 350 C) 150 to 250 D) 75 to 150

A

What is the normal range of negative pressure to use when suctioning an adult patient? A) -100 to -120 mm Hg B) -80 to -100 mm Hg C) -60 to -80 mm Hg D) -20 to -30 mm Hg

A

What is the purpose of a tracheostomy tube obturator? A) To minimize trauma to the tracheal mucosal during insertion B) To provide a patent airway should the tube become obstructed C) To help ascertain the proper the position by radiograph D) To provide a means to inflate and deflate the tube cuff

A

When holding cricoid pressure, how much pressure should be applied? I. 30 m Newtons II. 3 kg III. If applied to the bridge of the nose would be uncomfortable IV. 3 Newtons A) I, II, III, IV B) I, III C) I, II, III only D) II, III

A

When setting the tidal volume on a patient being mechanically ventilated, what criteria would be kept in mind? A) It should never cause the plateau pressure to exceed 28 mm Hg B) It should never cause the peak pressure to exceed 35 mm Hg C) It should result in the static pressure of less than 10 mm Hg D) It should result in a peak pressure of no more than 25 mm Hg

A

When the patient stabilized on mechanical ventilation with PEEP of 12 cm H2O and the FiO2 has been reduced to 0.40, how should the PEEP level reduce? A) In increments of 2 cm H2O every 6 hr B) In increments of 3 to 5 cm H2O every 2 hr C) In increments of 3 to 5 cm H2O ever 1 hr D) In increments of 5 cm H2O every 2 hr

A

When using capnometry or colorimetry to differentiate esophageal from tracheal placement of an endotracheal tube, which of the following conditions can result in a false-negative finding (e.e., CO2 present even when the tube is in the trachea)? A) cardiac arrest B) gastric CO2 diffusion C) right main stem intubation D) delivery of high FiO2

A

Which of the following Centers for Disease Control and Prevention (CDC) barrier precautions would you use when obtaining an arterial blood gas (ABG) through percutaneous puncture? I. gloves II. protective eyewear III. gown or apron Question options: A) I and II B) I and III C) II and III D) I, II, and III

A

Which of the following situations is most likely to call for ventilatory settings of low volume and high rate while allowing for permissive hypercapnia? A) Patient with ARDS B) Patient with neuromuscular disease C) Patient with chronic obstructive pulmonary disease D) Child with croup

A

Which of the following would decrease PaCO2 when ventilating a patient using intermittent mandatory ventilation with pressure support? A) Increase the level of pressure support B) Decrease the tidal volume C) Decrease the mechanical rate D) Increase the FiO2

A

While intubating with a straight blade the blade would be placed in the? A) epiglottis B) trachea C) vallecua D) glottis

A

You are working with a neonate in an incubator. She is being monitored with a transcutaneous oxygen electrode on her right upper chest. An hour ago, the patient's oxygen value was 52 torr, and now it is 115 torr. The nurse tells you that no change has occurred in the neonate's condition. What is the most likely explanation of this difference? Question options: A) Air has leaked under the electrode B) The patient has a patent ductus arteriosus C) The temperature inside the incubator has been increased D) The patient's cardiac output and lung condition have improved

A

Your patient has been having a severe asthma attack for the past several hours. Which of the following blood gas finding suggests that the patient may be experiencing respiratory muscle fatigue? A) PaCO2 44 mmHg B) pH 7.36 C) PaO2 55 mmHg D) SaO2 78%

A

Which of the following ventilator settings or measurements is most concerning to you during mechanical ventilation of a patient with acute asthma? A) Plateau pressure of 45 cm H2O B) Mechanical rate of 10/ming C) Tidal volume set at 6-8 mL/kg of ideal body weight D) Inspiratory flow of 80 L/min

A OR B

A 31 year old man suffering from food poisoning is having severe vomiting for the last two days. His blood gas and serum electrolyte analyses revealed the following: pH of 7.60, PaCO2 of 49 mmHg, an HCO3- of 47 mEq/L, a base excess (BE) of +20 mEq/L, a serum K+ of 2.5 mEq/L, and a serum of Cl- of 92 mEq/L. How would the respiratory therapist assess his acid-base condition? 1. severe hyperventilation 2. metabolic alkalosis 3. adequate compensatory response 4. minimal hypoventilation Question options: A)1, 2, and 3 B) 2 and 4 C) 3 only D) 2, 3, and 4

B

A 45-year-old patient is brought by ambulance into the Emergency Department from a business where there is a carbon monoxide leak. The patient is obtunded and has an irregular pulse. Which of the following is the least important to evaluate at this time? Question options: A) 12-lead electocardiogram B) ABGs analyzed through a CO-oximeter C) Glasgow coma analysis D) Pulse oximeter value from a first-generation unit

B

After an intubation attempt, an expired capnogram indicates a CO2 level near zero. What does the finding probably indicate? A) Abnormally high ventilation/perfusion ratio (V/Q) B) Placement of the endotracheal tube in the esophagus C) Placement of the endotracheal tube in the trachea D) Failure of the cuff to properly seal the airway

B

After obtaining an arterial blood sample, what should you do? 1. Apply pressure to the puncture site until bleeding stops 2. Place the sample in a transport container with ice slush 3. Check to see if the patient is getting anticoagulant therapy 4. Mix the sample by rolling and inverting the syringe A) 1 and 2 B) 1, 2, and 4 C) 3 and 4 D) 1, 2, 3, and 4

B

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a Vt of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H20. Which of the following actions would you recommend to the patient's physician? A) Decrease the inspiratory flow B) Lower the delivered Vt C) Administer a bronchodilator D) Add PEEP

B

During volume control ventilation, the clinician has control over which of the following? 1. Pressure waveform 2. Volume waveform 3. Flow waveform A) 1 or 2 only B) 2 or 3 only C) 2 only D) 1, 2, and 3

B

Ideally, the distal tip of a properly positioned endotracheal tube (in an adult man) should be positioned approximately how far above the carina? A)1 to 3 cm B) 3 to 6 cm C) 7-9 cm D) 4 to 6 in

B

If a patient is on a frequency of 20, with a 1 second inspiratory time, what is the expiratory time A) 1 second B) 2 seconds C) can not be determined D) 3 seconds

B

If the pressure waveform of a ventilator remains the same when a patient's lung mechanics change, then what is the ventilator? A) volume controller B) pressure controller C) time controller D) flow controller

B

Indications for arterial blood sampling by percutaneous need puncture include all of the following except: A) monitor the severity of a disease process B) assess the adequacy of tissue oxygenation C) evaluate ventilation and acid-base status D) evaluate a patient's response to therapy

B

Stratigies to reduce auto-PEEP in mechanically ventilated patients with obstructive lung disease include which of the following? 1. Use high inspiration flows (60-100 L/min) 2. Apply extrinsic PEEP 3. Use low Vt values (8-10 mL/kg) 4. Use high respiratory rates (>25/min) A) 1, and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

B

The ventilator mode that is either patient triggered and allows the patient to breath spontaneously between matador ventilatory breaths is known as _______ A) PSV B) SIMV C) CMV D) IMV

B

What factors contribute to the development of auto-positive and expiratory pressure (PEEP)? I. High expiratory Raw II. High inspiratory flows III. Inadequate expiratory time A) I and II B) I and III C) II and III D) I, II, and III

B

What is the normal P(A-a)O2 range while breathing room air? A) 25 mm Hg to 50 mm Hg B) 10 mm Hg to 25 mm Hg C) greater than 25 mm Hg D) less than 10 mm Hg

B

What is the normal P(A-a)O2 range while breathing room air? A) 25 to 50 mm Hg B) 10 to 25 mm Hg C) Greater than 25 mm Hg D) Less than 10 mm Hg

B

What limits should be initially set for high and low Vt values and/or minute volume alarms on a ventilatory support device? A) +/- 5% to 10% B) +/- 10% to 15% C) +/- 15% to 20% D) +/- 20% to 25%

B

When analyzing an ABG sample from a patient with acute respiratory distress syndrome and refractory hypoxemia, you notice a PaO2 of 141 mm Hg and a PaCO2 of 14 mm Hg. Which of the following analytic errors should you suspect? A) excessive time since sample collection B) exposure of the blood sample to air C) excessive heparin in the sample D) sample admixture with venous blood

B

When analyzing an ABG sample from a patient with acute respiratory distress syndrome and refractory hypoxemia, you notice a PaO2 of 141 mm Hg and a PaCO2 of 14 mm Hg. Which of the following analytic errors should you suspect? Question options: A) excessive time since sample collection B) exposure of the blood sample to air C) excessive heparin in the sample D) sample admixture with venous blood

B

Which of the following indicate that the patient being considered for extubation can provide adequate clearance of pulmonary secretions? 1. The patient has a maximum inspiratory pressure of 73 cm H20 2. The patient is alert and cooperative 3. The patient has a dead space-to-tidal volume ratio of 0,7 4. The patient coughs rigorously on suctioning A) 1 and 3 only B) 1, 2, and 4 only C) 3 and 4 only D) 2, 3, and 4 only

B

Which of the following is FALSE about the galvanic fuel cell O2 analyzer? A) it actually measure the PO2 and not the O2 concentration B) it requires an external power source (alternating current line or batteries) C) it has a slower response time that the Clark electrode D) Its fuel cells deplete and must be periodically replaced

B

Which of the following is FALSE about the galvanic fuel cell O2 analyzer? Question options: A) It actually measures the PO2 and not the O2 concentration. B) It requires an external power source (alternating current line or batteries). C) It has a slower response time than the Clark electrode. D) Its fuel cells deplete and must be periodically replaced.

B

Which of the following would you expect to occur if too much heparin was used in gathering an ABG sample from a patient A) increase in HCO3 B) decrease in PCO2 C) decrease in pH D) decrease in PO2

B

While suctioning a patient, you observe an abrupt change in the electrocardiogram waveform being displayed on the cardiac monitor. Which of the following actions would be most appropriate? A) Change to a smaller catheter and repeat the procedure B) Stop suctioning and immediately administer oxygen C) Stop suctioning and report your finding to the nurse D) Decrease the amount of negative pressure being used

B

You are asked to calibrate an O2 analyzer. Which of the following gases would you use for this procedure? 1. 100% oxygen 2. 50% oxygen 3. 21% oxygen (room air) A) 1 and 2 B) 1 and 3 C) 2 and 3 D) 1, 2, and 3

B

You are asked to perform a radial artery puncture on an unconscious patient. How can you confirm the presence of collateral circulation? I. Use a Doppler transducer to assess thumb blood flow with radial obstruction. II. Use a pulse oximeter to assess thumb blood flow with ulnar obstruction. III. Use a pulse oximeter to assess thumb blood flow with radial obstruction. Question options: A) I and II B) I and III C) II and III D) I, II, and III

B

A patient is receiving continuous mandatory ventilation in the control mode at a rate of 12/min. The inspiratory time control is set at 33%. What is the expiratory time? A) 1.65 sec B) 2.45 sec C) 3.35 sec D) 3.85 sec

C

A patient on SIMV with a tidal volume of 500, a set rate of 10 is breathing 20 times per minute. The total minute ventilation is 8.6L the exhaled machine tidal volume is 495. What is the spontaneous tidal volume A) 365 B) 410 C) 250 D) 477

C

A patient receiving continuous mandatory ventilation in the assist-control mode develops auto-PEEP. Which of the following general approaches would you consider to minimize the effects of auto-PEEP in this patient? 1. Increasing expiratory time 2. Applying PEEP 3. Switching ventilating mode to synchronized intermittent mandatory ventilation A) 1 and 2 only B) 1 and 3 only C) 2 and 3 only D) 1, 2, and 3

C

A patient with an opiate drug overdose is unconscious and exhibits the following blood gas results breathing room air. pH=7.19 PCO2=89 HCO3-=27 PO2=48 Which of the following best describes the patient's condition? A) Chronic hypoxemic respiratory failure B) Chronic hypercapnic respiratory failure C) Acute hyoxemic respiratory failure D) Acute hypercapnic respiratory failure

C

A practitioner forgets to ice an ABG sample and leaves it at room temperature for 45 minutes. Which of the following parameters can you predict will increase in this sample during that period? A) pH B) PaO2 C) PCO2 D) HbO3

C

The shape of the expired CO2 tracing of a patient is normal but instead of being zero, the baseline is elevated to about 12 mm Hg. Which of the following is the most likely problem? Question options: A) patient disconnected from the system B) obstruction of the sampling tube C) rebreathing D) presence of N2O

C

What is considered to be the single best indicator of effective ventilation? A) PaO2 B) SaO2 C) PaCO2 D) pH

C

What is the mode of ventilatory support in which patient's inspiratory efforts are augmented with a set amount of positive airway pressure? A) continuous mandatory ventilation (CMV) B) pressure support ventilation C) intermittent mandatory ventilation D) positive end-expiratory pressure (PEEP)

C

What physicologic effect will raising the expiratory positive airway pressure have in the patient receiving noninvasive positive-presssure ventilation? A) lower the mean airway pressure B) increase the tidal volume C) increase the functional residual capacity D) decrease the PCO2

C

When checking for proper placement of an endotracheal tube or a tracheostomy tube on a chest radiography, how far above the carina should the distal tip of the tube be positioned? A) 1 to 2 cm B) 2 to 4 cm C) 3 to 6 cm D) 6 to 8 cm

C

When titrating the FiO2 down from 50% to 21%, in what increments should it be reduced? A) All at once is acceptable B) No more than 5% C) 5%-10% D) 10% to 20%

C

Which of the following can cause false high readings when using a pulse oximeter? Question options: A) fetal hemoglobin B) intravascular dyes C) carboxyhemoglobin D) presence of metHb

C

Which of the following can cause hypoxemia? 1. Diffusion impairment 2. Alveolar hypoventilation 3. V/Q mismatch 4. Intrapulmonary shunting A) 1, 2, and 3 only B) 1, 3, and 4 only C) 1, 2, 3, and 4 D) 2, 3, and 4 only

C

Which of the following changes would occur if an arterial blood sample of a patient breathing room air were exposed to a large air bubble? I. Decreases PCO2 II. Decreased pH III. Increased PO2 A) I only B) I and II C) I and III D) II and III

C

Which of the following criteria should be met before considering use of a heat-moisture exchanger (HME) for a patient being placed on ventilatory support? 1. There should be no problem with retained secretions 2. The patient should not have fever (normothermic) 3. The patient should be adequately hydroated 4. The support should be short term (24-48 hours) A) 1, 2 and 3 only B) 2 and 4 only C) 1, 2, 3, and 4 D) 3 and 4 only

C

Which of the following is the recommended tidal volume for mechanical ventilation in patients with COPD? A) 4 to 8 ml/kg B) 3 to 5 ml/kg C) 6 to 8 ml/kg D) 10 to 12 ml/kg

C

Which of the following measures should be used in assessing the adequacy of a patients alveolar ventilation? I. PaO2 II. arterial pH III. PaCO2 A) I and II B) I and III C) II and III D) I, II, and III

C

Which of the following pulmonary function tests is most useful during an acute attack? A) vital capacity B) Total lung capacity C) Peak flow D) Terminal flow

C

Which of the following would you expect to occur if too much heparin was used in gathering an ABG sample from a patient breathing room air? A) Increase in pH B) Decrease in PaO2 C) Decrease inPCO2 D) Increase HbO3

C

While checking a crash cart for intubation equipment, you find the following: suction equipment, oxygen apparatus, two laryngoscopes and assorted blades, five tubes, Magill forceps, tape, lubricating gel, and local anesthetic. What is missing? 1. Obturator 2. Syringe(s) 3. Resuscitator bag and mask 4. Tube stylet A) 1, 2, and 3 only B) 2 and 4 only C) 2, 3, and 4 only D) 1, 2, 3, and 4

C

Your patient's clinical status abruptly changed and the alarms on the ventilator are sounding. What is/are the first step(s) you should take? A) Silence the alarms and adjust the alarm parameters B)Perform a rapid physical examination C) Remove the patient from the ventilatory and manually ventilate D) Check the potency of the airway

C

Analysis of an arterial blood sample taken from a healthy athlete reveals a pH of 7.36, a PCO2 of 45 mm Hg, and a PO2 of 43 mm Hg. Which of the following analytic errors should you suspect? Question options: A) excessive time since sample collection B) exposure of the blood sample to air C) excessive heparin in the sample D) sample admixture with venous blood

D

Analysis of an arterial blood sample taken from a healthy athlete reveals a pH of 7.36, a PCO2 of 45 mmHG which of the following analytic errors should you suspect? A) excessive time since sample collection B) expose of the blood sample to air C) excessive heparin in the sample D) sample admixture with venous blood

D

Compared with the oral route, the advantages of nasal intubation include which of the following? 1. Reduced risk of kinking 2. Less retching and gagging 3. Less accidental extubation 4. Greater long-term comfort A) 1 and 3 only B) 1, 2, and 3 only C) 3 and 4 only D) 2, 3, and 4 only

D

If a patient is on a frequency of 20, with a 1 second inspiratory time, what is the I:E ratio? A) 1:4 B) 1:5 C) 1:3 D) 1:2

D

In intubated patients, what do sources of increased imposed work of breathing include? I. endotracheal tube II. ventilatory circuit III. auto-PEEP A) I and II B) I and III C) II and III D) I, II, and III

D

Strategies to reduce auto-PEEP in mechanically ventilated patients with obstructive lung disease include all of the following except which one? A) Use of high inspiratory flows (60 to 100 L/min) B) Apply extrinsic PEEP C) Use low Vt values (8 to 10 ml/kg) D) Use high respiratory rates (greater than 25/min)

D

What chart information should be checked before performing artery puncture? 1. patient's primary diagnosis and history 2. presence of bleeding disorders or blood-borne infections 3. anticoagulant or thrombolytic drug prescriptions 4. respiratory care orders (O2 therapy) A) 1 and 2 B) 1 and 4 C) 1, 3, and 4 D) 1, 2, 3, and 4

D

What is the optimal treatment of intrapulmonary shunt? A) Increase the FiO2 B) Decrease the FiO2 C) Surgery D) Alveolar recruitment

D

Which of the following features incorporated into most modern endotracheal tubes assist with proper placement? I. length markings on the curved body of the tube II. imbedded radiopaque indicator near the tube tip III. additional side port (murphy eye) near the tube tip A) 1 and 2 only B) 1 and 3 only C) 2 and 3 only D) 1, 2, and 3

D

Which of the following is the cardinal sign of increased work of breathing? A) Hyperventilation B) Retractions C) Bradycardia D) Tachypnea

D

Which of the following techniques can be used to improve oxygenation beyond increasing the FiO2 or PEEP level? 1. Proning the patient 2. Use of an expiratory pause 3. Use of inverse I:E ratio ventilation A) 1 only B) 1 and 2 only C) 2 and 3 only D) 1 and 3 only

D

Which of the following terms describe the lung injury associated with the use of low tidal volumes? A) Biotrauma B) Barotrauma C) Volutrauma D) Atelectrauma

D

While intubating with a curved blade, it would be placed in the? A) nasal pharynx B) epiglottis C) oral pharynx D) vallecula

D

If a combitube is placed in the esophagus, ventilation is through the blue colored #1 tube A) True B) False

True

If a combitube is placed in the trachea, ventilation is provided directly to the trachea using the shorter clear colored tube #2 A) True B) False

True