TMC (LJU Version 11)

The correct answer is : A Explanation : Examination of this blood gas reveals a key finding consistent with hypocapnia, or decreased arterial CO2. This is suggestive of hyperventilation. Because this patient is receiving pressure control ventilation, the key method required to decrease arterial CO2 is to lower inspiratory pressure.

A 173-cm (5-ft 8-in), 65-kg (143-lb) male is receiving PC, A/C ventilation on the following settings: PEEP 15 cm H2O Set inspiratory pressure 22 cm H2O Mandatory rate 16 Total rate 16 FIO2 0.50 I:E 1:3 VT (exhaled) 725 mL ABG are as follows: pH 7.54 PaCO2 25 torr PaO2 108 torr HCO3- 22 mEq/L BE +1 mEq/L A respiratory therapist should recommend a decrease in which of the following? A. inspiratory pressure B. I:E C. PEEP D. mandatory rate

The correct answer is : C Explanation : Decreased breath sounds on the right is most suggestive of a possible pneumothorax. A chest radiograph is most helpful in assessing for this possibility.

A 22-year-old male patient with status asthmaticus is receiving VC A/C ventilation and is orally intubated with a 7.5-mm ET tube. The therapist notices a marked increase in peak airway pressures. BS are clear bilaterally but decreased on the right. The therapist should recommend A. inserting a chest tube in the right side, mid-clavicular line B. performing a bronchoscopy C. obtaining a portable chest radiograph D. scheduling a ventilation/perfusion scan

The correct answer is : B Explanation : Examination of this blood gas reveals a slight amount of chronic hypercapnia and hyperoxemia, or too much oxygen.

A 22-year-old male with cystic fibrosis is receiving 10 cm H2O CPAP with an FIO2 of 0.50. Arterial blood gas results are below: pH 7.36 PCO2 48 torr PO2 128 torr HCO3- 28 mEq/L BE 0 mEq/L The respiratory therapist should conclude that the patient has A. methemoglobinemia B. hyperoxemia C. hypocapnia D. uncompensated respiratory acidosis

The correct answer is : B Explanation : For a patient who will be traveling away from home and away from family support and other caregivers, the performance of bronchial hygiene is a concern. Because the patient will not be able to rely upon others for such procedures as chest percussion, the patient should be given the ability to provide his or her own bronchial hygiene independently. Additionally, expensive equipment may be inappropriate. Therefore, of the options listed the use of a hand-held vibratory PEP device would be most appropriate.

A 22-year-old patient with bronchiectasis will be attending college away from home and family. Due to significant daily expectoration of pulmonary secretions, the patient is concerned about maintaining adequate pulmonary hygiene while away from family support. The respiratory therapist should recommend A. cromolyn sodium inhalation daily B. vibratory PEP therapy C. IPPB with compressed air D. Spiriva (tiotropium bromide) Inhaler

The correct answer is : C Explanation : The ventilator graphic shown here exhibits a slight amount of pulmonary overdistension as manifested by the bird beak in the pressure volume loop. This can be resolved by decreasing the tidal volume. However, the patient is receiving PC ventilation and does not have a tidal volume setting. Thus, it is appropriate to decrease the set inspiratory pressure, which will result in a decreased delivered volume.

A 32-year-old female is being mechanically ventilated after sustaining multiple internal injuries from a motor vehicle accident. The patient is receiving PC ventilation on the following settings: Mandatory rate 16 FIO2 0.70 PEEP 10 cm H2O Inspiratory pressure (set) 35 cm H2O The following pressure-volume tracing is observed. The therapist should A. increase expiratory time B. remove mechanical deadspace C. decrease the set inspiratory pressure D. decrease PEEP

The correct answer is : D Explanation : As this patient receives sedation is obvious that their work of breathing decreases as evidenced by an increasing tidal volume which results in a decreasing spontaneous respiratory rate. As tidal volume increases and respiratory rate decreases, the effect is an increase in alveolar ventilation.

A 32-year-old male has a respiratory rate of 26/min and a tidal volume of 200 mL. Following sedation with a benzodiazepine medication, respiratory rate drops to 10/min and tidal volume increases to 520 mL. The respiratory therapist can accurately conclude that there was an increase in which of the following? A. pulmonary perfusion B. minute ventilation C. dead space ventilation D. alveolar ventilation

The correct answer is : D Explanation : The blood gas demonstrates a small amount of hyperventilation. Additionally, based upon the patient's predicted body weight, a tidal volume of 650 mL is too much. Thus, lowering the tidal volume to something more within range will help raise arterial CO2 to the proper level.

A 32-year-old male who weighs 60 kg (143 lb) is receiving VC SIMV ventilation following the surgical repair of a hernia with slow emergence from sedation. The following data is observed: pH 7.48 PaCO2 32 torr PaO2 110 torr HCO3- 23 mEq/L BE -1 mEq/L FIO2 0.45 Mandatory rate 12 Total rate 12 Tidal volume 650 mL The respiratory therapist should A. increase mandatory rate to 14 B. check autoPEEP C. decrease FIO2 to 0.21 D. decrease tidal volume to 450 mL

The correct answer is : C Explanation : This patient is obviously breathing well on CPAP and has acceptable blood gas results. Therefore, the next step for this patient is likely complete liberation from the ventilator, or in this case, extubation.

A 42-year-old patient is receiving VC AC ventilation due to complications after abdominal surgery. The patient has no history of pulmonary disease and is alert and oriented. The following data is observed: Mode CPAP Total rate 12 VT(spont) 425 mL PS 5 cm H2O PEEP 5 cm H2O FIO2 0.40 pH 7.42 PaCO2 38 torr PaO2 118 torr HCO3- 24 mEq/L BE 0 mEq/L MIP -42 cm H2O The respiratory therapist should recommend A. daily spontaneous breathing trials B. a change in PS to 0 cm H2O, ABG in 1 hr C. extubation D. continued full ventilatory support

The correct answer is : D Explanation : A physical examination that reveals a dull sound to percussion and decreased tactile fremitus, in conjunction with shortness of breath and a nonproductive cough, is most suggestive of a pleural effusion.

A 50-year-old male patient reports to the emergency department complaining of shortness of breath and a non-productive cough. Clinical examination reveals the following noted over the lower left lung field - dull to percussion - diminished breath sounds - decreased tactile fremitus The respiratory therapist should suspect which of the following conditions? A. pulmonary hypertension B. pulmonary tuberculosis C. pneumonia D. pleural effusion

The correct answer is : B Explanation : COPD patients often have difficulty weaning or liberating from mechanical ventilation. In this case, the use of pressure support would be most helpful as it augments the patient's spontaneous tidal volume, thus decreasing the work of breathing overall and facilitating longer spontaneous breathing trials.

A 52-year-old patient with COPD has been undergoing daily T-piece trails in an attempt to gradually wean from mechanical ventilation. For three consecutive days, the patient is unable to tolerate the trials for more than one hour and must be returned to full ventilatory support. The respiratory therapist should recommend which of the following? A. extubate the patient B. pressure support mode C. provide Xanax during trails D. discontinue all weaning trails for one week

The correct answer is : B Explanation : These flow-volume loop patterns show that the patient is moving more air after the initial bronchodilator test. This data is proof that the patient responds appropriately to bronchodilator therapy and may benefit from routine treatment.

A 54-year-old female completes pre and post bronchodilator FVC maneuvers with the follow graphic results. Which of the following should the respiratory therapist recommend based on this information? A. arterial blood gas analysis B. routine inhaled bronchodilator therapy C. visual assessment of the upper airway by bronchoscopy D. SBN2 test for gas distribution analysis

The correct answer is : C Explanation : This pulmonary function data shows that flows are markedly decreased. To determine if the patient is obstructed, the best test to use would be the FEV1/FVC percent. If this is not available, the FEV1 by itself is adequate. In this patient's case, the FEV1/FVC is less than 70 to 75%. Therefore, the patient is severely obstructive. Restrictive disease can be ruled out by looking at the slow vital capacity, or the forced vital capacity if the SVC is not available. In this case, FVC is diminished, indicating some level of restriction, but it is likely secondary to the obstruction.

A 61-year-old patient has the following pulmonary function results: Predicted Observed % Predicted FEV1 4.21 0.55 13.1 FEV1/FVC 70 16 -- FVC 5.80 3.30 56.9 TLC 6.90 7.27 105.0 FEF25-75% 4.45 0.87 19.6 The respiratory therapist should anticipate a treatment plan for A. mild obstructive lung disease process B. moderate restrictive lung disease C. severe obstructive pulmonary defect D. mixed mild restrictive and obstructive pulmonary defect

The correct answer is : D Explanation : The superficial evidence in this question indicates some sort of respiratory/ventilatory problem. However, the source of the problem is not evident and additional information is required. In this case, radiological examination of the chest may provide the additional information needed to determine the source of the problem.

A 62-year-old male, six hours post CABG, experiences a sudden onset of tachypnea 3 hours after extubation. Breath sounds are markedly decreased over the right lung field. Respiratory rate is 24/min, HR 110/min, BP 160/85 mm Hg, and SpO2 is 89% on 35% oxygen via air-entrainment mask. Which of the following should the respiratory therapist recommend NEXT? A. V/Q scan with Xenon gas B. begin CPAP by mask at 8 cm H2O C. deliver oxygen via HHF D. radiological examination of the chest

The correct answer is : B Explanation : The inability to pass a suction catheter down the tracheostomy tube is suggestive of an obstruction. In this kind of circumstance, the respiratory therapist should immediately remove the obstruction or remove the airway. The use of a suction catheter should be primarily used to clear the obstruction. In this case, the therapist is unable and therefore should act more aggressively to secure a patent airway by replacing the airway altogether.

A 62-year-old patient is brought to the emergency room (ER) from a local nursing care center where the patient has been in a vegetative state for 2 years. He routinely receives supplemental oxygen by trach collar and cool aerosol at 30%. He has a HR of 120 and an SpO2 of 83%. During a suction attempt, the therapist is unable to pass a suction catheter down the tracheostomy tube. What should the therapist do FIRST? A. use a stiffer suction catheter B. replace the airway C. switch to a nonrebreather mask D. switch to an air-entrainment mask at 50%

The correct answer is : A Explanation : A presurgical patient with greater-than-predicted pulmonary function result is more likely to avoid postoperative complications. The data suggests that the patient does not have significant pulmonary disease.

A 68-year-old male is scheduled for abdominal surgery. A preoperative spirometry exam reveals an FEV1 of 82% of predicted and an FEV1/FVC of 84%. The results would best indicate the patient has A. a low risk for postoperative complications B. increased risk for postoperative atelectasis C. a moderate risk for postoperative pneumonia D. increased airway resistance

The correct answer is : C Explanation : An SpO2 of 86% does not meet the physician's requirement to maintain oxygen saturation at 90%. Therefore, the titration of oxygen is required. Titration refers to a process of increasing or decreasing FIO2 in response to data to achieve a desired SpO2 or PaO2 value.

A COPD patient is receiving oxygen at 1 L/min when he was admitted to the hospital for suspected pneumonia. The physician orders a target SpO2 of 90%. The following clinical and laboratory data is obtained: RR 17 HR 101 BP 142/88 mm Hg SpO2 86% pH 7.35 PaCO2 68 torr PaO2 51 torr HCO3- 34 mEq/L BE +7 mEq/L The respiratory therapist should recommend which of the following FIRST? A. place a heated aerosol mask at FIO2 1.0 B. implement NIPPV C. titrate the oxygen flow rate D. switch to an air-entrainment mask at 0.55

The correct answer is : C Explanation : The tip of a central venous catheter should be positioned right before the right atrium, and sometimes slightly inside. Radiological evidence that shows the tip of the catheter positioned in the right ventricle would suggest that the catheter has been inserted too far and should be withdrawn.

A chest radiograph reveals the location of a central venous pressure catheter within moments after its insertion. The tip of the catheter is in the right ventricle. Based on this observation, the catheter A. has perforated a cardiac septal wall. B. is in appropriate position. C. should be withdrawn. D. should be advanced.

The correct answer is : D Explanation : Although an FEV1 is a flow, its data is achieved by performing a maneuver called FVC, or a forced expiratory spirogram. TLC, FRC, and RV cannot be determined through this method. They require more indirect procedures such as nitrogen washout and helium dilution.

A forced expiratory spirogram can reveal which of the following? A. FRC and FVC B. RV and FEV1/FVC C. TLC and FEV1 D. FEV1 and FVC

The correct answer is : B Explanation : Normally, when a homecare patient complains of possible nonfunctional equipment, the first step is to instruct the patient to change to an E cylinder for oxygen. However, in this case, that option is not offered. Therefore, the first step in troubleshooting this situation would be to check the catheter for potential obstruction. This would be an appropriate first action because an obstructed catheter is the most common reason for this type of problem.

A home care respiratory therapist is assisting a patient who complains the supply line to their transtracheal oxygen catheter keeps popping off. To troubleshoot and correct this problem the therapist should A. discontinue the transtracheal catheter B. check the catheter for obstruction C. replace the oxygen supply line D. secure the connection with medical tape

The correct answer is : C Explanation : Because this patient does not have a stated history of pulmonary disease and is considered to be in good health normally, coached coughing and deep breathing exercises are probably sufficient to treat pneumonia and facilitate bronchial hygiene.

A normally health track runner is hospitalized with right side pneumonia. The patient has chills and a temperature of 38.9 deg C (102 deg F). Which of the following will mostly likely provide sufficient aid to the patient? A. 30 minutes of ambulation daily B. in-exsufflation C. coached coughing and deep breathing exercises D. IPPB with bland aerosol q2 hrs

The correct answer is : C Explanation : The minimum equipment needed to transport a patient who is receiving mechanical ventilatory support is a bag-valve resuscitator.

A patient dependent on mechanical ventilatory support requires transport from the radiology department to the intensive care unit. Which of the following is required for the transport? A. multiple wave-length spectrophotometer B. a volume-cycled ventilator C. bag-valve resuscitator D. cardiac monitor with defibrillation capability

The correct answer is : B Explanation : A key treatment strategy associated with bronchiectasis is significant, aggressive bronchial hygiene.

A patient diagnosed with bronchiectasis, and who has a tracheostomy, has reported an increase in secretions and secretion thickness. A chest radiograph shows a cavitary disease. The patient is admitted. The respiratory therapist should recommend A. bronchoscopy to clear secretions B. therapy focusing on airway clearance C. routine bronchodilator therapy D. placing the patient in respiratory isolation

The correct answer is : C Explanation : The requirement for pillows to sleep properly or breathe better during sleeping is a condition usually related to congestive heart failure and is termed orthopnea.

A patient diagnosed with congestive heart failure requires 4 pillows to rest comfortably and breathe better. This is most consistent with A. dehydration B. apneustic ventilation C. orthopnea D. ketoacidosis

The correct answer is : D Explanation : All data suggests that the patient is ready to wean except for one piece of data. That is the VD/VT ratio which is above 60%. It must be below 60% for weaning to be considered.

A patient has been on mechanical ventilator support for 5 days. The physician would like to consider weaning the patient. The following clinical data is available: MIP -34 cmH2O VT (spont) 450 mL A-aDO2 220 mmHg VD/VT 0.70 VC 1.6 L RR 18/min Based on this data, the therapist should recommend A. obtain arterial blood gas analysis B. perform pulmonary function testing C. begin weaning with pressure support D. avoid weaning at this time

The correct answer is : A Explanation : A tracheostomy button is a device that directs exhaled air over the vocal folds and out the mouth rather than through the stoma.

A patient has maintained a tracheostomy for 5 weeks following a long bout of mechanical ventilation. After a slow weaning process, the patient has been breathing spontaneously for seven days. Which of the following devices will facilitate maintenance of the stoma once the cannula is removed? A. tracheostomy button B. transtracheal catheter C. obdurator D. Jackson tube

The correct answer is : A Explanation : In this question the arterial oxygen content is given (CaO2). However, the venous oxygen content is not provided. Additionally, sufficient information to determine the CvO2 by normal calculation is not available. Thus, CvO2 must be determined by estimation. Since normal CvO2 is about 5 vol% with an SvO2 of 75%, estimated CvO2 is about 4.3%. Of the answers given, 8.1 vol% is the closest estimation.

A patient has the following data: Hb 9 g/dL PvO2 35 torr SvO2 65% CaO2 15 vol% What is the patient's approximate C(a-v)O2? A. 8.1 vol% B. 2.8 vol% C. 10.1 vol% D. 6.2 vol%

The correct answer is : C Explanation : The use of overnight oximetry is often used to detect oxygen desaturation during the night that may be associated with central or obstructive sleep apnea. Because data indicates some periodic desaturation, the practitioner should suspect possible sleep apnea and should order diagnostic testing that will confirm or rule out the suspicion. This kind of sleep testing is also called polysomnography.

A patient has undergone overnight oximetry. Data shows several episodes of oxygen desaturation throughout the night. The respiratory therapist would expect orders for which of the following kind of testing? A. V/Q scan B. 24-hour Holter monitoring C. polysomnography D. pulmonary function testing

The correct answer is : A Explanation : Examination of this hemodynamic data reveals pressures that are all high. Elevated hemodynamic pressures across the board indicate fluid overload. This can be treated through the administration of diuretic medication.

A patient in distress has a chest radiograph that shows diffuse alveolar infiltrates while breath sounds reveal moist rales. The following data is available: CVP 13 mm Hg Right-side preload 14 mm Hg mPAP 28 mm Hg PCWP 22 mm Hg C.I. 1.7 L/min/m2 The respiratory therapist should administer A. diuretics B. inhaled nitric oxide C. Priscoline D. Xopenex

The correct answer is : A Explanation : The pulmonary function data shown in this case demonstrates very little response to bronchodilators, decreasing the ability for the practitioner to speculate on causative factors. Thus, additional information is required. The determination of lung volumes, which includes more comprehensive testing such as FRC determination, would be the next step in determining a possible cause.

A patient is being evaluated for obstructive lung disease as the following pulmonary function data: Pre-bronchodilator Post-bronchodilator FEV1 2.8 L 2.8 L FVC 3.3 L 3.4 L The patient's medical record indicates a 4-month history of episodic dyspnea with mild exercise. Chest radiograph and ECG are normal. Echocardiography shows an ejection fraction of 65% and normal stroke volume. Which of the following should the therapist recommend NEXT? A. lung volume determination B. Tensilon challenge C. CT scan of the chest D. methalcholine challenge

The correct answer is : A Explanation : When a patient stops smoking, their body experiences a decrease in metabolism and therefore can experience weight gain.

A patient is engaged in a smoking cessation program. During a routine visit to the counseling clinic, the patient expresses a concern about recent weight-gain with cessation of smoking. The respiratory therapist should explain that the reason for the weight gain is most likely due to A. decreased metabolism B. nicotine withdrawal C. hypothyroidism D. lack of self control due to compensation for the loss of tobacco

The correct answer is : B Explanation : When carbon monoxide poisoning is suspected, the use of a normal pulse oximeter, also called a single wave-length spectrophotometer, is inappropriate because it cannot detect carbon monoxide. Thus, to further assess the patient, the use of carbon monoxide analysis, also called hemoximetry, is indicated. If a multiple wave-length spectrophotometer is available, that method would be a superior way to analyze a patient for excessive carbon monoxide because it requires less time and money.

A patient is found on the side of the road, asleep in his car. CO poisoning is suspected. Which of the following is helpful to rule in or out CO poisoning? A. measurement of PAO2 B. hemoximetry C. single wave-length spectrophotometry D. CBC

The correct answer is : A Explanation : Of the options given, vibratory pet therapy would be most appropriate at promoting movement and expectoration of secretions and general bronchial hygiene. Postural drainage and percussion would also provide this but because the patient is recovering from a lobectomy and thoracic surgery in general, percussing over the thorax is contraindicated.

A patient is four hours post operative for a partial lobectomy of the lingular lobe. The patient complains of shortness of breath and has rhonchi in the middle right lobe. The respiratory therapist should recommend which of the following? A. vibratory PEP B. VEST therapy C. quad cough D. postural drainage and percussion

The correct answer is : C Explanation : This data shows increasing peak pressures while plateau pressures are remaining constant. This combination suggests that the patient does not experiencing a change in pulmonary compliance but rather decreasing dynamic compliance. This can be caused by many things, including secretions in the airway, an occluded ET tube, or airway resistance through bronchoconstriction, among others.

A patient is receiving VC AC ventilation with the following data: 3 PM 5 PM Plateau pressure (cm H2O) 33 33 Peak pressure (cm H2O) 39 46 VT (mL) 500 500 This data indicates A. pulmonary overdistension B. development of autoPEEP C. increase airway resistance D. decreased static compliance

The correct answer is : C Explanation : Each entrainment device, depending on the FIO2 chosen, has a specific ratio of oxygen to air. For 40%, the air-to-oxygen ratio is 3:1. Thus, to determine the total flow one must add 3+1 = 4 and multiply that by the indicated flow on the oxygen flow meter. In this case, 4 x 10 = 40 L/min.

A patient is receiving oxygen by air-entrainment mask at FIO2 0.40. The flow meter shows a flow of 10 L/min. What is the approximate total flow of gas to the patient? A. 10 L/min B. 30 L/min C. 40 L/min D. 20 L/min

The correct answer is : C Explanation : To analyze the patient for carbon monoxide poisoning, a hemoximeter must be used. A normal blood gas machine uses a Clark electrode, which is insufficient to detect carbon monoxide. A hemoximeter directly measures carbon monoxide in the blood.

A patient is suspected for smoke inhalation after being recovered from a burning building. Which of the following devices would be helpful in further investigating this suspicion? A. end-tidal CO2 infrared monitor B. arterial blood gas analyzer C. hemoximeter D. galvanic fuel cell analyzer

The correct answer is : A Explanation : Of the options given, continuous bronchodilator therapy with albuterol is most appropriate to address this significant asthmatic episode. The use of Xopenex every two hours would likely be insufficient and the other medications do not provide sufficient short-term bronchodilation.

A patient presents in the emergency department with severe respiratory distress as a result of an asthmatic episode. SpO2 is 86% on 2 L/min NC. Auscultation reveals bilateral expiratory wheezing. The therapist should recommend the initiation of A. continuous bronchodilator therapy with albuterol B. Xopenex 1.25 mg by MDI every two hours C. salmeterol by dry powder inhaler D. Spiriva inhaler, 2 puffs, PRN

The correct answer is : B Explanation : As PEEP increases, one of the biggest risks relates to blood pressure or hemodynamic pressures in general. Therefore, as PEEP is increased, the most significant and common risk is the development of hypotension.

A patient undergoes a change in PEEP from 8 cm H2O to 15 cm H2O. Which of the following would indicate an adverse reaction to the PEEP change? A. atrial arrhythmias B. hypotension C. tachycardia D. increase capillary refill time

The correct answer is : A Explanation : When the servo-controlled humidifier is set to maximum temperature and the humidifier is unable to achieve a higher, suitable temperature, the most likely cause is a faulty servo control.

A patient who is receiving VC A/C ventilation has developed thick, mucoid secretions over the last 8 hours. The servo-controlled humidifier is set to it maximum temperature. The digital temperature reading is 31 deg C (88 deg F). The therapist should A. replace the servo-controlled humidifier B. switch to a heat-moisture exchanger C. decrease the humidity temperature to 28 deg C D. perform a bronchoscopy for mucus plugs

The correct answer is : B Explanation : Although a bronchoscopy procedure is necessary to investigate deep pulmonary problems, such as lesions, the procedure itself can cause problems because of the width of the scope relative to the size of the airway. During the procedure the scope acts as a large airway obstruction. If the patient is receiving mechanical ventilatory support, it is likely that the high-pressure alarm will sound during this procedure. Therefore, it is appropriate to temporarily increase the high-pressure limit until the procedure is complete.

A patient who is receiving mechanical ventilation is scheduled for fiberoptic bronchoscopy to investigate a lesion in the right mainstem bronchus. Which of the following represents the most significant threat to ventilation during the procedure? A. stimulation of the vagal nerve and bradycardia B. airway obstruction C. loss of PEEP through suctioning D. excessive airway resistance

The correct answer is : C Explanation : When there is a shunt in place on one arm, the other are must be used for any puncture. Because ulnar circulation is reduced on the left arm, obtaining a blood gas through radial penetration is contraindicated. Therefore, use of the left brachial artery is most appropriate.

A patient who is undergoing dialysis is experiencing moments of hypoxemia as shown by a decreasing SpO2. Arterial blood gas analysis is ordered. A shunt is in place on the right arm and ulnar circulation on the left arm is markedly reduced. From what location should the respiratory therapist obtain an arterial sample? A. left radial B. right brachial C. left brachial D. right femoral

The correct answer is : C Explanation : For a patient who has a variable inspiratory requirement, and therefore breathes with a variable respiratory pattern, oxygen delivery through an air-entrainment device is more appropriate. Air-entrainment systems provide high flow and are more capable of meeting and/or exceeding the patient's inspiratory demand and spite of variability in the respiratory pattern.

A patient who requires supplemental oxygen at 40% has a variable respiratory pattern. Which of the following devices would most reliably provide a consistent oxygen concentration? A. nonrebreather mask B. nasal cannula C. air-entrainment mask D. face tent

The correct answer is : D Explanation : One of the possible outcomes associated with endotracheal suctioning, particularly on a patient who has low pulmonary compliance (such as patients with ARDS) is a pneumothorax. Clinical evidence, including a diaphoretic mottled look, hypertension, and anxiety, in conjunction with distal or absent breath sounds supports the suspicion that the patient has obtained a pneumothorax.

A patient with ARDS is receiving PC, A/C ventilation. During suctioning, the patient becomes tachypneic, diaphoretic, mottled, hypertensive, and anxious. Issues continue after the cessation of the suction procedure. Breath sounds are distant on the right compared to the left. Tracheal deviation is noted to the left. The therapist should prepare to respond to A. pulmonary emboli B. atrial tachycardia C. pulmonary edema D. a pneumothorax

The correct answer is : A Explanation : During the course of a hand-held small volume nebulizer treatment, it is common for the patient to begin coughing as secretions begin to move. This outcome must not be considered an adverse reaction but rather a desirable outcome. Therefore, it is appropriate to pause the treatment, encourage coughing, and then resume.

A patient with COPD is receiving aerosolized dornase alpha (Pulmozyme) via hand-held small volume nebulizer. During the treatment the patient begins to exhibit marked congestion and significant coughing. The most appropriate action by the therapist is to pause the treatment and A. assist the patient in clearing secretions though cough coaching B. provide oxygen by nonrebreather mask C. reduce the dosage of dornase alpha D. report the issue to the physician

The correct answer is : C Explanation : Of the options given the most appropriate way to visualize and determine the nature of a focal infiltrate in the right upper lung field would be through the use of bronchoscopy. A spiral CT scan could reveal some of the infiltrate's shape but would be very expensive and ultimately inconclusive.

A patient with a 60 pack-year history of smoking complains of a non-productive cough over the last 2 months. A chest radiograph reveals a focal infiltrate in the right upper lung field. The respiratory therapist should recommend which of the following? A. chest spiral CT scan B. bronchodilator therapy 4 times daily and PRN C. flexible bronchoscopy D. percutaneous lung biopsy

The correct answer is : A Explanation : This patient's blood gas shows adequate ventilation with inadequate oxygenation. Because the patient is already at or above 60% oxygen, hypoxemia must be addressed through the use of PEEP. Thus, increasing PEEP is the best option.

A patient with an IBW of 62 kg is receiving VC A/C ventilation with the following settings and corresponding arterial blood gas results: FIO2 0.65 Mandatory rate 15 VT 400 mL PEEP 5 cm H2O I:E 1:2 pH 7.36 PaCO2 35 torr PaO2 51 torr HCO3- 20 mEq/L BE -5 mEq/L The respiratory therapist should recommend A. an increase in PEEP to 10 cm H2O B. change FIO2 to 0.75 C. increasing flow rate to 40 L/min D. increasing tidal volume to 450 mL

The correct answer is : A Explanation : As the patient's heart rate goes from 82 to 129 per minute, it can be concluded that the patient is having an adverse reaction to the albuterol. Because the patient is on 2.5 mg, which is at the higher dose range, there is room to decrease the dosage based on the recommended adult therapeutic dose.

A patient with asthma is receiving a second dose of albuterol, 2.5 mg. During the treatment, the patient's HR increases from 82 to 129. The respiratory therapist should A. decrease the dosage of albuterol B. switch to Xopenex 1.25 mg C. administer budesonide D. switch to ipratropium bromide (Atrovent)

The correct answer is : C Explanation : Normally, paralysis for the purpose of intubation is best achieved by administering Anectine (succinylcholine chloride). The other paralytic medication listed is rocuronium bromide. Anectine is considered better because of its short half-life. However, in this case Anectine is contraindicated with status asthmaticus and therefore rocuronium is most appropriate. Diazepam (Valium) is a sedative that cannot provide a neuromuscular blockade. Romazicon is a benzodiazepine reversal drug and does not provide paralysis.

A patient with status asthmaticus has been intubated and sedated for prolonged mechanical ventilation. Which of the following drugs would be most appropriate to provide paralysis? A. succinylcholine chloride (Anectine) B. diazepam (Valium) C. rocuronium bromide (Zemuron) D. flumazenil (Romazicon)

The correct answer is : A Explanation : The pulmonary function exam that can reveal the most about an upper airway obstruction is a flow-volume loop. If a fixed upper airway obstruction is present, the loop will take on a rounded appearance, meaning the inspiratory side of the loop will be similar to the expiratory side.

A patient with suspected upper airway obstruction is undergoing evaluation. Which of the following tests should the respiratory therapist recommend to evaluate for this suspicion? A. flow-volume loop B. SBN2 C. FEF200-1200 D. closing volume

The correct answer is : D Explanation : When the difference of oxygen in the artery compared to the oxygen in the venous system increases, it must be assumed that tissue oxygen consumption is increasing. Oxygen consumption at the tissue level will typically increase because of the speed of blood flow across the tissues. Since the speed of blood flow is shown through the metric of cardiac output, an increase in oxygen consumption at the tissue level must mean that there is a decrease in cardiac output.

A patient's C(a-v)O2 has increased from 4.2 to 7.4 vol% following an increase in PEEP from 10 to 15 cm H2O. Which of the following best explains these data? A. alveolar overdistension B. decreased ventilation C. increase cardiac index D. reduced cardiac output

The correct answer is : B Explanation : When the transducer of an ART line is raised above the level from which it was zeroed and calibrated, the blood that pumps against the transducer will exert less pressure as it attempts to climb up to the transducer. This, therefore, will cause the indicated blood pressure to appear lower than actual. The opposite is also true. If the transducer is placed below the point at which it was zeroed, gravity will cause the blood to exert additional pressure against the transducer diaphragm, which will produce an indicated blood pressure that is higher than actual.

A patient's blood pressure is being monitored through an indwelling arterial line. At inception of the monitoring, the transducer was level with the heart and the system was zeroed. Since then, the patient has moved his arm, which has raised the transducer. Which of the following effect will this have on reported pressures? A. pressures will remain accurate B. systolic and diastolic pressures will be erroneously low C. systolic and diastolic pressures will be erroneously high D. systolic pressures will be erroneously low while diastolic pressures will be erroneously high

The correct answer is : A Explanation : One of the possible negative outcomes that can occur with the insertion of a tracheostomy tube is a pneumothorax. Data indicating absent breath sounds over the right lung field as well as a reduction in return volume suggests that a pneumothorax may have occurred on the right. A chest radiograph would be required to confirm this.

A respiratory therapist is assisting the anesthesiologist in the placement of an 8.0-mm tracheostomy tube on a patient who has ARDS and is receiving mechanical ventilation in the PC mode. During a troublesome insertion, the therapist observes the development of tachycardia, a marked reduction in the return volume, and absent breath sounds over the right lung field. The therapist should suspect A. right-sided pneumothorax B. a pleural effusion is developing on the right C. massive bilateral atelectasis D. the tracheostomy tube is too large

The correct answer is : D Explanation : Because there is virtually no helium in ambient air, calibrating a Wheatstone-Bridge helium analyzer with air should result in a value of 0%.

A respiratory therapist is calibrating the Wheatstone Bridge helium analyzer. What value would the respiratory therapist expect to observe when calibrating the analyzer to air? A. 0.8% B. 21% C. 0.2% D. 0%

The correct answer is : D Explanation : Of the devices listed, use of a capnometer will provide ventilation data as it reports exhaled CO2 with each breath.

A physician will be performing cardioversion on a patient with atrial tachycardia and asks the respiratory therapist to monitor the patient's ventilation. The therapist should select a A. pulse oximeter B. cardiac monitor C. multiple wave-length spectrophotometer D. capnometer

The correct answer is : C Explanation : A pulse oximeter, also known as a single wave-length spectrophotometer, is capable of detecting oxygen molecules only. When blood hemoglobin is bound with carbon monoxide, a pulse oximeter will show an erroneously high saturation because it cannot differentiate between carbon monoxide and oxygen. Therefore, carbon monoxide poisoning is a condition for which the practitioner should not trust pulse oximetry data.

A pulse oximeter is being used to monitor a patient's oxygenation status. In which of the following clinical conditions would the data produced by the oximeter device be considered inaccurate? A. pneumonia B. polycythemia C. carbon monoxide poisoning D. congestive heart failure

The correct answer is : B Explanation : Increasing expiratory time on a ventilator can be accomplished by either increasing inspiratory flow or decreasing the mandatory rate.

A respiratory therapist has been ordered to change the I:E ratio on a patient receiving VC A/C ventilation to allow for a longer expiratory time. Which of the following can be manipulated to accomplish this order? A. sensitivity and mandatory rate B. inspiratory flow rate or mandatory rate C. sigh volume and deadspace D. deadspace and inspiratory flow rate

The correct answer is : D Explanation : Normally, the presence of a low volume alarm, in conjunction with a lack of developing pressure shown on the pressure manometer, is suggestive of a leak. However, in this question none of the options allow for that. Therefore, the other most likely problem would be a malfunctioning exhalation valve.

A respiratory therapist is alerted by a low-volume alarm on a VC ventilator. The inspiratory pressure manometer is rising to a peak of 7 cm H2O during each inspiration. The therapist should A. remove kinks in the inspiratory pressure line B. examine the ET tube for kinks or occlusions C. drain condensate from the expiratory limb of the ventilator circuit D. examine the function of the exhalation valve

The correct answer is : B Explanation : Rapid shallow breathing index is a number that is determined by mathematically comparing the exhaled tidal volume with the total rate. Thus, to obtain the value one must use a device that measures volume. Of the devices listed, a vane respirometer is the only device that can accomplish this.

A respiratory therapist is asked to determine a patient's RSBI value. Which of the follow devices would be helpful in this determination? A. peak flow meter B. a vane respirometer C. end-tidal CO2 monitor D. positive/negative pressure manometer

The correct answer is : D Explanation : Of the options listed, a Ballard assessment is used to determine gestational age of an infant. Silverman/Anderson scoring is used to determine the degree of ventilatory difficulty and does not relate to gestational age. Apgar is used to determine the patient's overall vital stability in the first 1 and 5 min. after birth. Mallampati is a method used on adults to quantify the degree of difficulty of intubation and is not relevant in this case.

A respiratory therapist is asked to determine the gestational age of an infant delivered 10 minutes ago. Which of the following techniques should be used? A. Silverman-Anderson B. APGAR C. Mallampati D. Ballard

The correct answer is : A Explanation : Of the options given, the use of a non-rebreather mask is most helpful at maximizing arterial oxygenation and minimizing hypoxemia.

A respiratory therapist is participating on a Medical Emergency Response Team with a patient who is exhibiting severe hypoxemia. The patient has a DNI advanced directive. To maximize arterial oxygenation, the therapist should A. utilize a nonrebreather mask with the flow on flush B. provide manual ventilation with a bag-valve-mask C. place the patient on an air-entrainment mask set at FIO2 0.5 D. begin non-invasive positive pressure ventilation by mask

The correct answer is : A Explanation : For homecare patients, prevention of infections and general infection control should minimally be done by washing hands before and after therapy. Other options, including the use of alkaline gleuteraldehyde, is not appropriate for home use.

A respiratory therapist is providing education to a patient who will be self-administering nebulized albuterol at home. Which of the following instruction is critical to address infection control? A. washing hands before and after therapy B. utilizing cidex (alkaline gleuteraldehyde) once a week C. utilizing an acetic acid soak for non-disposable equipment daily D. soaking non-disposable equipment in 100% alcohol solution

The correct answer is : D Explanation : An arterial blood gas will be most revealing in terms of assessing the patient's ventilation and oxygenation status.

A respiratory therapist is reviewing the medical record of a 69-year-old patient admitted 2 hours prior. The record indicates the patient has chronic hypercapnia, emphysema, and an 80 pack-year history of smoking. Admission documentation shows the patient reported with moderate dyspnea. Currently, the patient is sleeping but arouses with significant verbal stimulation. The therapist should FIRST recommend A. pulmonary function testing B. CO-Oximetry C. single-breath nitrogen elimination test (SBN2) D. arterial blood gas analysis

The correct answer is : D Explanation : Clinical evidence suggests that this patient is continuing to have signs and symptoms associated with obstructive sleep apnea, even though they're using CPAP at night. When CPAP is insufficient, bilevel therapy becomes the next step. This type of therapy provides additional pressure during the inspiratory phase in addition to the positive airway pressure provided continuously.

A respiratory therapist is reviewing the status of a 65-year-old patient who has been treated for obstructive sleep apnea for 3 years. The patient is recently complaining of daytime sleepiness and takes a nap in his car during his lunch break. He is currently receiving nasal CPAP at 10 cm H2O. Recently ordered polysomnography reveals multiple periods of apnea with no chest or abdominal movement. The therapist should recommend A. switching to full face mask B. administering aminophylline by mouth nightly C. increasing CPAP to 14 cm H2O D. bi-level positive airway pressure

The correct answer is : D Explanation : If a suction catheter has difficulty passing through an endotracheal tube, it could be that the suction catheter is experiencing too much friction as it is inserted into the airway. This can often be remedied by decreasing size or diameter of the suction catheter

A respiratory therapist is unable to pass a 14 Fr suction catheter through a 7.0-mm ID nasotracheal tube. Lubrication of the catheter and minor repositioning does not seem to help. The therapist should do which of the following? A. deflate and reinflate the tube cuff with the proper pressure B. perform suctioning with a bronchoscope C. switch to an endotracheal tube D. utilize and 12 Fr catheter

The correct answer is : B Explanation : Caffeine citrate is a medication used to stimulate a patient's respiratory drive. If a newborn is ordered this medication, it is likely that the physician has concerns regarding the patient's natural respiratory drive and therefore, of the options given, apnea monitoring would be a consistent care technique.

A respiratory therapist notes a newborn has an order for daily administration of caffeine citrate at home when discharged. What home monitoring would be appropriate? A. APGAR determination daily B. apnea monitoring C. continuous SpO2 D. Holter

The correct answer is : B Explanation : The evaluation of this data shows a patient who appears to be strong in terms of independent ventilation. Thus, weaning is appropriate and a spontaneous breathing trial would be suitable for this patient. Other methods listed here are generally appropriate, but the levels associated with them are excessive.

A respiratory therapist observes the following data on a post-abdominal surgery patient who has been receiving VC SIMV ventilation for 18 hours: Spontaneous VT 480 mL MIP -38 cm H2O RR (spont) 18/min SpO2 99% FIO2 0.40 Mandatory rate 12/min VT (set) 550 mL The patient is alert and appropriately responsive to questions. Which of the following would be the BEST weaning method for this patient? A. CPAP of 8 cm H2O, FIO2 0.60 B. spontaneous breathing trial C. SIMV, rate 10, reduce rate by 2 every 4 hours until at 4/min D. PS ventilation at 15 cm H2O

The correct answer is : B Explanation : An increase in peak pressures suggests an increase in airway resistance, likely due to some transient issue such as secretions in the airway or bronchoconstriction. In addition to an increase in peak pressure, plateau pressures appear to be decreasing, suggesting a change in the stiffness of the lungs or an increase in pulmonary compliance.

A respiratory therapist observes the following while reviewing the ventilator flow sheet on a patient receiving VC A/C ventilation: 1:00 PM 2:00 PM 3:00 PM PEEP (cm H2O) 7 7 7 Peak Pressure (cm H2O) 31 35 44 Plateau Pressure (cm H2O) 28 26 22 The therapist can conclude which of the following is present? A. alveolar collapse, decreasing static compliance B. increasing airway resistance, increasing pulmonary compliance C. decreasing pulmonary compliance, increasing airway resistance D. pulmonary stiffening, decreasing dynamic compliance

The correct answer is : D Explanation : Because helium oxygen therapy consists of administration of predetermined mixtures of gases, additional air-entrainment is not desirable. Therefore, use of a nonrebreather mask is most appropriate.

Administration of a 60/40% helium-oxygen mixture requires which of the following masks? A. air-entrainment B. aerosol C. face tent D. nonrebreather

The correct answer is : A Explanation : A significant step in the performance of arterial blood extraction is to purge all air from the syringe after the blood has been extracted. Removing air bubbles prevents excessive oxygen from dissolving in the blood and producing erroneous results.

After completing arterial puncture and blood extraction into a disposable 3.0 mL syringe, the respiratory therapist should handle the sample by A. purging all air from the syringe B. placing the sample in an ice bath C. agitating the sample vigorously D. adding heparin to the syringe

The correct answer is : A Explanation : Epinephrine is the drug of choice to treat asystole. The other medications are not used in the situation.

After several moments of cardiac compressions with a patient suffering from a complete cardiopulmonary collapse, the patient's cardiac rhythm is consistent with asystole when compressions are momentarily halted. Which of the following medications would be most helpful to the patient: A. epinephrine B. Lidocaine C. Romazicon D. Quinidine

The correct answer is : C Explanation : To determine if a patient with asthma is responsive to bronchodilators, a variety of pulmonary function tests may be done. In this data, the pre-bronchodilator data suggests that there is no current constriction, making it difficult to check their responsiveness to any particular bronchodilator medication. Thus, it may be effective to use a practice that elicits bronchoconstriction first. This purposeful promotion of bronchoconstriction followed by the delivery of a bronchodilator is called an inhalation challenge. Methacholine and cold air are 2 methods of causing bronchoconstriction.

An 18-year-old female with a history of asthma since she was 9-years-old has the following pulmonary function results: Pre-bronchodilator Post-bronchodilator FVC (% predicted) 84 85 FEV1 (% predicted) 85 87 FEV1/FVC (%) 83 85 Peak flow (% predicted) 97 95 The respiratory therapist should recommend which of the following? A. SNB2 testing B. DLCO determination C. inhalation challenge D. maximum voluntary ventilation test

The correct answer is : D Explanation : According to the National Institute of Health asthma guidelines, asthmatic episodes may be progressively treated. After the second or third dose of aerosolized albuterol, continuous albuterol may be attempted.

An 18-year-old patient with asthma is receiving a second dose of aerosolized albuterol. Following the first treatment, the patient demonstrates more audible wheezing. Ten minutes after the second treatment, the patient's breath sounds are markedly diminished. The respiratory therapist should recommend A. Deliver 2.5 mg aerosolized albuterol every 2 hrs B. Intubate and institute VC A/C ventilation C. Change to nebulized Xopenex 1.25 mg D. Start continuous nebulized bronchodilator therapy at 10 mg/hr

The correct answer is : C Explanation : The proper size of endotracheal tube can roughly be determined by looking at the first digit of the ideal body weight in kilograms. In this case, the patient appears to have an IBW of 82 kg and therefore the appropriate ET tube size would be approximately 8.0. Because the patient is intubated with a 6.5 mm ET tube, the patient would likely demonstrate evidence of air hunger because of the airway resistance imposed by the excessively small ET tube.

An 82-kg (180-lb) IBW, orally intubated patient is brought by EMS responders to the emergency department. The patient's SpO2 is 89% on FIO2 0.40, administered by mechanical ventilation through a 6.5-mm ET tube. The patient is breathing asynchronously with the ventilator and peak pressure is 42 cm H2O with no change in plateau pressure. Intercostal retractions are noted. The respiratory therapist should recommend A. check for the development of autoPEEP B. increase peak inspiratory flow rate C. exchanging the airway with a larger ET tube D. sedate and paralyze the patient with midazolam and anectine

The correct answer is : B Explanation : The data shown here, especially pulse and blood pressure, indicate an emergent condition. Hyperresonance and absent breath sounds is suggestive of a tension pneumothorax. Because the tension is likely building, the patient is experiencing hemodynamic degradation that is dangerous. This is manifested by the low blood pressure. This problem should be remedied in an emergent way. This can be done by inserting a 14-gauge needle into the left chest, in between ribs. This will allow immediate venting of air and minor amounts of fluid to be ejected from the lung space and will provide immediate hemodynamic improvement.

An adult patient has a respiratory rate of 28, a pulse of 138, and a blood pressure of 85/65 mm Hg. Breath sounds are absent on the left and diagnostic percussion reveals hyperresonance on that same side. The respiratory therapist should FIRST recommend A. insert a chest tube in the left chest B. insert a 14-guage needle into the left chest C. radiographic examination of the chest D. schedule a V/Q scan

The correct answer is : B Explanation : Examination of this hemodynamic data reveals that the central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure are all excessively low. This is most consistent with dehydration or hypovolemia. Additionally, urine output supports this supposition.

An adult patient with a history congestive heart failure and who was involved in a motor vehicle accident is in the intensive care unit receiving mechanical ventilatory support. The following data is available: CVP 4 cm H2O mPAP 12 mm Hg PCWP 5 mm Hg PvO2 44 torr Urine output 5 mL/hr The respiratory therapist should conclude the patient is A. exhibiting reduced tissue oxygen consumption B. hypovolemic C. in cardiogenic shock D. experiencing fluid overload

The correct answer is : D Explanation : AutoPEEP is measured by initiating an expiratory hold just prior to the next breath. This gives time for the system to measure the residual total positive pressure. The amount that this pressure is above the set PEEP is considered excessive accumulated auto PEEP.

An expiratory hold initiated just prior to the next inspiratory phase facilitates the measurement of which of the following? A. PIP B. P(plat) C. P50 D. auto-PEEP

The correct answer is : C Explanation : Course crackles are most commonly associated with pulmonary secretions. Atelectasis would be described as fine crackles and pleural inflammation would most often be described as a friction rub.

Coarse crackles are auscultated over both lung fields. This is most consistent with the presence of A. atelectasis B. pleural inflammation C. pulmonary secretions D. mucus plug

The correct answer is : C Explanation : The maneuver expressed here, which is a deep breath followed by a maximal forceful exhalation, is called peak flow.

During bedside spirometry, the respiratory therapist asks the patient to take a deep breath followed by a maximal, forceful exhalation. The therapist observes the point on the graph that shows the fastest air movement. Which of the following is being measured? A. FEF 200-1200 B. FEV1 C. peak flow D. forced vital capacity

The correct answer is : B Explanation : An emergency medical response team in a hospital is used to help an individual caregiver troubleshoot and decide appropriate intervention for a patient who is demonstrating marginal stability with regard to their vitals.

During nasotracheal suctioning, the respiratory therapist notices the patient is no longer responsive to verbal stimuli. HR is 38/min. RR is 7/min. Which of the following should the therapist do NEXT? A. contact the patient's physician, STAT B. activate the emergency medical response team C. perform arterial blood gas analysis, STAT D. check the patient for a mucus plug

The correct answer is : B Explanation : An expectorated tracheostomy tube may be reinserted immediately in an acute situation.

During routine tracheostomy care, for a patient who is ventilator dependent and has had his trach in place for 2 weeks, the trach tube becomes dislodge during an acute coughing episode. The therapist should A. perform oral intubation, call the anesthesiologist B. reinsert the trach tube C. insert a temporary laryngectomy tube, call the physician D. place gauze over the stoma, monitor carefully

The correct answer is : D Explanation : When the patient experiences an adverse reaction to any particular medication, rather than decrease the dosage of that medication to a low or minimal therapeutic dosage, it is better to switch to a different medication in the same class. In this case, it is appropriate to switch from albuterol to Xopenex.

During the administration of 2.5 mg nebulized albuterol, a patient complains of nausea and palpations. Heart rate has increased from 98 to 128/min. After terminating the treatment and reporting to the appropriate health care team members, which of the following should the respiratory therapist recommend for the next treatment? A. Change to fluticasone by MDI B. Switch to ipratropium bromide (Atrovent) q2 hrs C. Change to 2 puff of beclomethasone (Vanceril) D. Switch to 0.63 mg Xopenex

The correct answer is : D Explanation : Pressure support is a mechanism that overcomes airway resistance, both mechanical and anatomical, to help decrease the work of breathing in a patient. It is especially helpful for patients who are weaning from mechanical ventilatory support. It specifically increases the size of their own spontaneous tidal volume.

For a patient receiving VC SIMV ventilation, which of the following would reduce the work of spontaneous breathing during a ventilator liberation strategy? A. NAVA B. pressure control ventilation C. APRV D. pressure support

The correct answer is : D Explanation : While oxygenation can be addressed by increasing FIO2, PEEP may be used to accomplish the same thing as well as improve alveolar recruitment and prevent alveolar collapse.

For a patient receiving mechanical ventilation, what ventilator control would be most helpful at improving oxygenation and reducing collapsed alveoli? A. mechanical deadspace B. peak flow C. mandatory rate D. PEEP

The correct answer is : D Explanation : When obtaining transcutaneous PO2 and PCO2 data, it is important that the electrode be placed on the skin and given enough time to heat the skin surface so that the capillaries are properly dilated. Until that is done readings may be erroneous.

For what reason should a transcutaneous PO2 and PCO2 value not be trusted immediately after placing the electrode on the skin? A. lack of normalize acid-base balance of the skin B. insufficient time for circulation to slow under the electrode C. because the electrode is not yet calibrated D. capillaries are not yet heated to dilate vessels properly

The correct answer is : A Explanation : The lack of a plateau in the end-tidal CO2 waveform is suggestive of airway obstruction.

How should the respiratory therapist respond to the following capnographic tracing? A. examine the patient for airways obstruction B. obtain an ABG C. calibrate the capnometer D. check for a disconnection

The correct answer is : B Explanation : Moderate inspiratory and expiratory stridor may be treated with racemic epinephrine. This alpha-1 medication can constrict vessels and tissues and reduce inflammation. If stridor is considered to be severe or marked, racemic epi not the best choice. An airway should be established immediately. This action is preferred over racemic epinephrine because of the time it takes for the medication to have effect. Therefore, racemic epinephrine should be used in cases involving mild and moderate stridor.

Immediately after extubation, a patient demonstrates moderate inspiratory and expiratory stridor. The respiratory therapist should prepare to administer A. oral Benzocaine B. racemic epinephrine C. topical spray Lidocaine D. cool bland aerosol

The correct answer is : A Explanation : Immediately after intubation with an ET tube or a tracheostomy tube that is equipped with an inflatable cuff, the cuff should be inflated to a pressure of 20-26 cm H2O. Or, if expressed in torr, cuff pressure should not exceed 20.

Immediately following insertion of a tracheostomy tube for the provision of positive pressure mechanical ventilation, enough air should be added to the tracheostomy tube cuff to? A. pressurize the cuff to 20 cm H2O B. prevent air passage around the cuff at peak inspiration C. disable vocal speech D. make the pilot balloon taught

The correct answer is : A Explanation : Immediately after placement of an oral endotracheal tube, tube location can be assessed by examining symmetry of chest rise and by auscultating breath sounds. In this case, breath sounds are absent on the left indicating the tube has advanced too far into the right mainstem bronchus and should be withdrawn. For exact placement a chest radiograph is ultimately required. However, the tube may be moved based on breath sounds independently. When a patient is intubated with the ET tube advanced too far, it has been most likely inserted into the right mainstem because the right bronchus bifurcates at a less acute angle than does the left.

Immediately following oral intubation on a patient involved in a motor vehicle crash, auscultation reveals absent breath sounds on the left. Which of following is the most likely reason for this finding? A. intubation in the right mainstem bronchus B. flail chest C. unilateral bronchoconstriction D. tension pneumothorax on the left

The correct answer is : D Explanation : According to a normal oxygen dissociation curve, at a normal pH, a PaO2 of 75 mmHg correlates to an SpO2 of approximately 90%.

In the presence of a normal pH, a PaO2 of 75 mm Hg would correlate to an SpO2 of approximately A. 80% B. 95% C. 85% D. 90%

The correct answer is : B Explanation : Perhaps the most common physical sign of airway resistance is the use of accessory muscles.

Increased airway resistance is most likely accompanied by A. CHF B. use of accessory muscles C. flattening diaphragm D. alveolar collapse

The correct answer is : B Explanation : One of the most common side effects associated with inhaled albuterol is tremors.

Inhaled albuterol has which of the following most common side effects? A. systemic hypotension B. tremors C. nausea D. increased mPAP

The correct answer is : C Explanation : A key measurement for a neuromuscular patient with myasthenia gravis is vital capacity. As the paralysis ensues, the diaphragm becomes unable to move and the disease is demonstrated by a marked reduction in the patient's basic ventilatory parameters, including VC, VT, and MIP. VC is more telling than tidal volume because the myasthenia gravis patient can often maintain a near normal tidal volume for longer than they can VC. When a vital capacity is found to be below 1.0 L, mechanical ventilatory intervention is indicated.

It is determined that a patient with myasthenia gravis requires mechanical ventilatory support. Which of the following parameters most likely indicated this intervention? A. FEV1 B. SpO2 C. VC D. VT

The correct answer is : D Explanation : A bronchoscopy is the best procedure to use when a specific bleeding site needs to be located within the pulmonary tree. Although the bronchoscope is unable to penetrate the distal portions of the tree, most bleeding will occur higher up and can be visualized through the bronchoscope. Additionally, once the bleeding site is observed, measures can be taken with the bronchoscope to stop or minimize bleeding. Some of these measures include instillation of epinephrine, compression of the site with the scope, or placement of a Fogarty catheter, which is a long-term tamponade of the bleeding site.

It is suspected that a patient is bleeding from a site within the pulmonary tree. Which of the following would be most appropriate to locate the potential bleeding site? A. percutaneous biopsy B. CT scan of the chest C. V/Q scan D. bronchoscopy

The correct answer is : C Explanation : In this question, there is an obvious that there is a broad problem among physicians to incorrectly order bronchodilator therapy. Although physicians could be spoken to individually, a more efficient method would be to create a bronchodilator protocol. This is a documented set of instructions that allows a physician to order bronchodilator therapy, without having to provide the specifics of how the therapy is given or what drug or dosage is used. This approach helps to standardize care and avoid problems with physician orders.

Orders for short and long-acting bronchodilator medication administration by many physicians has been inconsistent and sometimes inappropriate for some patients. To best prevent this type of activity, the respiratory therapist should recommend A. instructing pharmacy not to distribute medication until a respiratory assessment is done. B. determining which physicians are making such orders and report them to the department medical director C. development of a bronchodilator therapy protocol. D. restricting offending physicians from ordering bronchodilator therapy.

The correct answer is : A Explanation : Peak flow measurements are especially helpful in patients with asthma or patients who are suspected to have airway obstruction, mostly due to bronchoconstriction.

Peak flow measurements are indicated in which of the following conditions, if present? A. airway obstruction B. Guillain-Barre' C. myasthenia gravis D. ARDS

The correct answer is : B Explanation : Of the drugs listed, Ativan would be most appropriate to provide sedation without causing hypotension. As the patient is already hypotensive, use of such drugs as morphine could increase the degree of hypotension and harm the patient.

Prior to beginning patient pulmonary function testing, a respiratory therapist uses a 3-L calibrated, certified syringe to check the accuracy and precision of the pulmonary function testing equipment. The measurements are: 2.65 L, 2.71 L, 2.69 L. The therapist could conclude that the? A. PFT equipment requires calibration or maintenance B. room temperature should be raised before retesting C. syringe requires recalibration D. equipment is acceptable for patient testing

The correct answer is : A Explanation : A vane respirometer is a device that measures volume and must be calibrated from time to time. This can be done with a three-liter super syringe. This syringe is certified and calibrated for accuracy and should be trusted above all other instruments in the pulmonary function laboratory.

The best way to determine the accuracy of a vane respirometer is a A. 3-liter syringe B. an infrared sensor C. pneumotachometer D. Wheatstone bridge analyzer

The correct answer is : D Explanation : This ECG tracing is generally normal but shows pronounced Q waves. Q waves that are either excessively wide or excessively deep are associated with cardiac tissue death, likely from a previous myocardial infarction. This is especially true in the absence of current signs or symptoms and distress.

The following ECG tracing is recorded for a 65-year-old male who is being monitored in the cardiac intensive care unit. Based on this rhythm, the respiratory therapist will note which of the following in the medical record? A. patient has sinus tachycardia B. cardiac ischemia is present C. patient is currently experiencing myocardia injury D. patient has sustained cardiac tissue damage from a previous myocardial infarction

The correct answer is : D Explanation : Examination of this chest radiograph reveals the presence of a tracheostomy tube and a pleural effusion. A pneumothorax would show a larger black area over a lung field and a chest tube would show up on the periphery in the pleural space. Neither of these are present in this film.

The following chest radiograph is observed. Which of the following is evident in the film? A. tracheostomy tube, pneumothorax B. chest tube, pneumothorax C. pneumothorax, pleural effusion, chest tube D. tracheostomy tube, pleural effusion

The correct answer is : B Explanation : This data shows a remarkable difference between arterial oxygenation and venous oxygenation as listed in the PaO2 and PvO2, respectively. Normally, venous oxygenation should be about 25% less than arterial oxygenation. In this case, however, it is less than 50%. This suggests that tissues are consuming more oxygen, which supports the conclusion that blood is flowing slower across the tissues. When blood flows slower across the tissues, it can be concluded that cardiac output is decreasing. Therefore, it would be appropriate to examine cardiac output based upon this data.

The following data is observed on a patient receiving VC A/C ventilation: Mandatory rate 14 VT 500 mL FIO2 0.55 PEEP 8 cm H2O Laboratory data: SpO2 92% PvO2 32 mm Hg PaO2 76 mm Hg The respiratory therapist should A. decrease VT B. determine current cardiac output C. raise PEEP to 12 cm H2O D. increase FIO2 to 1.0

The correct answer is : D Explanation : This data shows a remarkable difference between arterial oxygenation and venous oxygenation as listed in the PaO2 and PvO2, respectively. Normally, venous oxygenation should be about 25% less than arterial oxygenation. In this case, however, it is less than 50%. This suggests that tissues are consuming more oxygen which supports the conclusion that blood is flowing slower across the tissues. When blood flows slower across the tissues, it can be concluded that cardiac output is decreasing. Therefore, cardiac function should be assessed either by measuring cardiac output or by checking the cardiac index.

The following data is observed on a patient receiving VC A/C ventilation: PEEP 12 cm H2O FIO2 0.60 VT 550 mL Mandatory rate Laboratory data: SpO2 90% PvO2 29 mm Hg PaO2 70 mm Hg The respiratory therapist should A. increase FIO2 to 0.80 B. calculate PVR C. assess the A-aDO2 to determine treatment D. determine current cardiac index

The correct answer is : A Explanation : This group of data shows that with increasing PEEP the patient exhibits improved oxygen saturation. However, as PEEP is further increased, there is an ultimate degradation in hemodynamics that may result. According to this data, the patient's hemodynamic status deteriorates significantly at a PEEP level of 20 cm H2O. This is manifested by a sudden decrease in pulmonary compliance from 61 to 50 mL/cm H2O and a corresponding sharp decrease in blood pressure.

The following data were obtained while an adult patient was receiving VC AC ventilation with an FIO2 0.60. 1000 1015 1030 1045 HR 90 92 106 110 BP (mm Hg) 135/88 128/86 119/80 101/75 SpO2 (%) 80 91 94 95 Static Compliance 20 42 61 50 PEEP (cm H2O 5 10 15 20 Which of the following PEEP levels should the respiratory therapist recommend? A. 15 cm H2O B. 20 cm H2O C. 10 cm H2O D. 5 cm H2O

The correct answer is : C Explanation : Regarding the pressure volume loops, it is evident that the first one shows over distention as manifested by the small beak. However, the beak disappears even though the tidal volume has remained unchanged. This would suggest that the patient has developed more lung space, which is likely achieved through alveolar recruitment.

The following pressure-volume waveform is observed on a 32-year-old patient who is receiving VC A/C ventilation following abdominal surgery. When originally instituted, the waveform demonstrated a small bird's beak pattern. Two hours later, the beak formation has disappeared. VT has stayed consistent at 8 mL/kg. SpO2 remains unchanged at 95%. Which of the following can the respiratory therapist conclude? A. autoPEEP is developing B. PEEP is insufficient C. alveoli have likely been recruited D. the lung may have become perforated

The correct answer is : D Explanation : The standard dosing frequency for tiotropium (Spiriva) is every 24 hours.

The standard dosing frequency for inhaled tiotropium (Spiriva) is every? A. 12 hrs B. 6 hrs C. 8 hrs D. 24 hrs

The correct answer is : C Explanation : AutoPEEP is a condition whereby gases become trapped in the lungs due to an insufficient exhalation time before the next mechanical breath begins. AutoPEEP may be reduced by either decreasing the mandatory rate, which allows more time for exhalation on each cycle, or by increasing inspiratory flow which decreases inspiratory time and thereby lengthens expiratory time. In truth, this is primarily dealt with by increasing the flow. However, in this question the only suitable option is to decrease the mandatory rate. Of course, a decrease in the rate would result in a decrease in alveolar ventilation which must be compensated for in other ways.

The respiratory therapist has discovered the development of autoPEEP on a patient due to decreased dynamic compliance. Which of the following should the respiratory therapist do? A. decrease expiratory time B. increase the I:E ratio C. decrease mandatory rate D. decrease inspiratory flow

The correct answer is : C Explanation : The patient's history and pulmonary function result (the FEV1 of 42%), in addition to an excessive smoking history, suggests chronic obstructive pulmonary disease. This suspicion is further corroborated by noting a normalized pH in the presence of hypercapnia (excessive CO2). Additionally, the patient is very hypoxic and thus requires supplemental oxygen.

The respiratory therapist is performing an initial assessment on a new client in the pulmonary clinic. The patient has a 90 pack-year history of smoking, an FEV1 of 42% of predicted, and a DLCO of 15 mL CO/min/mm Hg. The following arterial blood gas data is available pH 7.37 PaCO2 56 torr PaO2 43 torr HCO3- 32 mEq/L BE + 6 mEq/L Which of the following is the most appropriate NEXT step? A. admit the patient a pulmonary rehabilitation program B. schedule the patient for sleep studies C. initiate supplemental oxygen D. perform a chemical cardiac stress test

The correct answer is : D Explanation : To determine the number of mL needed, one must first determine how many mg per mL with that specific concentration of mediction. This can be done by taking the concentration (strength) and multiplying it by 10. ie, 0.05% x 10 = 0.5 mg/mL. In this case, 2 mg is needed. Thus 2 mg/0.5 mg/mL = 4.0 mL.

The respiratory therapist notes an order in a patient's record for 2 mg of a drug. The normal stock concentration of the drug is 0.05%. How many mL will be required to meet the ordered dosage? A. 10.0 mL B. 2.5 mL C. 1.0 mL D. 4.0 mL

The correct answer is : B Explanation : The presence of fever and purulent pulmonary secretions suggests the possibility of an infection. A CBC would confirm the presence of an infection but a sputum gram stain would actually identify the class of offending pathogenic organism (gram-positive or gram-negative) Although not offered here, a more appropriate exam would be a sputum C&S which would provide specific organism information and suggest the most appropriate antimicrobial therapy. If a sputum gram stain is done and the class of organism is identified, a general class of antibiotics may be started until more specific pathogenic organism identification is done.

The respiratory therapist observes a gradual increase in peak inspiratory pressure over the last 24 hours on a patient who is receiving mechanical ventilation. Additionally, the patient has become febrile and is producing purulent pulmonary secretions. The therapist should recommend which of the following? A. exploratory bronchoscopy B. sputum gram stain C. bronchodilator therapy D. lung tissue biopsy

The correct answer is : D Explanation : A VQ scan that shows excess ventilation and reduced perfusion indicates that gases are penetrating the alveolar complex of the lungs but blood is not perfusion or flowing past that area. Therefore, a problem related to lack of blood flow in the pulmonary vasculature would be most closely associated with the condition pulmonary embolism.

The results of a ventilation perfusion scan shows excess ventilation compared to perfusion in the right lower lobe. This observation suggests A. panlobular emphysema B. tuberculosis with cavitary disease C. air-trapping D. pulmonary embolism

The correct answer is : C Explanation : This blood gas demonstrates acute hypercapnia with normal oxygenation. Several actions may be taken to decrease CO2, including an increase in tidal volume, an increase in mandatory rate, and a decrease in dead space. In this case, carbon dioxide is significantly off of target by more than four torr. Therefore, the most appropriate adjustment would be an increase in rate.

Thirty minutes after initiating SIMV VC ventilation, a patient has the following data: FIO2 0.45 Mandatory rate 10 Total rate 10 Tidal volume 500 mL PEEP 6 cm H2O pH 7.28 PaCO2 54 torr PaO2 89 torr HCO3- 24 mEq/L BE -4 mEq/L SaO2 95% The respiratory therapist should recommend A. increasing VT to 550 mL B. decreasing FIO2 to 0.40 C. increasing mandatory rate to 14 D. maintaining current settings

The correct answer is : D Explanation : This blood gas shows the patient is hyperventilating by a small amount. This can be addressed by lowering mandatory rate, decreasing tidal volume, or adding dead space. Because CO2 is low only by a slight amount, the addition of dead space is the most acceptable answer. Decreasing tidal volume would be appropriate except that a tidal volume of 350 mL is below the patient's range.

Thirty minutes after initiating VC A/C ventilation on a 75-kg (166-lb), 157-cm (5-ft, 8-in) female patient, the following data is obtained: FIO2 16 0.5 Mandatory rate 16 Total rate 16 Tidal volume 550 mL PEEP 5 cm H2O pH 7.46 PaCO2 33 torr PaO2 82 torr HCO3- 24 mEq/L BE 0 mEq/L SaO2 93% The respiratory therapist should recommend A. decreasing rate to 12 B. decreasing VT to 350 mL C. maintaining current settings D. adding 50 mL deadspace

The correct answer is : C Explanation : Of the options listed, the use of overnight oximetry is used to detect periodic oxygen desaturation, which may be connected to obstructive or central sleep apnea. Although the exam is not conclusive, it is enough to indicate further testing with regard to sleep. This kind of testing is called polysomnography.

Use of overnight oximetry at home is intended to determine the need for which of the following? A. continuous cardiac rhythm monitoring B. echocardiography C. polysomnography D. electroencephalography

The correct answer is : B Explanation : To determine the minute ventilation of the patient, one should multiply the tidal volume by the rate. In this case, tidal volume is expressed in milliliters. Because minute ventilation should be expressed as L/min, tidal volume must be translated to liters. Thus, .425 x 12 = 5.1 L.

What is the minute ventilation (L/min) of a 150-lb (68-kg) male who has a tidal volume 425 mL and a respiratory rate of 12? A. 6.2 B. 5.1 C. 7.4 D. 3.3

The correct answer is : D Explanation : During the transport of the patient on a ventilator, movement from place to place and bed to bed presents the most obvious risk of accidental disconnection. Thus, the disconnect alarm is most important during the transport.

What is the most important characteristic in a transport ventilator that will be used during a transport within a hospital? A. operates on batteries for at least 1 hour B. return tidal volume reporting C. pressure support mode D. disconnect alarm

The correct answer is : B Explanation : The purpose of sterilizing and cleaning nondisposable respiratory equipment after each patient is to prevent nosocomial infection. Although hand washing is the most effective way to prevent nosocomial infections, proper management of respiratory equipment comes in at a close second.

What is the purpose of cleaning and sterilizing nondisposable respiratory care equipment after each patient? A. In order to protect staff from becoming contaminated B. To prevent nosocomial infection C. To increase the useful life of the equipment D. To avoid a pandemic

The correct answer is : C Explanation : To determine static compliance, tidal volume is divided by plateau pressure after subtracting any PEEP. In this case, (500/(15-5) = 50 cm H2O.

What is the static compliance in mL/cm H2O, given the following data on a patient receiving VC AC ventilation? Plateau pressure 15 cm H2O Peak pressure 25 cm H2O VT 500 mL PEEP 5 cm H2O A. 20 B. 25 C. 50 D. 33

The correct answer is : A Explanation : As the temperature of any gas decreases, its ability to hold water also decreases. Therefore, a gas that has a relative humidity of 100% that then undergoes a temperature decrease must eject the excessive water. This is called condensate or rainout. This phenomenon can be seen commonly in the morning when there is dew found on plants and objects.

What will occur if a gas that is saturated with 100% relative humidity with no humidity deficit at 33.4 deg C (92.1 deg F) cools to 25.1 deg C (77.2 deg F)? A. relative humidity will remain 100%, rainout will occur B. relative humidity will drop by about 25% C. a humidity deficit will develop D. evaporation will decrease the humidity deficit

The correct answer is : B Explanation : A reservoir bag on a non-rebreather mask that collapses with each breath is an indication that the flow to the mask is likely insufficient and should be increased.

When the respiratory therapist notices the reservoir bag on a nonrebreather mask is collapsing with each breath, the therapist should A. inspect the valve between the mask and reservoir B. increase oxygen flow to the bag C. administer lorazepam (Ativan) D. switch to a partial rebreather mask

The correct answer is : B Explanation : Alveolar hyperventilation will cause a reduction in both arterial and exhaled CO2. Since normal CO2 is around 40 torr, a CO2 of 32 would be consistent with alveolar hyperventilation.

Which of the following arterial carbon dioxide tension values is consistent with alveolar hyperventilation? A. 55 torr B. 32 torr C. 65 torr D. 45 torr

The correct answer is : B Explanation : One of the side effects associated with inhaled nitric oxide is systemic hypotension. The purpose of nitric oxide is to dilate pulmonary vessels and relieve pulmonary hypertension. However, it also decreases systemic blood pressure. Therefore, systemic blood pressure must be monitored closely in patients who are taking inhaled nitric oxide.

Which of the following clinical outcomes is a side effect of inhaled nitric oxide? A. contraction of smooth muscle tissue B. systemic hypotension C. elevation of leukocyte count D. cardiac artery hardening

The correct answer is : C Explanation : Rapid shallow breathing index (RSBI) is a calculation that requires the measurement of volume and respiratory rate. Of the devices listed here, a vane respirometer is the only one that truly measures volume.

Which of the following could the respiratory therapist use to determine a patient's rapid shallow breathing index? A. pneumotachometer B. infrared CO2 detector C. vane respirometer D. maximum inspiratory pressure manometer

The correct answer is : C Explanation : There are several ways to determine proper exposure of a chest radiograph. Of the options listed, spaces between the vertebrae that are clear and distinct is one way for confirming the quality of the x-ray exposure. A heart shadow should be visible and cardiac vessels are rarely visible. Level apexes helps to know if the patient was rotated properly but does not provide information regarding exposure.

Which of the following indicates a properly exposed chest radiograph? A. no heart shadow is visible B. apecies are level C. spaces between the vertebrae are clear and distinct D. cardiac vessels are visible

The correct answer is : D Explanation : Of the options given here, autoclave would be the most effective sterilization procedure.

Which of the following infection control methods is the most effective for eradicating harmful microorganisms on patient care equipment? A. pasteurization B. iodine wipe C. isopropyl alcohol wipe D. autoclave

The correct answer is : C Explanation : VC ventilation, also called volume-controlled ventilation, is a mode of ventilation that is characterize by the ending of inspiration through delivery of a predetermined tidal volume.

Which of the following is most accurately descriptive of VC ventilation? A. flow is constant until a preset volume is delivered B. inspiration ends when a preset pressure setting is reached C. the inspiratory phase terminates after delivery of a preset volume D. pressure is constant for a specified period of inspiratory time

The correct answer is : C Explanation : The presence of a productive cough for several weeks or months is usually associated with bronchitis. If a patient experiences more than six months of the year in such a state, the condition would then be called chronic bronchitis.

Which of the following is most likely in a patient who is complaining of a productive cough that started 3 months ago? A. asthma B. mucoviscidosis C. bronchitis D. foreign body aspiration

The correct answer is : B Explanation : Insertion of a bronchoscope into the patient's airway can cause a significant cough reflex. This can complicate the procedure and place the patient in great distress during the process. To prevent or decrease the cough reflex, aerosolized lidocaine may be administered to the patient's airway prior to the procedure. Lidocaine comes in many preparations such as Xylocaine and benzocaine and many others.

Which of the following medication would be most helpful in anesthetizing a patient's airway just prior to a flexible bronchoscopy procedure? A. anectine (Succinylcholine Chloride) B. lidocaine HCL (Xylocaine) C. benzocaine D. cardizem

The correct answer is : A Explanation : Of the medications listed, only Xopenex is a beta-2 agonist.

Which of the following medications is classified as a beta2 agonist? A. levalbuterol (Xopenex) B. aminophylline C. racemic epinephrine D. ipratropium bromide

The correct answer is : B Explanation : Of the drugs listed, Ativan would be most appropriate to provide sedation without causing hypotension. As the patient is already hypotensive, use of such drugs as morphine could increase the degree of hypotension and harm the patient.

Which of the following medications is most suitable to provide sedation for a patient with chronic bronchitis and hypotension who is receiving mechanical ventilation? A. Romazicon (flumazenil) B. lorazepam (Ativan) C. morphine D. solu-medrol

The correct answer is : D Explanation : Because diuretic medication causes the body to expel electrolytes, which are inseparable with body fluids, it is important to closely monitor potassium, sodium, chloride, and other electrolytes. In some cases, as fluid is being discharged, some electrolytes may require replenishment. Electrolytes are important because they facilitate muscle contraction in the body, and most notably contraction of the heart.

Which of the following should be closely monitored in a patient receiving diuretic medication? A. blood urea nitrogen B. CBC C. ABGs D. serum electrolytes

The correct answer is : B Explanation : In patients with neuromuscular disorders, such as Guillain-Barré syndrome and myasthenia gravis, the most appropriate monitoring technique includes those basic ventilatory parameters, including tidal volume, maximum inspiratory pressure, and vital capacity. In these types of patients vital capacity will fall gradually. The patient should be monitored until vital capacity falls below one liter, at which point the assumption of ventilation should occur through intubation and mechanical ventilation.

Which of the following should be primarily used to monitor the degradation of ventilation in a patient diagnosed with Guillain-Barre' Syndrome? A. end-tidal CO2 B. vital capacity C. maximum expiratory force D. peak flow

The correct answer is : C Explanation : The proper positioning for orotracheal intubation is called sniffing position.

Which of the following should be used to facilitate orotracheal intubation? A. neck hyperextended B. chin-to-chest C. sniffing position D. head turned to the left

The correct answer is : D Explanation : The description provided in this question is most consistent with CPAP, also called continuous positive airway pressure.

Which of the following will provide a continuous elevation of baseline pressure during inspiration and expiration on a patient who is breathing spontaneously? A. IPPB B. APRV C. NAVA D. CPAP

The correct answer is : D Explanation : The preferred method to provide continuous monitoring of arterial oxygen and carbon dioxide levels in a newborn is transcutaneous monitoring. This is a device that consists of a heated electrode that is placed on the skin of the infant. The electrode can detect minute perfused gases across skin and estimate PO2 and CO2. While it is not as accurate as arterial blood gas analysis, it does provide fairly precise data without removing precious blood volume from the infant.

Which of the following would be most helpful in continuously monitoring the arterial oxygen and carbon dioxide levels in a newborn? A. single-wavelength spectrophotometry B. pulse oximetry C. arterial blood gas analysis D. transcutaneous monitoring

The correct answer is : B Explanation : This patient is exhibiting an adverse reaction to the therapy. The first reaction of the therapist should be to stop the therapy and ensure the patient's vital stability. Subsequently, alternative therapies may be considered to accomplish the same objective without causing a similar adverse reaction.

While coaching a patient with cystic fibrosis on the use of a PEP therapy device, the patient suddenly becomes short of breath and cyanotic above the waist. The most appropriate action is to A. schedule a V/Q scan after completion of the treatment B. discontinue the treatment C. switch to IPV D. perform NT suctioning

The correct answer is : B Explanation : The purpose of a volume-oriented incentive spirometer is to keep all aspects of the lungs inflated and to prevent the collapsing of alveoli.

While demonstrating the use of a volume-oriented incentive spirometer, the patient asks the respiratory therapist to explain the purpose of the therapy. The therapist will suggest the therapy is intended to A. monitor inspiratory capacity B. prevent parts of the lungs from collapsing C. stretch the alveoli D. remove secretions from the lower lobes

The correct answer is : D Explanation : When the collection canister of a suction system becomes full, a valve actuates and interrupts suction. To remedy this, the disposable suction bag or container must be replaced.

While performing endotracheal suctioning with a closed-system suction catheter on a patient who is intubated with a 7.5-mm ET tube, the respiratory therapist notices the suction at the tip of the catheter suddenly stops. Which of the following should the therapist check? A. hospital vacuum system B. patency of the ET tube C. integrity of the suction catheter baggy D. collection canister

The correct answer is : C Explanation : The presence of premature the ventricular contractions is considered an adverse reaction sometimes associated with postural drainage and percussion and with patients whose head of bed is lowered. If this type of adverse reaction occurs, the first step is to discontinue the treatment. Coughing is considered to be positive evidence that the therapy is working. However, uncontrollable coughing can put the patient at risk for oxygen desaturation and hypoxemia. Both are reasons to discontinue the therapy.

While performing postural drainage with the head-of-bed down 30 degrees, a patient with bronchiectasis begins to cough uncontrollably and exhibits PVCs on the ECG monitor. The therapist should A. coach the patient through coughing and expectoration B. provide supplemental oxygen and continue C. place the patient in Flower's position D. bring the head of bed up 15 degrees trendelenburg

The correct answer is : C Explanation : This one-minute and five-minute data would be consistent with Apgar scores of five and eight.

While reviewing a newborn's medical record, the following data is noted by the respiratory therapist: 1 min 5 min Muscle tone weak weak RR 20 42 Color acrocyanosis pink Pulse 90 118 Reflex grimace cough The therapist would expect to see which of the following one-minute and five-minute APGAR scores? A. 7 and 10 B. 6 and 7 C. 5 and 8 D. 4 and 9

The correct answer is : C Explanation : Technically, documentation in the progress notes do not constitute an official change in care. They represent thoughts of healthcare workers regarding the potential problems, diagnoses, and treatment plans of the patient. To be made official, orders must be written in the chart. Therefore, physician orders should be monitored for changes when documentation in the progress notes occur.

While reviewing the progress notes on a patient's medical record, the respiratory therapist notes a new list of care recommendations related to ventilator weaning documented by the physician. The therapist should A. implement the changes from the progress notes B. discuss the recommendations with the nurse C. check for new respiratory care orders D. initiate any pertinent weaning protocols

The correct answer is : B Explanation : Significant expiratory stridor, along with evidence of ventilatory distress immediately after extubation, is typically associated with inflammation of the upper airway or of the vocal folds. Because the stridor is considered to be marked, otherwise known as severe, reestablishment of an airway takes top priority. The use of decongestant medications, such as racemic epinephrine, is insufficient because of the time it would take to decrease swelling tissues and because of the risk present.

Within 3 minutes of oral extubation, a patient exhibits marked inspiratory and expiratory stridor, intercostal retractions, and general dyspnea. Which of the following should the therapist recommend? A. cool aerosol therapy by mask B. reintubation C. non-invasive ventilation D. nebulized racemic epinephrine