Questions missed on TMC
A 70 kg male patient performs spirometry before and after receiving 2.5 mg albuterol delivered via metered dose inhaler. Which of the following FEV1 results would indicate a significant response to the bronchodilator?
12% increase in FEV1
The therapist is using an O2 flowmeter set at 15 L/minute to deliver an 80-20 helium-oxygen gas mixture. Calculate the actual flow that the patient is receiving.
27 L/minute
Droplet transmission requires close contact, what is the distance range in feet for possible transmission:
3
You are preparing for oral tracheal intubation and can visualize the soft palate and only the base of the uvula. Using the Mallampati Classification score, what class does this patient belong to?
4
A 150 lb. patient with a tidal volume of 500 ml and a rate of 16 and an end tidal CO2 of 28 has a return blood gas PaCO2 value of 32 mmHg. How do you remedy this value?
Change the rate to 12
A patient with congestive heart failure would benefit from which of the following medications?
Digitalis
A rapid response team is called to the surgical step down unit to assess a 30 year old male patient following a thoracentesis. The patient received lorazepam (ativan) during the procedure. Auscultation reveals clear bilateral breath sounds. The patient is minimally responsive and has slow, shallow respirations. Which of the following medications could help this patient?
Flumanzenil (Romazicon)
A patient with Stage 4 cancer of the lung, and several endobronchial masses, has labored respirations. Which of the following can we employ to reduce his work of breathing.
Heliox
A patient presents to the emergency room for the third time in a month with a chief complaint of feeling his heart skip beats. His 12 lead ECG shows normal sinus rhythm. What should the therapist recommend?
Holter/event monitor
The following data is recorded on a patient receiving NIV in the ICU. What should the respiratory therapist recommend? NIV Settings IPAP: 18 EPAP: 10 FiO2: .50 ABG results PH 7. 32 PaCO2 50 PaO2 120 HCO3 23
Increase the EPAP and IPAP
All of the following methods reduce auto PEEP except:
Increasing the flow rate
A patient on a mechanical ventilator is diagnosed with pulmonary hypertension. The patient is being treated with nitric oxide at 40 ppm. They draw an ABG and notice that the blood color is an unusual chocolate brown color. What may be the cause of this?
MetHb 40%
A patient receiving 80% FiO2 and 40 ppm nitric oxide lab work demonstrates methemoglobinemia. What would you recommend treating this condition?
Methylene Blue
A patient in the medical ICU is receiving volume control mechanical ventilation due to pneumonia. The patient appears restless, is pulling at his IV's and ETT, and has a total respiratory rate of 35 breaths/minute. Which of the following medications should the respiratory therapist recommend? Ventilator settings Mode: A/C Rate: 16 Tidal volume: 500 ml FiO2: .70 PEEP: 10
Midazolam
Interpret the following spirometry results Predicted Observed % of Predicted FVC 6.3 L 4.2 L 66% FEV1 4.8 L 2.0 L 42% FEV1/FVC 70% 80%
Mild restrictive disorder, and no obstructive disorder
An adult patient with a history of asthma has received 3 back to back treatments of nebulized albuterol. The patient has shown no improvement in her peak flow measurements. What should the respiratory therapist recommend next?
Systemic corticosteroids
You should recommend AGAINST performing a diagnostic bronchoscopy procedure on a patient with:
an uncorrected bleeding disorder
A patient in ICU suddenly deteriorates. The attending doctor wants to rule out acute pulmonary embolism as the cause. Which of the following laboratory tests would be most helpful to this end?
d-dimer
Which of the following tests would you recommend to assess an outpatient's compliance with a smoking cessation program?
exhaled carbon monoxide
While doing a ventilator check on a patient receiving volume-controlled ventilation you observe a substantial drop in pressure on the pressure vs. time waveform after triggering of most machine breaths. Which of the following best explains this finding?
inadequate inspiratory flow setting
A patient in ICU is receiving a continuous IV drip of an opioid analgesic for sedation and pain relief. Which of the following would you recommend for monitoring this patient?
real-time waveform capnography
A neonate receiving inhaled nitric oxide (iNO) for the treatment of persistent pulmonary hypertension is receiving 80 ppm of iNO, and an Fio2 of 0.80. What should be the therapist's concern in this situation?
that the patient will develop rebound vasoconstriction
Select the correct amount of time necessary to sterilize medical equipment with glutaraldehyde.
20 minutes
Which of the following tests would you recommend in order to evaluate a patient with moderate to severe COPD.
6-minute walking distance
What is the alveolar minute ventilation for a 68 kg (150 lb) patient on mechanical ventilation with the following settings: Mechanical deadspace50 mlRate10Tidal volume700 ml
6.5 LPM
What is the alveolar minute ventilation for a 68 kg (150 lb) patient receiving mechanical ventilation with the following settings?
6.5 LPM
Which of the following vacuum pressure ranges should be used for endotracheal suctioning of a neonate's airway?
60-80
Using the following spirometry results, calculate the patient's total lung capacity? VC 5.2 L IC 4.1 L RV 2.4 L ERV 1.5 L
7.6 L
A 130 kg, 72 inch male patient has just been intubated in the medical ICU due to suspected ARDS. The respiratory therapist is asked to recommend initial ventilator settings for the patient. Which of the following is an appropriate tidal volume for this patient?
700 ml
The following arterial blood gas results were obtained from a patient with asthma while wearing a 2 LPM nasal cannula. What can the respiratory therapist conclude from these results? PH 7.36 PaCO2 44 PaO2 290 HCO3 26 BE +2
A laboratory error occurred
As compared to predicted normal, a patient has a normal FEV1, a normal FEF25-75, but a markedly reduced FVC. Test results are repeatable. Which of the following is the most likely underlying problem:
A restrictive disorder of the lungs or chest wall
While assessing an adult patient on mechanical ventilation, the respiratory therapist notes gurgling sounds coming from the patient's mouth. The cuff pressure measures 18cm H20, and the ETT is secured at 23 cm at the lip. What should the therapist do NEXT?
Add air to the cuff
Which of the following bronchodilators are classified as a rescue medications?
Albuterol
Increased PaCO2 with decreased pH and PaO2 values on an ABG result from what type of preanalytical error?
Analyzer calibration
A patient is diaphoretic with an axillary temperature of 103 F. The most appropriate treatment is?
Antibiotics
The respiratory therapist is called to help in the evaluation of a 55 year-old male patient. The following signs and symptoms are noted: oral temperature of 40⁰ C (104.5⁰ F), diaphoresis, respiratory rate of 32, the use of accessory muscles of respiration, and palpable rhonchi in the right lower lobe. You would suspect which of the following diagnoses
Bacterial pneumonia
Systematic inaccuracy is related to which term used in Quality Control.
Bias
A patient presents to the emergency room following a motor vehicle accident. The patient appears pale despite receiving 100% oxygen via non-rebreather. Which of the following laboratory tests would best reflect the patient's ability to oxygenate?
CBC
Contraindications to nasopharyngeal airway insertion include?
Closed head injury
The endotracheal tube cuff pressure of an adult male ICU patient reads 38 mm Hg. The patient weighs 75 Kg, is 68 inches tall, and has a size 8.0 ETT. What should the therapist do NEXT?
Deflate the cuff using the minimal occluding volume technique and reassess
Which of the following medications is associated with oral candidiasis (thrush)?
Flovent
What of the following airways enters through the glottis?
ETT
Which of the following conditions results in an increased FRC?
Emphysema
Which of the following tests are used to measure total lung capacity?
Forced vital capacity
To provide accurate measurement of ABG samples, a blood gas analyzer must undergo frequent two-point calibration of all of the following except:
HCO3
The respiratory therapist is asked to recommend a bronchodilator for a patient in the cardiac ICU. The patient is wheezing bilaterally, and is currently receiving beta blockers for his high blood pressure. What alternative should the respiratory therapist recommend?
Ipratropium bromide
A patient's bed in the ICU is raised to provide routine care. The patient has a PAC in place and the transducer is attached to an IV pole next to the bed. What effect will raising the bed have on the patients CVP?
It will cause a false high reading
How would a respiratory therapist position a patient with unilateral lung disease to help improve oxygenation?
Left or right lateral decubitus with "good" lung down
Heliox 70/30 is being administered along with continuous albuterol nebulization. After 1 hour, data are as follows: HR 170 RR 30 BP 95/55 pH 7.38 PvCO2 42 PvO2 36 HCO3 25 BE -2 SpO2 92% Breath sounds are slightly improved but are still diminished with expiratory wheezes. Which of the following should be recommended to the physician?
Maintain current therapy
An 90 kg male patient, currently receiving oxygen via 50% Venturi mask, requires intubation and mechanical ventilation. What initial ventilator settings should the respiratory therapist recommend?
Mode: Volume control/AC Mandatory rate: 20 breaths/min Tidal volume: 550 ml FiO2: .50 PEEP: 5 cm H2O
Interpret the following spirometry results Predicted Observed % of Predicted FVC 5.81 L 4.92 L 84% FEV1 4.52 L 2.0 L 44% FEV1/FVC 70% 65%
Moderate obstructive disorder
An unconscious patient arrives in the emergency department following a motor vehicle accident. What should the respiratory therapist do FIRST to establish this patient's airway?
Modified jaw thrust maneuver
A conscious patient in the ICU has a large amount of secretions, requiring frequent nasotracheal suctioning. Which of the following airways should the respiratory therapist recommend?
Nasopharygeal airway
A 4-month infant is admitted for treatment of bronchiolitis. The infant's temp is 37. He is irritable and coughs frequently. The following data are available: HR 168 RR 72 SaO2 90% A respiratory therapist should prepare for:
Nasopharyngeal suctioning
Pre and post bronchodilator spirometry reveals the following findings. How should the respiratory therapist interpret this? MeasurementPre bronchodilator %Post bronchodilator %FVC88%89%FEV172%78%FEV1/FVC65%67%
Obstructive disorder with insignificant response to bronchodilator
A patient with a cuffed tracheostomy tube is undergoing a speaking valve trial. Immediately after placing the valve, the patient experiences marked distress and desaturation. What should the respiratory therapist do at this time?
Place patient on supplemental oxygen to help improve SpO2
The respiratory therapist receives orders to administer 1.25 mg xopenex to an 6 year old child. What should the respiratory therapist do?
Recommend 0.31mg xopenex
A 54 year-old male patient is admitted through the ER with fever and excessive diarrhea over the past 24 hours. ECG reveals frequent PVC's. Which of the following laboratory tests should the respiratory therapist recommend?
Serum electrolytes
A patient receiving NPPV and supplemental oxygen complains of dryness and discomfort when using a Passover humidifier, what should the respiratory therapist recommend for this patient?
Switch the patient to an HME
A 50-year-old male patient is being treated for a pulmonary embolism. He is receiving 50% O2 by mask. The results of a P(A-a)O2 study indicate that his alveolar arterial difference is 205 torr. What is the best interpretation of this study?
The alveolar-arterial difference is increased.
Upon completion of a smoking cessation program, a patient with COPD has the following arterial blood gas drawn on 2 LPM nasal cannula: PH 7.39 PaCO2 55 torr PaO2 70 torr HCO3 33 mEq/L Hb 16g/dL O2Hb 93% COHb 7% MetHb 0.7%
The patient has methemoglobinemia
Which combined spirometry measurements can be used to calculate total lung capacity?
VC, and RV
A patient receiving mechanical ventilation following abdominal surgery has been placed on a spontaneous breathing trial. The respiratory therapist notes the patient is grimacing, and tachypneic. Which of the following medications should the respiratory therapist recommend?
Valium (Diazepam)
A patient with asthma and mucus plugging is receiving postural drainage and chest percussion for the removal of secretions. The patient is anxious and complains of pain during the procedure. The physician asks the respiratory therapist which of the following they would recommend.
Vibratory PEP
High-level disinfection destroys all of the following except:
bacterial spores
While performing the Heimlich maneuver on a choking patient, the patient loses consciousness and is lowered to the floor. What should the respiratory therapist do NEXT?
begin CPR
A doctor wants your recommendation on how to monitor the cardiopulmonary status of a patient undergoing a bronchoscopy procedure during moderate sedation. You should recommend the following:
end-tidal CO2 monitoring
