Sills Exam Mode
Inspiratory stridor is usually associated with a patient who has A. Asthma. B. Pulmonary edema. C. Pneumonia. D. Laryngotracheobronchitis
Laryngotracheobronchitis
Question: A patient with emphysema who is confined to the home receives 2 L/min of O2 continuously by nasal cannula. What is the best O2 delivery system for the patient? A. O2 concentrator B. E-tank C. Portable liquid oxygen system
A
An adult patient with bronchospasm is receiving mechanical ventilation with a VT of 600 mL and a flow of 30 L/min. The following data are measured: PIP: 45 Pplat: 30 Calculate the patient's airway resistance in cm H2O/L/sec. 13 15 20 30
30 cmH2O/L/sec
During a CPR attempt, the physician wants to assess how effectively the brain is being perfused and oxygenated. What should be evaluated? A. Electroencephalogram results B. Constriction of the pupils to light C. Cough reflex stimulation D. Hering-Breuer reflexes
B
How should the following blood gas values, obtained while the patient breathed room air, be interpreted? pH7.22 PaCO263 torr PaO252 torr HCO3-24 mEq/L BE0 mEq/L SaO283% 1.Moderate hypoxemia 2.Severe hypoxemia 3.Uncompensated metabolic acidosis 4.Uncompensated respiratory acidosis 5.Compensated metabolic alkalosis A. 1 and 4 only B. 2 and 4 only C. 1 and 5 only D. 2 and 3 only
1 and 4 only
When an E-cylinder with an attached regulator is turned on, a loud hissing noise is heard. The flow meter is turned off. All of the following should be tried to correct the situation: 1.Tighten the regulator on the stem of the cylinder.2.Replace the regulator washer.3.Replace the regulator.4.Turn the flow meter on to flush. A. 3 only B. 2 and 4 only C. 1, 2, and 4 only D. 1, 2, and 3 only
1, 2 and 3 only
A blood gas analyzer must be calibrated with the following gas mix: 21% O2, 10% CO2, and 69% N2. Local barometric pressure is 750 torr, and the water vapor is 47 torr. What should be the calibration point for the PO2 electrode? A. 12 torr B. 70 torr C. 148 torr D. 158 torr
148 torr
A hospital is developing a ventilator-associated pneumonia protocol. In order to help minimize the risks of VAP in the ventilator population, which of the following should be implemented? 1.Routinely change all ventilator circuits within 48 hours of use.2.Change ventilator circuits when obviously fouled with sputum or blood.3.Closed-airway suctioning should be used whenever possible.4.A heat-moisture exchanger (HME) is the preferred method of humidification. A. 2 and 3 only B. 3 and 4 only C. 1, 2, and 3 only D. 1, 2, 3,
2 and 3 only
Which of the following questions should be asked to find out if a patient has orthopnea? 1.Do you ever cough up blood? 2.Can you lie flat in bed without getting short of breath?3.How many flights of stairs can you climb? 4.How many pillows do you use when sleeping? 5.Do any foods seem to make it easier to cough productively? A. 1 only B. 2 and 4 only C. 3 and 5 only D. 3, 4, and 5 only
2 and 4 only
An adult patient with a tracheal tumor is admitted with shortness of breath. Breath sounds reveal inspiratory and expiratory wheezing sounds over the central chest area. The patient's SpO2 is 85% on room air. What should the respiratory therapist recommend? A. 30% oxygen and 70% helium by nonrebreathing mask at 8 L/min B. Nonrebreathing mask with 10 L/min of oxygen C. Transtracheal oxygen catheter at 4 L/min D. High-flow nasal cannula at 20 L/min
30/70 heliox by nonrebreathing mask at 8 L/min
A 35-year-old woman with sepsis who weighs 55 kg (121 lb) is to receive volume-cycled ventilation in the assist/control mode in the ICU. The most recent ABG results, with her spontaneously breathing an FIO2 of 0.50, are listed: pH7.33PaCO245 torrPaO254 torrHCO3-22 mEq/LBE-2 mEq/L Which of the following would be the most appropriate ventilator settings? A. 1 B. 2 C. 3 D. 4
4
The following bedside spirometry values are measured on a fit 35-year-old woman who weighs 64 kg (141 pounds): Tidal volume450 mLVital capacity3900 mLInspiratory capacity3100 mLRespiratory rate14 breaths/min Based on this information, what is her minute alveolar ventilation? A. 4340 mL B. 6300 mL C. 7000 mL D. 37,100 mL
4340 mL
A 40-year-old patient with primary pulmonary hypertension is being supported by mechanical ventilation. In addition, the physician is adding NO therapy at a concentration of 10 ppm. The patient's pulmonary vascular resistance (PVR) is ranging between 290 and 350 dynes sec cm5. When the PVR increases, the patient's pulse oximetry value decreases from 89% to 84% on 50% oxygen. The respiratory therapist should recommend the following change: A. Increase the nitric oxide level to 15 ppm. B. Decrease the nitric oxide level to 5 ppm. C. Begin 80%/20% heliox therapy. D. Hyperventilate the patient on the ventilator
A
A mechanically ventilated patient has an increased mean airway pressure. The physician believes this is the cause of a decrease in the patient's cardiac output. What should be done to decrease the mean airway pressure? A. Decrease PEEP. B. Decrease the patient's FIO2. C. Shorten expiratory time. D. Increase VT.
A
A patient who is recovering from pneumonia is receiving mechanical ventilation with the following settings: ModePC, SIMVFIO20.35Mandatory rate10Total rate16VT600 mLPEEP15 cm H2O Following are arterial blood gas analysis results: pH7.39PaCO239 torrPaO2107 torrHCO3-23 mEq/LBE-1 mEq/L What should be recommended at this time? A. Decrease the PEEP to 10 cm H2O. B. Decrease the FIO2 to 0.25. C. Switch to the assist/control mode. D. Initiate bilevel ventilation
A
A patient with asthma is receiving mechanical ventilation on a microprocessor-type ventilator. It is noticed on the flow/time waveform graph that the patient has an incomplete exhalation. All of the following would correct the problem EXCEPT A. Adding inflation hold. B. Increasing flow. C. Decreasing VT. D. Increasing expiratory time
A
A patient with postpolio syndrome and pneumonia is 173 cm (5 ft, 8 in) tall and weighs 60 kg (132 lb). Bedside spirometry and arterial blood gases drawn on room air are as follows: Respiratory rate28/minVT250 mLVital capacity600 mLMIP-16 cm H2O pH7.30PaCO262 torrPaO245 torrHCO3-28 mEq/LBE+4 mEq/L Based on this information, what should be recommended? A. Intubate and begin mechanical ventilation. B. Initiate CPAP therapy. C. Begin IPPB with normal saline for 15 minutes. D. Begin incentive spirometry several times per hour.
A
A pulmonary function test results in the following flow-volume loop tracing. How should the results be best interpreted? A. Obstructive lung disease B. Poor patient effort C. Restrictive lung disease D. Diffusion defect
A
An adult mechanically ventilated patient is recovering from ARDS. The physician wants to know if her shunt fraction has decreased. Which of the following would provide the best information? A. P(A-a)O2 B. PaO2 C. PvO2 D. Static lung compliance
A
An automobile crash victim has a closed-head injury and increased intracranial pressure. Mechanical ventilation is started with 40% oxygen, a mandatory rate of 16/min, and a tidal volume of 500 mL. ABG results on these settings show:pH7.48PaCO228 torrPaO2107 torrHCO3-23 mEq/LBE-1 mEq/LSaO299%What should the respiratory therapist recommend at this time? A. Keep the present ventilator settings. B. Decrease the oxygen percentage. C. Decrease the tidal volume. D. Decrease the rate.
A
An intubated patient is being ventilated with a resuscitation bag during a transport. The respiratory therapist notices that the disposable CO2 detector has stopped changing color with the patient's breathing cycle. What is the first thing that the respiratory therapist should do? A. Auscultate for bilateral breath sounds. B. Deflate the cuff and withdraw the endotracheal tube 2 cm. C. Blow through the CO2 detector to check its functioning. D. Deliver a larger tidal volume to the patient
A
During a thoracentesis procedure for removal of fluid from the right pleural space, what is the best position for a cooperative, mobile patient? A. Sitting upright and leaning slightly forward B. Reverse Trendelenburg C. Trendelenburg D. Pron
A
Question: A neonate born 2 months prematurely is developing signs of respiratory distress syndrome. Despite being on a pressure-limited, time-cycled ventilator and receiving 90% oxygen, he is still hypoxemic. He is having sternal retractions, and his chest x-ray is showing signs of atelectasis. What should the respiratory therapist recommend? A. Instill exogenous surfactant through the endotracheal tube. B. Nebulize levalbuterol (Xopenex) through a small-volume nebulizer. C. Change to a high-frequency ventilator.
A
Question: A patient was found unconscious in a parked car in a closed garage with the engine running and is being evaluated in the Emergency Department. A pulse oximeter on a finger on the left hand shows an SpO2 of 93%. An ABG sample drawn from the right radial artery and analyzed through a CO-oximeter shows an SaO2 of 73%. What is the most likely explanation for the different values? A. The patient's carboxyhemoglobin (COHb) level is increased. B. Arterial blood flow to the left arm is increased. C. Arterial blood flow to the right arm is decreased.
A
Question: A patient who is receiving volume-controlled ventilation has a peak pressure of 50 cm H2O and a plateau pressure of 35 cm H2O. The respiratory therapist decreases the peak flow from 60 to 40 L/min. What will this change on the ventilator? A. The I:E ratio B. Increase in the VT C. A lower plateau pressure
A
Question: A patient with an 8-mm ID fenestrated tracheostomy tube is to receive IPPB treatments for unresolved atelectasis. After the patient initiates a breath, it is found that the machine does not cycle off to allow exhalation. After manually stopping the delivered breath, what should be done to resolve the problem? A. Inflate the cuff and insert the inner cannula. B. Increase the set pressure. C. Tell the patient to exhale forcefully to terminate inspiration.
A
Question: A patient with an endotracheal tube is ordered to have 35% O2 delivered. Equipment includes an air-entrainment (jet) large-volume nebulizer, aerosol tubing, and a T-piece. What can the respiratory therapist do to ensure that the O2 percentage is delivered and humidity is maximized? A. Add 100 mL of aerosol tubing to the T-piece. B. Adjust the jet nebulizer to deliver 40% O2. C. Switch to an ultrasonic unit. D. Switch to a cascade-type humidifier
A
Question: A premature neonate who weighs 2200 g is receiving 40% oxygen in an oxygen hood and has the following ABG values:pH7.26PaCO256 torrPaO243 torrHCO3-22 mEq/LBE-2 mEq/LWhat should the respiratory therapist recommend next? A. Intubate and begin mechanical ventilation with 50% oxygen. B. Begin nasal CPAP at 5 cm water. C. Increase the oxygen to 50% in the oxygen hood.
A
Question: An adult patient is suspected of having emphysema. Which of the following tests should the respiratory therapist recommend to help confirm the problem? A. Residual volume and total lung capacity B. VT and inspiratory reserve volume C. Diffusing capacity
A
Question: An anxious patient with pulmonary edema and a respiratory rate of 30/min is wearing a nonrebreathing mask. The reservoir bag is collapsed. What should the respiratory therapist recommend? A. Increase the flow of O2 to the mask. B. Remove the one-way valves on the mask. C. Sedate the patient.
A
Question: An intubated patient has been receiving 40% O2 through a T-adapter with 100 mL of added aerosol tubing. When the equipment is replaced, the aerosol tubing is accidentally left off. What impact will this have on the patient? A. Decreased PaO2 B. Increased work of breathing C. Increased PaCO2
A
Question: During a successful CPR attempt, an adult patient has an oral 6-mm endotracheal tube placed. Mechanical ventilation is started in the SIMV mode. During spontaneous breaths, the patient's work of breathing is noted to be increased. What could correct this? A. Add pressure support ventilation. B. Increase the ventilator VT. C. Switch to CPAP.
A
Question: In which of the following clinical situations should independent lung ventilation be recommended? A. Unilateral bronchopleural fistula B. Cystic fibrosis C. Acute respiratory distress syndrome
A
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 17-year-old female asthmatic patient has been admitted to the hospital. A 28% air-entrainment mask has been placed on her. After 30 minutes the following arterial blood gas results are found:pH7.51PaCO231 torrPaO291 torrHCO3-24 mEq/LBE0 mEq/LSaO296%After 2 days of care, the patient is ready to go home. What medication should be recommended to aid in her long-term asthma management? A. Fluticasone and salmeterol (Advair Diskus) B. Digoxin (Lanoxin) C. Levalbuterol (Xopenex)
A
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 35-year-old 75-kg (165-lb) patient is received in the Emergency Department after being transported by ambulance from the scene of a house fire. The patient is wearing a nonrebreathing mask that is running at 8 L/min. Burns and ashes are seen on the patient's face and neck.What should the respiratory therapist recommend as the best device to use for determining the patient's oxygenation? A. CO-oximeter B. Pulse oximeter C. Blood gas analyzer
A
Calculate the dead space volume on a patient, given the following data:PaO2 = 85 mm HgPvO2 = 39 mm HgPaCO2 = 45 mm HgPE CO2 = 25 mm HgTidal volume = 700 mL A. 252 mL B. 310 mL C. 380 mL D. 444 mL
B
An 8-year-old child with pneumonia who weighs 30 kg (66 lb) is receiving mechanical ventilation. Relevant data follow: ModePC, SIMVFIO20.70Mandatory rate10Total rate20VT200 mL pH7.49PaCO234 torrPaO255 torrHCO3-24 mEq/LBE0 mEq/L What should be recommended? A. Increase the SIMV rate. B. Add 5 cm H2O PEEP. C. Add pressure support. D. Sedate the patient
Add 5 cmH2O of PEEP
An adult patient with a suspected myocardial infarction is received in the Emergency Department by ambulance. Breath sounds reveal crackles in all lung fields, and pink, frothy secretions are being coughed out. A 2-L/min nasal cannula is on the patient. What should the respiratory therapist recommend in this situation? A. Leave the patient with the current O2 flow and perform an assessment. B. Apply a nonrebreathing mask to the patient. C. Intubate the patient and initiate volume-cycled ventilation. D. Suction the patient's airway
Apply a nonrebreathing mask to the patient
A 60-kg (132-lb) female patient with heart failure and pulmonary edema is receiving mechanical ventilation with these settings: ModeVC, A/CFIO20.70Rate12VT450 mLPEEP10 cm H2O The following information is available: 2 PM3 PMSpO292%80%Peak pressure (cm H2O)5060Plateau pressure (cm H2O)4050 What is the first thing the respiratory therapist should recommend? A. Increase the PEEP to 20 cm H2O. B. Increase the FIO2 to 1.0. C. Calculate the patient's change in compliance. D. Get an ABG sample.
B
A patient is being prepared for transport. Calculate about how many hours an E-cylinder of O2 will last with a pressure of 1400 psig and the flow set at 3 L/min. A. 0.5 hour B. 2 hours C. 8 hours D. 18 hours
B
A patient is receiving pressure-controlled ventilation. The physician asks the respiratory therapist to interpret the following patient information: 10 AM2 PMExhaled tidal volume800 mL650 mLRespiratory rate12/min12/minPeak pressure40 cm water40 cm waterPEEP7 cm water7 cm water How should this information be interpreted? A. Lung compliance has improved. B. Decreased lung compliance C. Increased dead-space ventilation D. Decreased airway resistance
B
A patient who is being treated for a suspected myocardial infarction is given a simple O2 mask at 5 L/min. What would be the most appropriate way to quickly evaluate the patient's response to the supplemental O2? A. ABG analysis B. Measurement of SpO2 C. Capnography D. Check the PtcO2
B
A patient with bronchitis and many secretions is receiving mechanical ventilation with a heat-moisture exchanger for humidification. After bronchodilator and mucolytic medications are nebulized, the patient coughs vigorously. Suddenly, the patient's high-pressure alarm sounds. What could be the cause? A. Bronchospasm B. Secretions in the HME C. Leak in the circuit D. Decreased airway resistanc
B
A patient with pneumonia and shock is receiving 70% O2. How should the following ABG values be interpreted?pH7.20PaCO255 torrPaO235 torrHCO3-20 mEq/LBE-4 mEq/LSaO272%1.Moderate hypoxemia2.Severe hypoxemia3.Combined respiratory and metabolic acidosis4.Uncompensated respiratory acidosis5.Compensated metabolic acidosis A. 1 and 4 only B. 2 and 3 only C. 2 and 4 only D. 1 and 5 onl
B
A pediatric patient receiving mechanical ventilation has a respiratory rate of 50, an inspiratory time of 0.3 second, and an expiratory time of 0.9 second. What is the patient's I:E ratio? A. 1:1 B. 1:3 C. 2:3 D. 3:
B
An adult patient has a pneumothorax. Auscultation will reveal which of the following breath sounds? A. Crackles B. Diminished C. Resonant D. Wheezing
B
An adult patient has an 8-mm interior diameter tracheostomy tube in place. What is the outer diameter of the largest suction catheter that should be used for removing secretions? A. 2 mm B. 4 mm C. 6 mm D. 8 m
B
An adult patient has been receiving volume-controlled ventilation. Review of the chart reveals that over the past 4 hours, the plateau pressure has been stable at 25 cm H2O, whereas the peak pressure has increased from 30 to 45 cm H2O. What could explain this situation? 1.Decreased lung compliance2.Bronchospasm3.Airway secretions4.Increased lung compliance A. 1 only B. 2 and 3 only C. 1 and 4 only D. 2, 3, and 4 only
B
An unconscious adult patient has been brought to the Emergency Department with a suspected cervical spine injury. While lying supine, the patient is showing signs of an upper airway obstruction. How should the airway be opened at this time? A. Insert an oropharyngeal airway. B. Perform the jaw-thrust maneuver. C. Hyperextend the neck and head. D. Turn the patient onto either side
B
Question: A 12-year-old patient was intubated after an allergic reaction to an antibiotic medication resulted in hypotension and laryngeal edema. Two days later, the patient is stable, breathing spontaneously, and ready for extubation. Twenty minutes after being extubated, the patient has moderate inspiratory stridor. Vital signs and pulse-oximeter values are acceptable on 30% oxygen. What therapeutic procedure should be done now? A. Reintubate the patient. B. Give a nebulized racemic epinephrine treatment. C. Increase the patient's delivered oxygen percentage.
B
Question: A 35-year-old, 60-kilogram (132-lb) female patient with Guillain-Barré syndrome is receiving volume-controlled ventilation. The chest radiograph indicates bilateral basilar atelectasis. Ventilator settings follow:ModeAssist/controlFIO20.40Mandatory rate10Total rate12VT350 mLPEEP5 cm H2OpH7.34PaCO249 torrPaO285 torrHCO3-26 mEq/LBE+2 mEq/LWhat should the respiratory therapist recommend? A. Increase the PEEP to 10 cm H2O. B. Increase the VT. C. Add inflation hold.
B
Question: A 45-year-old woman with a history of pulmonary fibrosis has been admitted to the hospital with a productive cough and increased shortness of breath on exertion. She is tachypneic, with breath sounds revealing crackles in both lower lobes. Which of the following diagnostic tests would be most beneficial in determining the patient's problem? A. Bronchial challenge test B. Posteroanterior chest radiograph C. Anteroposterior chest radiograph
B
Question: A patient is ordered to receive 40% O2 with aerosol through a heated large-volume jet nebulizer. When the system is analyzed, the results show that 45% O2 is being delivered. What is the most likely cause of the problem? A. Inadequate water in the reservoir B. Collection of water in the tubing C. O2 flow that is set too high
B
Question: A patient is receiving O2 by mask through a heated aerosol nebulizer. The aerosol is noticed to be coming into the mask in puffs rather than continuously. What should the respiratory therapist do to correct the situation? A. Increase the O2 percentage. B. Drain any water from the aerosol tubing. C. Add reservoir tubing to the mask.
B
Question: A patient with COPD is enrolled in a pulmonary rehabilitation program and wants to know what can be self-monitored to follow progress in the program. The respiratory therapist would recommend which of the following? A. Capnography results B. 6-minute walking distance C. Pulmonary function study improvements D. Hematocrit values over time
B
Question: A patient with acute respiratory failure is being managed with a nasal mask to deliver bi-level NPPV. The upper-level pressure is 20 cm H2O, and the lower pressure level is 5 cm H2O. Due to a worsening of the patient's lung compliance, the tidal volume has decreased. What would be the best way to restore the original tidal volume? A. Switch to a full face mask. B. Increase the high pressure level. C. Intubate the patient and maintain the present settings.
B
Question: A patient with chest trauma has a left-sided tension pneumothorax. After a pleural chest tube is inserted, it is connected to a three-chamber pleural-drainage system with suction. The respiratory therapist should expect to see bubbling in the1.Suction-control chamber.2.Drainage-collection chamber.3.Water-seal chamber.4.Pressure-relief chamber. A. 3 only B. 1 and 3 only C. 2 and 4 only
B
Question: A patient's tuberculosis skin test is reactive. A solution of 1.8% saline is nebulized to induce a productive cough and get a sputum sample. After the treatment is over, the respiratory therapist auscultates the patient and notices diffuse wheezing. How should this information be interpreted? A. The patient has vesicular breath sounds. B. The patient has reactive airways. C. The procedure was effective.
B
Question: A postoperative patient with a hospital-acquired pneumonia received aerosol therapy before needing mechanical ventilation. Which of the following is the most likely source of the bacterial infection? A. Heat-moisture exchanger B. Large-volume nebulizer C. Cascade-type humidifier
B
Question: A pulmonary function test produces the following results: FVC 3600 mL, FEV1 2000 mL, FEV2 2400 mL, FEV3 3200 mL, FEV4 3400 mL, FEV5 3500 mL, and FEV6 3600 mL. What would be the patient's FEV3 percentage? A. 67% B. 89% C. 100%
B
Question: After getting a new order to start postural drainage with percussion and vibration, the respiratory therapist should first A. Describe the treatment to the patient. B. Review the patient's chart. C. Auscultate the patient's lungs.
B
Question: An adult patient is being set up for mask CPAP for the treatment of obstructive sleep apnea. The ordered CPAP level is not being maintained. What should the respiratory therapist do? A. Get an order for a lower CPAP level. B. Seal off any leaks. C. Decrease the air flow.
B
Question: An adult patient with a neurologic disease is being evaluated for progression of the disease. What is the minimal safe MIP the patient should be able to inhale? A. -10 cm H2O B. -20 cm H2O C. -30 cm H2O
B
Question: Following a successful resuscitation effort, an adult patient has an oral endotracheal tube inserted and is receiving mechanical ventilation. Auscultation reveals decreased breath sounds on the left side of the chest. What is the most likely cause of this? A. The VT is set too low. B. Endotracheal tube in the right mainstem bronchus C. The cuff is deflated.
B
Question: In which of the following clinical situations could nebulized hypertonic saline solution (>0.9% saline) be recommended as a mucolytic for a sputum induction procedure? A. Patient suspected of having bacterial pneumonia B. Patient suspected of having lung cancer C. Patient with asthma
B
Question: Respiratory care equipment is cleaned and disinfected or sterilized between patients in order to A. Protect the respiratory therapist from infection. B. Prevent cross-contamination between patients. C. Help with control inventory.
B
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 17-year-old female asthmatic patient has been admitted to the hospital. A 28% air-entrainment mask has been placed on her. After 30 minutes the following arterial blood gas results are found:pH7.51PaCO231 torrPaO291 torrHCO3-24 mEq/LBE0 mEq/LSaO296%On the basis of this information, the respiratory therapist would determine that the patient has A. Acute respiratory acidosis. B. Acute respiratory alkalosis. C. Acute metabolic alkalosis.
B
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 35-year-old 75-kg (165-lb) patient is received in the Emergency Department after being transported by ambulance from the scene of a house fire. The patient is wearing a nonrebreathing mask that is running at 8 L/min. Burns and ashes are seen on the patient's face and neck.After mechanical ventilation is initiated, the measured VT is found to be less than what is set. Auscultation reveals a bubbling sound in the larynx during inspiration. What should be done to correct the situation? A. A larger tube should be placed into the patient's airway. B. More air should be added to the cuff of the tube. C. The tube should be pulled back from the right mainstem bronchus.
B
Question: The respiratory therapist is assisting in the care of a patient who has been admitted with acute heart failure. What is most likely to be found in this patient? A. Asymmetrical chest movement B. Peripheral edema C. Clubbing of the fingers
B
Question: While attempting to suction an adult patient orally with a Yankauer device, the respiratory therapist finds that the secretions are too thick to be easily removed. The suction pressure is set at -50 mm Hg. What should be done? A. Switch to a flexible suction catheter. B. Increase the vacuum pressure. C. Use a nasopharyngeal tube as a suction route.
B
Which test would be best for assessing the reversibility of an asthmatic patient's airway problem? A. Arterial blood gas analysis B. Before-and-after bronchodilator study C. Inspiratory and expiratory chest radiographs D. Methacholine challenge test
B
Question: The respiratory therapist is assisting with the initiation of independent lung ventilation (ILV) and the insertion of a double-lumen endotracheal tube. All of the following should be done before intubation EXCEPT A. Inflate and deflate the bronchial cuff. B. Insert ventilator circuit adapters into both proximal lumina. C. Set the mechanical ventilator in the ILV mode.
C
A 152-centimeter (6-ft), 145-kg (320-lb) male patient is diagnosed with obstructive sleep apnea. What should the respiratory therapist choose to treat the patient's obstruction problem? A. Bilevel ventilation at home B. Tracheostomy and placement of a fenestrated tube C. Chest-cuirass ventilator in the home D. Overnight intubation and ventilation in the hospital
Bilevel ventilation at home
A patient has complained for the second time that she feels lightheaded after receiving a breathing treatment with a bronchodilator medication. Her palpated pulse has varied from 88 before, to 144 during, and 105 after the treatment. Her before- and after-treatment blood pressures were 125/82 and 140/95 mm Hg. What should the respiratory therapist recommend be done during the next treatment? A. Check for increased jugular vein distention. B. Measure bedside spirometry. C. Perform ECG monitoring. D. Get an ABG sample
C
A patient is receiving a set VT on a volume-preset ventilator. If the patient's actual delivered VT is to be determined, which of the following must be known?1.Dead space in the humidifier2.Peak pressure3.Exhaled VT4.Compliance of the circuit5.Set VT A. 1, 4, and 5 only B. 2, 4, and 5 only C. 2, 3, and 4 only D. 1, 2, 3, and 4 onl
C
During an assisted walk, a 50-year-old postoperative patient complains of sudden shortness of breath, chest pain, and pain down his left arm. His pulse is 140 and irregular, he is sweating heavily, and he is cyanotic. What is the first thing that should be done to determine the problem? A. Pulse-oximeter reading B. ABG sampling C. 12-lead electrocardiogram D. Capnograph
C
During the initiation of IPPB therapy, the machine self-cycles repeatedly without any inspiratory effort on the part of the patient. What should the respiratory therapist do to correct the situation? A. Have the patient inhale more quickly. B. Increase the delivered pressure. C. Adjust the sensitivity control. D. Adjust the terminal flow control.
C
Question: A 2-year-old patient with an upper airway infection demonstrates a high-pitched sound over the larynx during inspiration. Lung sounds are present and normal over all fields. What is the most important thing that should be recorded in the patient's chart? A. The patient has normal breath sounds. B. Both lungs are expanding normally during inspiration. C. The patient has inspiratory stridor.
C
Question: A 20-year-old patient is seen in the Emergency Department with a broken leg after falling off a bicycle. The patient is anxious and is complaining of difficulty breathing. Blood gases are drawn with the following results:pH7.53PaCO230 torrPaO2107 torrHCO3-25 mEq/LBE+1 mEq/LSaO299%How should they be interpreted?1.Excessively corrected hypoxemia2.Normal oxygenation3.Combined respiratory and metabolic alkalosis4.Uncompensated respiratory alkalosis5.Uncompensated respiratory acidosis A. 1 and 4 only B. 2 and 5 only C. 2 and 4 only
C
Question: A 50-year-old male patient has arrived by ambulance to the Emergency Department. The paramedics have placed an esophageal-tracheal Combitube into him. The attending physician wishes to place an oral endotracheal tube into the patient while still keeping a secure airway. What should be done to prepare for this? A. Withdraw the Combitube and replace it with a laryngeal mask airway. B. Keep the Combitube in place until the patient is intubated. C. Deflate the proximal cuff on the Combitube before intubating the patient.
C
Question: A 60-year-old, 55-kg (121-lb) female patient with known COPD is receiving volume-control ventilation. Current settings and ABG results follow:ModeVC, SIMVFIO20.30Mandatory rate8Patient rate4VT450 mLPeak flow50 L/minPressure support5 cm H2OpH7.25PaCO270 torrPaO263 torrHCO3-30 mEq/LBE+6 mEq/LWhat should be recommended? A. Increase the FIO2 to 0.40. B. Increase the inspiratory flow. C. Increase the mandatory rate.
C
Question: A 9-year-old patient is being treated in the Emergency Department for asthma. She is receiving 0.5 mL (2.5 mg) of albuterol (AccuNeb) by small-volume nebulizer. After 10 minutes, she complains that her hands are trembling and her heart is racing. For her next treatment what should be recommended? A. Administer a beta-blocker medication before the albuterol. B. Switch to an MDI with the same dose of medication. C. Decrease the dose to 0.3 mL. D. Change to epinephrine (Adrenaline) at the same dose
C
Question: A home care respiratory therapist receives a phone call from a patient who is receiving low-flow O2 through a nasal cannula. The patient states that she can't feel any gas coming through it. An oxygen concentrator is the home O2 source. What should the patient be told to do first to help determine the problem? A. Switch to the backup O2 system. B. Reset the circuit breaker to the concentrator. C. Put the cannula prongs into a bowl of water to check for bubbles.
C
Question: A patient has complained about increased work of breathing and shortness of breath. Which of the following is the best way to evaluate his ventilation ability? A. SpO2 B. Peak flow C. PaCO2
C
Question: A patient with COPD is receiving 40% O2 with an air-entrainment mask. What should the respiratory therapist recommend if the patient becomes drowsy and disoriented? A. Evaluate the patient for orientation to person, place, and time. B. Change the patient to a nonrebreathing mask. C. Decrease the patient's inspired O2 percentage.
C
Question: An adult patient with uncontrollable seizures has been ordered to be paralyzed and placed onto a mechanical ventilator. Which of the following medications should be selected? A. Morphine sulfate (Duramorph) B. Succinylcholine chloride (Anectine) C. Pancuronium bromide (Pavulon)
C
Question: An optimal PEEP study is being performed on an adult patient. The following data are available:TimePEEP(cm H2O)Compliance(mL/cm H2O)CardiacOutput(L/min)PaO2(torr)Pressure of MixedVenous Oxygen (torr)2:004434.955312:458475.061373:3012525.372414:1516465.08438On the basis of these findings, what PEEP level should be used? A. 4 cm H2O B. 8 cm H2O C. 12 cm H2O
C
Question: An unconscious intubated patient is receiving 35% O2 and aerosol by way of a T-piece. While evaluating the patient, the respiratory therapist notices that, during inspiration, the aerosol cannot be seen coming from the T-piece reservoir tubing. What can be done to correct this situation? A. Add another 100 mL of reservoir tubing. B. Change the patient to an HME. C. Increase the flow of aerosol to the patient. D. . Decrease the length of the reservoir tubing
C
Question: Based on the following data, calculate the patient's static lung compliance (in L/cm H2O):VT600 mLPeak airway pressure30 cm H2OPlateau pressure20 cm H2O A. 0.012 B. 0.020 C. 0.030
C
Question: For the prevention of tracheostenosis in a patient with an endotracheal tube, which of the following is the most important? A. Keeping the tube stable B. Careful tube insertion C. Low cuff pressure D. Proper tube length
C
Question: Initially, an adult patient has a PaO2 of 52 torr on room air. After the application of 30% O2 by mask, the patient's PaO2 is 85 torr. How should this be interpreted? A. Normal oxygenation B. Uncorrected hypoxemia C. Corrected hypoxemia
C
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 17-year-old female asthmatic patient has been admitted to the hospital. A 28% air-entrainment mask has been placed on her. After 30 minutes the following arterial blood gas results are found:pH7.51PaCO231 torrPaO291 torrHCO3-24 mEq/LBE0 mEq/LSaO296%To improve the pharmacologic management of this patient's bronchospasm, what additional drug should the respiratory therapist recommend? A. Acetylcysteine (Mucomyst) B. Nicotine polacrilex (Nicorette) C. Ipratropium bromide (Atrovent HFA)
C
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 35-year-old 75-kg (165-lb) patient is received in the Emergency Department after being transported by ambulance from the scene of a house fire. The patient is wearing a nonrebreathing mask that is running at 8 L/min. Burns and ashes are seen on the patient's face and neck.The physician has determined that the patient needs to be supported on a volume-cycled ventilator. What airway should be recommended in this situation? A. 6-mm ID tracheostomy tube B. 9-mm ID nasal endotracheal tube C. 8-mm ID oral endotracheal tube
C
Question: The respiratory therapist is assisting with the breech-position delivery of a 40-week gestational-age baby. After delivery, the newborn is observed to have a respiratory rate of 38/min. How should this be interpreted? A. Tachypnea B. Bradypnea C. Eupnea
C
Question: While administering a bronchodilator through a metered-dose inhaler with a reservoir, the respiratory therapist notices that the patient is using accessory muscles of breathing. The most likely cause of this is that A. The nozzle of the MDI is plugged. B. The patient is not coordinating inspiration with the MDI. C. The patient's airway resistance is increased.
C
The Trendelenburg position would be contraindicated for PDT in a patient with A. Pneumonia. B. Cystic fibrosis. C. Cerebral aneurysm. D. Cholecystectomy
C
To properly calibrate pulmonary function testing equipment, which of the following should be done? A. Measure a room-air sample for PO2. B. Measure volume with a Wright respirometer. C. Measure volume with a 3-L syringe. D. Compare a PO2 value with a PCO2 value.
C
A conscious spontaneously breathing adult patient has an oxygenation problem. It is decided that the patient needs an increased functional residual capacity. What should be initiated? A. APRV B. IPAP C. CPAP D. PSV
CPAP
An adult patient has been receiving mechanical ventilation for several days because of a head injury with cerebral edema. An HME has been in use, and pulmonary secretions have been minimal. Over the past 12 hours, the peak pressure has been noted to increase gradually, while the plateau pressure remains unchanged. What should be recommended? A. Reintubate with a larger endotracheal tube. B. Begin postural drainage with percussion and vibration. C. Switch to bilevel ventilation at the peak and plateau pressures. D. Change to a heated wick-type humidifier
Change to heated wick type humidifier
A 57-year-old patient with known COPD is receiving mechanical ventilation because of an acute pulmonary infection. The settings are as follows:ModePC, SIMVFIO20.35Mandatory rate8Total rate16VT550 mLSpontaneous VT300 mLPressure support5 cm H2O ABGs are as follows: pH7.38PaCO255 torrPaO267 torrHCO3-33 mEq/LBE+8 mEq/L What should be recommended at this time? A. Increase the SIMV rate to 12. B. Increase the FIO2 to 0.45. C. Add 10 cm H2O PEEP. D. Maintain the present settings.
D
A patient diagnosed with Pseudomonas pneumonia is having her respiratory care equipment changed. Her nondisposable large-volume nebulizer must be disinfected. What is the best way to do this? A. Place it into the autoclave. B. Wipe it down with 70% alcohol solution. C. Wipe it down with a glutaraldehyde solution. D. Place it into the pasteurization machine
D
A respiratory therapist is assisting in a bronchoscopy procedure. The patient begins to push away at the bronchoscope and is not cooperative. Which of the following drugs should be recommended? A. Pancuronium bromide (Pavulon) B. Dopamine hydrochloride (Intropin) C. Propranolol (Inderal) D. Midazolam (Versed
D
An 85-kilogram (187-lb) male patient with head trauma and increased intracranial pressure is receiving mechanical ventilation. The following data are available:ModeVC, A/CFIO20.40Rate12VT600 mLPEEP5 cm H2OpH7.39PaCO242 torrPaO295 torrHCO3-24 mEq/LBE0 mEq/LThe physician asks for recommendations. The respiratory therapist should recommend that the respiratory rate be A. Maintained because the ABG results are acceptable. B. Increased so that the I:E ratio is altered. C. Decreased to reduce the mean airway pressure. D. Increased to hyperventilate the patient
D
An adult patient is receiving mechanical ventilation. When the respiratory therapist places a hand on the patient's chest, palpable rhonchi are detected. What is the most likely cause? A. Bronchospasm B. Subcutaneous emphysema C. Pleural effusion D. Airway secretionS
D
An adult patient with bronchitis has received bland aerosol therapy. Auscultation reveals rhonchi (crackles) in both lung bases. What should be recommended? A. The aerosol therapy should be discontinued. B. A mucolytic drug should be nebulized. C. Postural drainage therapy should be started. D. The patient should be encouraged to cough
D
An adult patient with congestive heart failure is receiving noninvasive positive-pressure ventilation by nasal mask. The chest radiograph shows increased fluid in the lungs, and the most recent ABG results show a decrease in the PaO2. What should be done to improve the patient's condition? A. Change to a full face mask. B. Increase the high-pressure level. C. Intubate the patient and continue therapy. D. Increase the low-pressure level.
D
During a CPR attempt on a 10-year-old child, the respiratory therapist is handed a manual resuscitation bag and mask. The flow meter connected to it is delivering 10 L/min of O2. A VT breath is delivered, but the patient does not exhale. What should be done?1.Give another breath and see if the patient exhales.2.Turn the O2 flow up higher.3.Check the valve on the bag for debris.4.Remove the mask and bag so that the patient can exhale. A. 1 only B. 2 and 3 only C. 2 and 4 only D. 3 and 4 only
D
During the course of an optimal PEEP study, an adult patient receives a VT of 800 mL on the ventilator. Based on the data, which of the following would result in the best static compliance? Plateau pressure (cm H2O)PEEP (cm H2O)1.3502.4043.4284.4312 A. 1 B. 2 C. 3 D. 4
D
Question: A 17-year-old patient was resuscitated from a near-drowning incident. She is conscious and has the following clinical data:Respiratory rate16VT450 mLVC2200 mLMIP-43 cm H2OHeart rate92Blood pressure124/86 mm Hg ABG analysis results drawn while the patient is wearing a nonrebreathing mask show the following: pH7.52PaCO229 torrPaO257 torrHCO3-24 mEq/LBE0 mEq/L What should be recommended at this time? A. Maintain present therapy and repeat blood gases in an hour. B. Intubate and initiate mechanical ventilation. C. Give 50% O2 air-entrainment mask. D. Initiate 5 cm H2O CPAP and 80% oxygen by nasal mask
D
Question: A 45-year-old patient is receiving 10 cm H2O CPAP by face mask and sitting in the semi-Fowler's position. When the patient is assessed, the trachea is seen to be deviated to the right and there are no breath sounds over the left side. What could be the cause? A. Right mainstem bronchus intubation B. Consolidation of the right lung C. A leak at the face mask D. Pneumothorax on the left side
D
Question: A 49-year-old patient who had a bowel resection yesterday is being evaluated for incentive spirometry. The patient's VT is 400 mL, and uncoached inspiratory capacity is 800 mL. At what value should the patient's initial incentive spirometry be set? A. 400 mL B. 600 mL C. 800 mL D. 1000 ML
D
Question: A 65-kilogram (143-lb) patient is being ventilated in the Recovery Room after abdominal surgery until the effects of anesthesia wear off. Ventilator settings and ABG data are as follows:ModeVC, SIMVFIO20.35Mandatory rate14Total rate14VT450 mLPeak flow40 L/minPEEP0Pressure support0pH7.52PaCO228 torrPaO2120 torrHCO3-24 mEq/LBE0 mEq/LWhat should be recommended? A. Add 5 cm H2O pressure support. B. Decrease the VT to 300 mL. C. Decrease the FIO2 to 0.3. D. Decrease the rate to 12/min
D
Question: A high spinal cord injury patient occasionally uses O2 by nasal cannula during the day and requires volume-controlled mechanical ventilation at night to sleep. Which of the following would be the most appropriate for the patient? A. Transtracheal O2 catheter B. Speaking-type tracheostomy tube C. Tracheostomy button D. Fenestrated tracheostomy tube
D
Question: A patient has been found to have a Clostridium tetani (tetanus) infection. What should be recommended to kill all microorganisms that could be found on any respiratory care equipment? A. 70% ethyl alcohol soak B. White vinegar (acetic acid) soak C. Pasteurization D. steam autoclave
D
Question: A patient who is receiving mechanical ventilation develops Staphylococcus aureus pneumonia. The most likely cause of the infection is that A. The suction catheters are contaminated. B. A primary infection exists in another organ. C. An IV catheter insertion site is infected. D. Improper gloving or handwashing techniques exist.
D
Question: A patient with COPD and congestive heart failure has been treated with supplemental oxygen, digitalis (Digoxin), and furosemide (Lasix). His electrocardiogram is now showing flattened T waves. What should the respiratory therapist recommend to evaluate this change in his condition? A. ABG analysis B. Urinalysis C. Complete blood count D. Serum electrolytes
D
Question: A postoperative 70-kg (154-lb) patient is receiving mechanical ventilation with the following settings:Tidal volume700 mLRespiratory rate12/minuteFIO20.40Flow50 L/min Arterial blood gas results on these settings show: pH7.52PaCO230 mm HgPaO295 mm HgHCO3-24 mEq/LBE0 mEq/LSaO298% What should be done to correct the patient's blood gas values? A. Increase the peak flow. B. Administer bicarbonate. C. Decrease the FIO2 to 0.35. D. decrease the Vt
D
Question: A recently intubated patient will have tracheal suctioning performed for the first time. The procedure should be stopped when which one of the following occurs? A. Secretions are removed. B. The SpO2 value is 92%. C. The patient coughs. D. Bradycardia is detected
D
Question: An order is received to begin postural drainage, percussion, and vibration on an 18-year-old female. The chest radiograph film shows the superior and inferior segments of the left lingula are opaque. Auscultation reveals crackles in this area. The respiratory therapist would proceed to do all of the following EXCEPT A. Tip the patient's head down 15 degrees. B. Explain the importance of the treatment. C. Rotate the patient one-fourth turn up from supine. D. Percuss and vibrate in the left anterior chest area
D
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 17-year-old female asthmatic patient has been admitted to the hospital. A 28% air-entrainment mask has been placed on her. After 30 minutes the following arterial blood gas results are found:pH7.51PaCO231 torrPaO291 torrHCO3-24 mEq/LBE0 mEq/LSaO296%What would be the best drug to use to treat her acute problem? A. Cromolyn sodium (Intal) B. Racemic epinephrine (Asthmanefrin) C. Propranolol (Inderal) D. Albuterol
D
Question: The following is a situation that consists of a clinical event and a series of questions related to it. Study the situation closely and choose the best answer to the questions after it.A 35-year-old 75-kg (165-lb) patient is received in the Emergency Department after being transported by ambulance from the scene of a house fire. The patient is wearing a nonrebreathing mask that is running at 8 L/min. Burns and ashes are seen on the patient's face and neck.An assessment reveals that the patient cannot speak above a whisper, and a high-pitched sound is heard over the larynx during inspiration. What would be the patient's problem? A. Crepitation B. Asthma C. Pneumothorax D. upper airway obstruction
D
Question: When a respiratory therapist is assisting with the insertion of an endotracheal tube, the following should be done:1.Hyperoxygenation should be performed before the intubation is attempted.2.A curved blade should be attached to the laryngoscope handle to lift the epiglottis.3.The head and neck should be put into the sniffing position.4.Apnea periods should be limited to 30 seconds for each intubation attempt.5.A stylet should be inserted into a nasal endotracheal tube. A. 1, 2, and 3 only B. 2, 3, and 4 only C. 3, 4, and 5 only D. 1, 3, and 4 only
D
Question: While doing equipment rounds, the respiratory therapist hears a high-pitched whistling sound coming from the bubble humidifier connected to the patient's 24% air-entrainment mask. The O2 flow meter is set at 8 L/min. What should be done?1.Add water to the humidifier.2.Turn down the oxygen flow.3.Tighten all tubing and equipment connections.4.Remove the bubble humidifier. A. 1 only B. 2 only C. 1 and 3 only D. 2 and 4 only
D
After abdominal surgery, a 40-year-old 72-kg (158-lb) patient is receiving mechanical ventilation in the recovery room with a microprocessor-type ventilator. Current ventilator settings and ABG analysis results are provided below: ModeVC, A/CFIO20.40Mandatory rate12Total rate12VT700 mLFlow50 L/min pH7.53PaCO228 torrPaO2117 torrHCO3-24 mEq/LBE0 mEq/L What should the respiratory therapist recommend at this time? A. Decrease the minute volume. B. Increase the flow. C. Decrease the O2 percentage. D. Change to SIMV
Decrease minute volume
A 40-year-old 70-kg (154-lb) postoperative patient is receiving volume-cycled ventilation. The patient is unconscious and apneic, and the ventilator settings are as follows: ModeAssist/ControlFIO20.40Mandatory rate10VT800 mLPeak flow40 L/min 7.55/27/85/24 What should the respiratory therapist recommend in this situation? A. Decrease the VT. B. Increase the peak flow. C. Decrease the FIO2 to 0.45. D. Decrease the respiratory rate
Decrease the Vt
A 25-year-old female patient weighing 60 kg (132 lb) was mechanically ventilated after an accidental overdose of sleeping pills. She is now awake and alert and has been breathing on a T-piece for the past hour. Her vital signs and spirometry results follow: Heart rate79Blood pressure122/80 mm HgRespiratory rate14VT450 mLVC2100 mLMIP-45 cm H2O While the patient is breathing 30% O2, her ABG analysis results show the following: pH7.41PaCO238 torrPaO2115 torrHCO3-24 mEq/LBE0 mEq/L What should be recommended? A. Place the patient back on the ventilator to rest. B. Decrease the FIO2. C. Extubate the patient. D. Begin IPPB every 4 hours
Extubate the patient
A newborn is ordered to receive nasal CPAP at 8 cm H2O. The respiratory therapist notices that with each inspiration, the CPAP pressure drops to 2 cm H2O. During exhalation, the pressure returns to 8 cm H2O. What is the most likely cause of the pressure fluctuations? A. The CPAP exhalation valve is sticking. B. Flow through the CPAP system is too low. C. The piped-in O2 and air pressures are fluctuating. D. The neonate is leaking through his or her mouth.
Flow through the CPAP system is too low
Near the end of an oxygen-powered small-volume nebulizer treatment that is delivering levalbuterol (Xopenex) and dornase alfa (Pulmozyme), the patient complains of dizziness and tingling fingers. What is the most likely cause of these complaints? Hyperventilation Adverse reaction to Xopenex Hyperoxygenation Adverse reaction to Pulmozyme
Hyperventilation
A 43-year-old cholecystectomy patient with clear breath sounds is to receive preventive treatment for atelectasis. What should the respiratory therapist recommend? A. Flutter valve B. Bronchodilator therapy by MDI C. Intrapulmonary percussive ventilation D. Incentive spirometry
Incentive Spirometry
A patient with heart failure and pulmonary edema is being mechanically ventilated with the following settings: ModeVC, SIMVFIO20.50Mandatory rate12Total rate16Set VT500 mLSet minute ventilation6.0 LPEEP5 cm H2O ABG analysis results: pH7.44PaCO235 torrPaO252 torrHCO3-23 mEq/LBE-1 mEq/L Hemodynamic values: Pulse95BP110/75 mm HgPulmonary artery pressure30/16 mm HgPulmonary capillary wedge pressure12 mm HgPvO235 torr What should the respiratory therapist recommend? A. Increase PEEP to 10 cm H2O. B. Remove the PEEP. C. Change to PC, SIMV mode. D. Change to CPAP at 10 cm H2O
Increase the PEEP to +10
A 58-year-old female patient with asthma has received a breathing treatment with 0.31 mg of levalbuterol (Xopenex) and 5 mL of normal saline given by handheld nebulizer. After 30 minutes her peak flow is checked. It is found to be unchanged from before the treatment. What should the respiratory therapist recommend? A. Increase the dose of levalbuterol. B. Decrease the saline to 3 mL. C. Change to Proventil HFA by MDI. D. Increase the flow of oxygen to the nebulizer
Increase the dose of levalbuterol
An adult male patient with pneumonia is being supported by mechanical ventilation. The physician has written an order to suction twice a shift (every 4 hours). The patient is intubated with an 8.5-mm ID endotracheal tube and is being suctioned with a 14F catheter. Over the last two shifts, the patient's secretions have been increasing in volume. What should the respiratory therapist suggest to improve the patient's care? A. Increase the frequency of suctioning. B. Increase the duration of suctioning. C. Change to a 16F catheter. D. Change to a suction catheter with a Coudé tip
Increase the frequency of suctioning
A patient with status asthmaticus has been given pancuronium bromide (Pavulon) to assist with mechanical ventilation. For patient safety, which of the following is the most important alarm to monitor? A. Inspiratory/expiratory ratio B. Minute-volume C. Low-pressure D. O2 percentage
Low pressure
An adult patient with bilateral pneumonia is receiving mechanical ventilation in the VC, A/C mode. The patient's peak airway pressure is 55 cm H2O with a plateau pressure of 47 cm H2O. PEEP is set at 7 cm H2O. The patient has a pneumothorax in each lung. What should the respiratory therapist recommend? Decrease PEEP to 5 cmH2O Aerosolize beta-agonist medication Add inflation hold Initiate PC/AC ventilation
Initiate PC/AC ventilation
The respiratory therapist is called to assist in the Emergency Department with a motor vehicle accident victim. The patient is unconscious, has severe facial trauma with blood in the nasopharynx and oropharynx, and is in respiratory distress. What should be recommended? A. Insert a tracheostomy tube. B. Insert an oropharyngeal tube. C. Insert a nasopharyngeal tube. D. Insert a transtracheal O2 catheter.
Insert a tracheostomy tube
A 45-year-old patient is receiving volume-controlled ventilation with a VT of 550 mL. The patient's peak pressure is 45 cm H2O with a plateau pressure of 34 cm H2O. The physician decides to switch the patient to pressure-controlled ventilation with a pressure limit of 45 cm H2O. This change results in a VT of 650 mL. The respiratory therapist should recommend the following: A. Changing to bilevel ventilation at volume-control pressures B. Switching back to volume-controlled ventilation C. Lowering the pressure setting to attain the previous VT D. Initiating pressure support at 8 cm H2O
Lowering the pressure setting to attain the previous Vt
A 61-kilogram (135-lb) adult female with a neuromuscular disease has been admitted for observation. Bedside spirometry is performed every 2 hours and reveals the following: The patient has shown progressive difficulty in clearing her pulmonary secretions and is having difficulty swallowing. What should the respiratory therapist recommend? A. Oral suctioning B. Nasal CPAP C. Mechanical ventilation D. IPPB every 2 hours
Mechanical ventilation
A 40-year-old patient fell at home and suffered a broken jaw that had to be wired closed. If the patient were to develop a secretion management problem, what would be the best device to help in suctioning? A. Nasopharyngeal airway B. Oropharyngeal airway C. Cricothyroid catheter D. Tracheostomy button
Nasopharyngeal airway
A conscious patient with multiple trauma is being evaluated in the Emergency Department and found to be in respiratory distress. What should be recommended for the initial O2 delivery device? Endotracheal tube 40% air entrainment mask Nonrebreathing mask NC at 3 L/min
Nonrebreathing mask
Because of facial trauma, a 77-kg (170-lb) adult patient was given an emergency tracheostomy and had a 6-mm ID tracheostomy tube placed. Mechanical ventilation was started with a tidal volume of 550 mL because of apnea. The respiratory therapist notices that the intracuff pressure is 40 cm H2O with a 100-mL tidal volume leak. What should be done to correct this situation? Put a larger tracheostomy tube inside the patient Increase tidal volume by 100mL Inflate cuff until the leak stops Initiate HFJV
Put a larger tracheostomy tube inside the patient
A capnometer is being used to evaluate an intubated patient who is receiving mechanical ventilation. After coughing vigorously and being suctioned, the patient appears stable, but the capnometer reading shows no exhaled CO2. What could be the problem? The capnometer is out of calibration O2% was not decreased after suctioning Patient is hyperventilated Secretions have blocked the capnometer adapter
Secretions have blocked the capnometer adaptor
A 60-year-old patient was transported to the hospital after a car accident. She was initially unconscious but is now awake. What should the respiratory therapist assess to evaluate the patient's orientation to time? That the patient knows who her physician is That the patient knows the day and date That she can follow instructions That she knows she is in the hospital
That the patient knows the day and date
Upon entering a patient's room, a respiratory therapist notices that the bed sheets cover the entrainment ports on the air-entrainment mask. What is the likely result of this? A. The pressure relief valve on the humidifier will pop off. B. The delivered O2 percentage will be lower than expected. C. The mask will deliver the expected O2 percentage at a lower total flow. D. The mask will deliver a higher-than-expected O2 percentage.
The mask will deliver a higher than expected O2 percentage
After a combination transcutaneous O2 and CO2 monitor is removed from the thigh of a preterm neonate, a red circle is seen on the skin. The respiratory therapist would conclude that A. The measured values are not reliable. B. The unit is operating normally. C. The patient has been burned. D. A pulse oximeter should be used instead
The unit is operating normally
A parent brings an 18-month-old child to the Emergency Department because of coughing and vomiting during a recent meal. On assessing the child, the respiratory therapist notices inspiratory stridor. What should be recommended as the best way to determine the child's respiratory difficulty? A. Barium swallow B. Upper airway radiograph C. Chest radiograph D. Pulse oximetry
Upper airway radiograph
CPR has been performed for 10 minutes on a 45-year-old male patient. The patient has been intubated, cardiac drugs administered by IV, and defibrillation performed. The physician says to stop the chest compressions. A carotid pulse can be felt, the blood pressure is 110/60 mm Hg, and the following ECG tracing is seen: Perform defibrillation again Resume chest compressions Give epinephrine via ETT Ventilate patient and continue to monitor
Ventilate patient and continue to monitor
A 28-year-old patient with bilateral pneumonia and many secretions is going to be intubated and placed onto a mechanical ventilator. The physician asks the respiratory therapist which type of ventilator to use. What should be recommended for this patient? A. Noninvasive bilevel B. Independent lung ventilation C. Volume-cycled D. Pressure-cycled
Volume cycled
An adult patient who was involved in a motor vehicle accident has been placed on mechanical ventilation. The patient has broken ribs and a pleural chest tube in the left side. Air is seen to be bubbling through the water-seal chamber. What is the most likely reason for this? A. The wall-vacuum level is set too high. B. The patient has a left pleural air leak. C. The ventilator's peak pressure is too high. D. A right-sided pneumothorax is present
b
Question: A patient with pulmonary edema has the following arterial blood gas values while breathing 40% oxygen:pH7.46PaCO228 mm HgPaO245 mm HgHCO3-20 mEq/LBE-4 mEq/LSaO277%What would be the best treatment? A. Noninvasive positive-pressure ventilation with 40% oxygen B. IPPB with 100% oxygen C. Intrapulmonary percussive ventilation with 40% oxygen D. Mask CPAP with 80% oxygen
d
What would be the best recommendation the respiratory therapist could make for a patient who is hypoxemic and has a 45% pneumothorax? A. Increase the patient's inspired oxygen percentage. B. Insert a pleural chest tube. C. Have the patient begin flutter valve therapy to reexpand the affected lung. D. Insert a mediastinal chest tube
insert a pleural chest tube
A patient with thick secretions and bronchitis has just been intubated. What should the respiratory therapist recommend for humidification purposes? A. Bland aerosol through a small-volume nebulizer B. HME C. Cool bubble-type humidifier D. Heated wick-type humidifier
heated wick type humidifier
A 50-year-old patient with ARDS is receiving volume-cycled ventilation. The settings are as follows: ModeSIMVFIO20.65Mandatory rate12Total rate14VT500 mLPeak flow60 L/minPEEP5 cm H2OPressure support7 cm H2O The most recent ABG results follow: pH7.41PaCO237 torrPaO255 torrHCO3-24 mEq/LBE0 mEq/L Which of the following should be done? A. Increase the pressure support to 12 cm H2O. B. Switch to A/C with the same settings. C. Increase the PEEP level to 8 cm H2O. D. Switch to pressure control ventilation
increase the PEEP to 8 cm H2O
An 85-kg (187-lb) male patient is being mechanically ventilated as a result of an accidental overdose of a barbiturate. His ventilator settings and ABG results follow: ModePC, SIMVFIO20.40Mandatory rate10Total rate10VT600 mLPressure support4 cm H2O pH7.31PaCO254 torrPaO290 torrHCO3-26 mEq/LBE+2 mEq/L What should be recommended in this situation? A. Increase the rate to 12. B. Institute bilevel ventilation. C. Increase the pressure support to 8 cm H2O. D. Add 100 mL of mechanical dead space.
increase the rate to 12
A 48-year-old patient with advanced emphysema wishes to continue a very active social and work schedule. What should the respiratory therapist recommend for an oxygen-delivery system? . Portable E-cylinder with cart B. Portable liquid oxygen system with reservoir nasal cannula C. Air compressor with 50 feet of tubing to nasal cannula D. H tank at all work and social locations
portable liquid O2 system with reservoir nasal cannula
After completing a check on a patient's mechanical ventilator, the respiratory therapist notices that the ECG monitor shows the following rhythm. The patient's carotid pulse cannot be felt. What should be done? A. Recommend defibrillation. B. Auscultate for breath sounds. C. Turn up the O2 concentration. D. Palpate for the heart rhythm
recommend defibrillation
A Bird Mark 8 is being used to deliver IPPB for temporary breathing support of a 60-year-old patient with heart failure and pulmonary edema. The physician wishes to give her 100% O2 at this time and decrease the oxygen as she improves. What should be recommended? A. Run the unit through an oxygen blender. B. Pull the air-mix knob out from the unit. C. Have the patient wear a nonrebreathing mask. D. Have the patient wear an air-entrainment mask
run the unit through an oxygen blender
During the initial administration of formoterol (Foradil) by dry powder inhaler, a patient's heart rate is found to increase from 80 to 120 beats/min. What should the respiratory therapist recommend? A. Stop the treatment and evaluate the patient. B. Administer nebulized lidocaine (Xylocaine). C. Check the function of the SVN. D. Add 3 mL of normal saline to the SVN and continue.
stop the treatment and evaluate the patient
Upon entering a patient's room to check on a nasal cannula setup, the respiratory therapist hears a high-pitched whistling sound coming from the bubble-type humidifier. What should be done to correct the problem? A. Add water to above the fill-line on the reservoir bottle. B. Straighten any kinks in the O2 tubing. C. Turn down the O2 flow. D. Properly place the cannula prongs into the patient's nostrils.
straighten any kinks in the o2 tubign
A patient with pneumonia is sitting up in bed and has a respiratory rate of 30/min with a regular pattern. Accessory muscles of ventilation are being used. The respiratory therapist would determine her breathing pattern to be A. Kussmaul's respiration. B. Cheyne-Stokes respiration. C. Tachypnea. D. Eupnea
tachypnea
A patient with congestive heart failure has a flow-directed pulmonary artery catheter placed for monitoring purposes. After being given furosemide (Lasix), the patient has an increased urine output and the PvO2 value changes from 25 torr to 39 torr. What could be the cause? A. The patient's tissues are better oxygenated. B. The catheter is blocking the pulmonary artery. C. The patient's condition has worsened. D. A pulmonary embolism has developed
the patient's tissues are better oxygenated