Attempt 1

A respiratory therapist is using an oxygen-calibrated flowmeter to administer 70/30 heliox. To deliver a flow of 16 L/min, the therapist should set the oxygen flowmeter to?

10 16/1.6=10

A respiratory therapist notes a patient's soft palate cannot be viewed. What is the patient's Mallampati score?

4

A respiratory therapist is evaluating a 25-year-old male with asthma. The patient currently uses 2 puffs of albuterol at least four times a week. The patient complains of occasional limitations to normal activity, waking at least 1 night a week, and having two exacerbations requiring an ED visit within the last 6 months. According to NAEPP guidelines, which of the following should a respiratory therapist recommend? A. budesonide (Pulmicort) B. montelukast (Singulair) C. Xipratropium (Atrovent) D. omalizumab (Xolair)

A

According to CLIA standards, quality control must be performed for blood gas analyzers every A. 8 hours. B. 48 hours. C. 72 hours. D. 24 hours.

A

Which of the following is the most significant factor leading to the development of tracheomalacia? A. cuff pressure B. trauma during intubation C. intracuf volume D. tube length

A

A patient who is conscious with an intact gag reflex requires an artificial airway to prevent obstruction of the upper airway by the tongue. Which of the following types of airways is most appropriate in this situation? A. nasopharyngeal B. oropharyngeal C. oral endotracheal tube D. tracheostomy tube

A No OPA as that can stimulate the gag reflex

A respiratory therapist is called to see a 59-year-old male who has been in a persistent vegetative state for several months following a stroke. He is diaphoretic, and has a pulse of 120/min and an SpO2 of 81% with a 28% tracheostomy collar. The therapist is unable to pass a suction catheter. Which of the following should the therapist do FIRST? A. Replace the tracheostomy tube. B. Increase suction pressure by 20%. C. Initiate mechanical ventilation. D. Use a smaller suction catheter.

A The patient appears to have an obstructed tracheostomy tube and is exhibiting respiratory distress with oxygen desaturations. The tube should be replaced immediately.

An 18-year-old male with cystic fibrosis is admitted for pneumonia and increasingly thick pulmonary secretions. The patient's home regimen consists of albuterol and HFCWO. A physician has ordered albuterol, HFCWO, and aztreonam (Cayston). A respiratory therapist should anticipate the addition of which of the following inhaled medications? A. dornase alfa (Pulmozyme) B. tobramycin (TOBI) C. pentamidine isethionate (NebuPent) D. iloprost (Ventavis)

A dornase/ pulmozyme

A 22-year-old patient with a history of intermittent wheezing has the following pulmonary function test results: Prebronchodilator Postbronchodilator FEV1 (% of predicted) 84 88 FVC (% of predicted) 85 86 FEV1/FVC (%) 84 86 Peak flow (% of predicted) 98 96 Which of the following should a respiratory therapist recommend? A. lung volume measurements B. inhalation challenge C. DLCO testing D. polysomnography

B

A 77-year-old male patient is scheduled to undergo open heart surgery. Preoperative spirometry results show the patient's FEV1 is 80% of predicted and the FEV1/FVC is 83%, indicating A. high risk for postoperative pulmonary complications. B. low risk for postoperative pulmonary complications. C. the patient has obstructive lung disease. D. the patient has restrictive lung disease.

B

An adult patient is receiving PC, SIMV and the following data are observed: FIO2 0.80 Mandatory rate 15 Spontaneous rate 32 Set inspiratory pressure 20 cm H2O PEEP 10 cm H2O SpO2 92% On inspection, the patient demonstrates suprasternal retractions during spontaneous breaths. Which of the following should a respiratory therapist do NEXT? A. Decrease the rise time setting. B. Switch to A/C mode. C. Increase the FIO2 to 0.90. D. Change set inspiratory pressure to 25 cm H2O.

B

In which of the following circumstances will tracheal secretions tend to dry in an intubated patient? A. a water vapor pressure of 47 mm Hg B. a relative humidity of 100% at 22° C (71.6° F) C. a dew point of 37° C (98.6° F) D. an absolute humidity of 44 mg/L

B

While a respiratory therapist auscultates a patient's chest, the patient repeats the words, "ninety-nine." Transmission of vocal sounds is increased in the right lower lobe compared to the other lung fields. Which of the following does this most likely indicate? A. pleural effusion B. consolidation C. pneumothorax D. pulmonary edema

B

While reviewing a medical record, a respiratory therapist notes a patient has shortness of breath, pleuritic chest pain, low-grade fever, tachypnea, tachycardia, and a swollen, tender right leg. The patient has a 50 pack-year history of smoking and known coronary artery disease. These findings are MOST consistent with A. pneumonia. B. pulmonary embolism. C. myocardial infarction. D. acute exacerbation of COPD.

B

respiratory therapist is reviewing the medical record of an infant to determine whether any respiratory care is indicated in the home. Which of the following suggests the need for home apnea monitoring? A. albuterol aerosol every 4 hours prn B. caffeine citrate daily C. APGAR scores of 3 and 4 D. oxygen by cannula at 0.25 L/min

B

A respiratory therapist is assisting a physician perform a tracheotomy on a patient who is receiving PC ventilation. After the stoma is opened and the tracheostomy tube is inserted, the therapist observes increased heart rate, decreased exhaled tidal volume, and distant breath sounds over the right chest. This information is most indicative of a A. circuit leak. B. right pneumothorax. C. kink in the ventilator circuit. D. right mainstem intubation.

B Keeping the current invasive procedure in mind, the diminished breath sounds over the affected area and an increased heart rate are consistent with a pneumothorax.

A patient has been receiving mechanical ventilation through a tracheostomy tube for 16 days. The patient begins to thrash about in the bed following withdrawal of a drug-induced coma. The patient's tracheostomy tube has become dislodged. After the patient is pharmacologically sedated, a respiratory therapist should NEXT A. obtain an ABG sample. B. perform nasal intubation. C. reinsert the tracheostomy tube. D. initiate oxygen therapy.

C

A respiratory therapist is preparing to perform an arterial puncture on a nonresponsive patient whose medical history includes a diagnosis of HIV. For the protection of the patient and therapist, the therapist should A. have another medical professional in the room when performing the puncture. B. confirm the diagnosis with the patient's family before performing the puncture. C. use universal precautions when obtaining the sample. D. wear gloves, a gown, and a mask when obtaining the sample.

C

When extubating an adult patient, which of the following should a respiratory therapist do FIRST? A. Deflate the cuff. B. Remove the tube holder from the patient's face. C. Position the patient in an upright position. D. Suction while the patient coughs.

C

Which of the following should be used to most accurately assess oxygen saturation in a patient with suspected smoke inhalation? A. point-of-care blood gas analyzer B. capnometer C. hemoximeter (CO-oximeter) D. pulse oximeter

C

While testing the proper function of a flow-inflating bag, a respiratory therapist notes the bag does not fully inflate with occlusion of the patient connector. Which of the following may be the cause of the problem? A. malfunctioning inlet valve B. excessive oxygen flow C. open-flow control valve D. missing oxygen reservoir

C

A respiratory therapist is evaluating a 57-year-old male with the following vital signs: HR 143/min RR 25/min BP 76/54 mm Hg SpO2 85% When examining the patient's chest, the therapist notes an absence of breath sounds in the left chest with a hyperresonant percussion note. Which of the following should the therapist recommend FIRST? A. Insert a chest tube in the left chest. B. Obtain a chest radiograph. C. Insert a 14-gauge needle in the left chest. D. Obtain ABG analysis results.

C (c) C. The patient has a tension pneumothorax. Inserting a needle in the chest is the quickest action based on the vital signs.

A 47-year-old male with a BMI of 50 kg/m2 is undergoing a sleep study with titration of CPAP. The patient's baseline AHI is 59. At a CPAP level of 7 cm H2O, the AHI is 9. A respiratory therapist should recommend A. maintaining the current level of CPAP. B. decreasing the CPAP. C. increasing the CPAP. D. changing to bilevel PAP.

C The goal of CPAP intervention is to completely eliminate apnea and hypopnea episodes, standard protocol is to incrementally increase the CPAP level until this occurs.

A patient with a laryngeal tumor is receiving 80/20 heliox by a nonrebreathing mask connected to an oxygen flow meter set at 5 L/min. The patient is alert, but appears agitated. Vital signs are: HR 130/min RR 30/min BP 140/90 mm Hg SpO2 90% Which of the following is a respiratory therapist's most appropriate action? A. Recommend sedating the patient. B. Change to 70/30 heliox. C. Increase the gas flow to the mask. D. Recommend nebulized racemic epinephrine.

C The flow to the mask is insufficient and will result in dilution of both the oxygen and helium concentrations with air. Increasing the flow will ensure the patient receives the desired gas mixture.

A 61-year-old male with dyspnea and nonproductive cough has the following examination results noted over the right lower lung field: - dullness to percussion - decreased tactile fremitus- diminished breath sounds Which of the following is most likely to produce these findings? A pulmonary embolism B pneumonia C pneumothorax D pleural effusion

D

A patient with COPD is receiving PC ventilation with flow triggering and has significant air trapping displayed on ventilator graphics. The patient's spontaneous breathing efforts are not always detected by the ventilator. Which of the following changes should a respiratory therapist recommend to improve patient-ventilator synchrony? A. Switch to pressure triggering. B. Switch to a square-wave flow pattern. C. Increase peak inspiratory flow. D. Increase the set PEEP.

D

A patient with severe COPD is receiving PC, A/C ventilation with 30% oxygen. The patient is tachypneic, hypertensive, anxious, and mottled. Auscultation reveals distant breath sounds on the right as compared to the left. Tracheal deviation to the left is observed. A respiratory therapist should recommend evaluation for a potential A. mucous plug. B. myocardial infarction. C. pulmonary embolism. D. pneumothorax.

D (c) D. A right-sided pneumothorax will result in diminished breath sounds on the right and possibly a tracheal shift to the left.

A 16-year-old male has been receiving VC, A/C ventilation for 24 hours following admission for a drug overdose. The patient is alert and oriented, and has been weaned to PSV of 5 cm H2O and an FIO2 of 0.40. The following data are collected after 30 minutes: pH 7.47 PaCO2 34 mm Hg PaO2 121 mm Hg HCO3- 25 mEq/L A. Continue PSV with current settings. B. Return to VC, A/C ventilation. C. Decrease PS to 3 cm H2O. D. Extubate the patient.

D (c) D. The patient meets all criteria for extubation.

A 56-year-old male requires continuous mechanical ventilation following cardiac arrest. His heart rate is 110/min and blood pressure is 96/50 mm Hg. A pulmonary artery catheter has been inserted. Patient data are: Body surface area 2 m2 Cardiac output 3.6 L/min PPA 30 mm Hg PCWP 12 mm Hg A respiratory therapist should recommend administering A. a beta blocker. B. a pulmonary vasodilator. C. a diuretic. D. an inotropic agent.

D An inotropic agent should be used to increase myocardial contractility, which in turn, should increase blood pressure.

Which of the following should a respiratory therapist recommend for a patient who is receiving mechanical ventilator support and has moderate musculoskeletal pain? A. propofol B. midazolam HCl (Versed) C. lorazepam (Ativan) D. fentanyl citrate (Sublimaze)

D (u) A. Propofol is a sedative and will not be useful for analgesia. (u) B. Midazolam HCl (Versed) is an anxiolytic agent and will not be useful for analgesia. (u) C. Lorazepam (Ativan) is an anxiolytic agent and will not be useful for analgesia. (c) D. !!!!!Fentanyl citrate (Sublimaze) is an analgesic agent and will be helpful to reduce musculoskeletal pain

Following a bariatric surgery procedure 2 days ago, a patient with a PBW of 55 kg (121 lb) remains hospitalized with signs of sepsis. The patient is intubated and receiving VC, A/C ventilation with the following settings: FIO2 0.50 Mandatory rate 18/min VT 350 mL PEEP 12 cm H2O After returning from radiology, the patient's peak inspiratory pressure is 45 cm H2O and plateau pressure is 35 cm H2O. ABG analysis reveals: pH 7.39 PCO2 38 mm Hg PO2 49 mm Hg HCO3- 23 mEq/L BE -2 mEq/L SO2 (calc) 84% A respiratory therapist should recommend A. increasing the mandatory rate. B. decreasing the tidal volume. C. inline bronchodilator therapy. D. a lung recruitment maneuver.

D lung recruitment

PFT showing a restrictive disease

FEV1 FVC <80

PFT showing obstructive disease

FEV1/FVC<70

A tracheostomy tube that was placed 24 hours ago is accidentally dislodged from a patient receiving mechanical ventilation. A respiratory therapist should FIRST A. suction the patient's mouth and provide a cool mist aerosol. B. occlude the stoma and ventilate with a bag-valve-mask resuscitator. C. insert a supraglottic airway and administer aerosolized epinephrine. D. deflate the cuff and reinsert the tracheostomy tube.

Given the tracheostomy was placed 24 hours ago, the tract has likely not epithelialized. Creation of a false tract and malposition can occur if an attempt is made to blindly reinsert the tracheostomy tube. The correct course of action is to occlude the stoma and ventilate with a bag-valve-mask resuscitator while preparations are made to reintubate by the mouth or nose.

DKA breathing pattern

kussmaul fast deep