TMC questions

A patient is suspected of having developed a pulmonary embolus. Which of the following tests should the therapist recommend to confirm the diagnosis?

VD/VT

A change in airway resistance would be reflected by a change in

dynamic compliance

A patient has a transcutaneous oxygen monitor ordered. In order to properly maintain the monitor the therapist should

place the heat setting between 44 and 45 degrees Celsius

A flattened diaphragm, widened intercostal spaces and blunting of the costophrenic angles on a chest x-ray would be most consistent with

pleural effusion

A patient is receiving 60% oxygen via a heated nebulizer. The therapist notes that there is insufficient aerosol flow being delivered to the patient. Possible reasons for this include: 1. water collecting in tubing 2. low nebulizer water flow 3. excessive flow 4. shallow breathing

1 & 2 only water collecting in tubing low nebulizer water flow

A patient has frequent premature ventricular contractions. Which of the following laboratory measurements would be helpful in determining the cause? 1. CaO2 2. BUN 3. serum electrolytes

1 & 3 CaO2 serum electrolytes

The following pulmonary function data was obtained from a patient: predicted observed FVC 3.8 2.1 RV/TLC 35 36 compliance 95 39 FEV 1.0 83 86 FEF 25-75. 3.4. 3.6 DLCO 25 8 These values would be consistent with which of the following conditions? 1. restrictive pulmonary disease 2. obstructive pulmonary disease 3. pulmonary diffusion defect

1 & 3 restrictive pulmonary disease pulmonary diffusion defect

The therapist wants to increase the minute volume for a patient receiving continuous ventilation with a volume cycled ventilator. Which controls could help accomplish this? 1. rate 2. pressure limit 3. tidal volume 4. flowrate

1 & 3 only rate tidal volume

A patient with chronic bronchitis is to receive therapy to help remove a large amount of thick purulent secretions. Which of the following devices would be most helpful? 1. mechanical percussor 2. incentive spirometer 3. heated humidifier 4. ultrasonic nebulizer

1 & 4 only mechanical percussor ultrasonic nebulizer

The patient's PAO2 is determined to be 650 mmHg. This would indicate the patient has

pneumonia

Proper instruction for a post op appendectomy patient receiving incentive spirometry therapy would include: 1. deep inspirations 2. inspiratory hold 3. strong cough effort 4. pursed lip breathing

1, 2, & 3 deep inspirations inspiratory hold strong cough effort

An adult patient is intubated with a 7.0 mm ID endotracheal tube. What size suction catheter should be used to suction this patient?

10 French

What is the recommended I:E ratio for NPPV?

1:2

A heat moisture exchanger (HME) could be appropriately used in which of the following situations? 1. long term mechanical ventilation 2. short term mechanical ventilation 3. transport mechanical ventilation

2 & 3 short term mechanical ventilation transport mechanical ventilation

A pressure cycled ventilator being used for continuous ventilation failed to cycle into inspiration. This might be caused by: 1. sensitivity set too high 2. failure of apnea control 3. an obstruction in the system 4. expiratory line disconnected

2 & 4 only failure of apnea control expiratory line disconnected

A patient is receiving controlled ventilation via a Bird Mark 7 ventilator. Suddenly the ventilator will not cycle into expiration. This problem may be caused by: 1. development of pneumothorax 2. disconnected expiratory valve 3. leak in the patient tubing 4. ruptured endotracheal tube cuff

2, 3 & 4 disconnected expiratory valve leak in the patient tubing ruptured endotracheal tube cuff

A patient with ARDS is receiving mechanical ventilation in the SIMV mode with an FIO2 of 0.60. The physician asks the therapist to perform an optimal PEEP study and the following data is obtained: PEEP 10 15 20 25 Cst .020 .025 .030 .035 PaO2 40 68 84 91 PvO2 29 32 43 38 QS/QT 28 26 19 21 What is the optimal PEEP level for this patient?

20 cmH20

Which of the following will increase the volume delivered to a patient on a pressure limited ventilator? 1. decreasing the sensitivity 2. increasing the flow setting 3. decreasing the flow setting 4. increasing the pressure setting

3 & 4 only decreasing the flow setting increasing the pressure setting

A patient has been weaned from mechanical ventilation. The physician would like the patient's respiratory muscle strength evaluated to determine further wearability. The therapist should evaluate which of the following? 1. VD/VT 2. VE 3. MIP 4. CST 5. VC

3 & 5 only MIP VC

When the FIO2 setting on a large volume nebulizer is changed from 40% to 60%, which of the following will occur? 1. total flow to the patient will increase 2. more air will be entrained through the nebulizer 3. the density of the aerosol will increase

3 only the density of the aerosol will increase

A patient's CaO2 is 20.1 vol% and the CvO2 is 14.6 vol%. The oxygen consumption is 220 mL/min. The patient's cardiac output would be

4 L/min

What is the normal range for pulmonary capillary wedge pressure in an adult?

4-12 torr

A patient's minute volume is 8.5 L/min and the respiratory rate is 13. What is the tidal volume?

650 mL

A 2 year old child with croup has been intubated for 4 days with a 4 mm ID uncured endotracheal tube. Heated aerosol at an FIO2 of .21 has been delivered to the patient. The physician asks the therapist to evaluate the patient for possible extubation. Which of the following would most likely indicate that the patient is ready for extubation?

Breath sounds are heard around the tube on auscultation.

Serial measurements of the CaO2 and CvO2 have been gathered on a patient receiving mechanical ventilation following coronary artery bypass surgery. Which of the a-v content differences below show the greatest decrease in cardiac output?

CaO2 18.5 CvO2 11.1

What gives the most accurate measurements of volume and flow?

Collins water sealed spirometer

Which of the following statements is true concerning positive expiratory pressure (PEP) therapy?

It may help improve secretion expectoration, decrease hyperinflation and improve airway maintenance.

A patient has taken an overdose of morphine. What drug is indicated to counteract the effects of the morphine?

Naloxone

Which of the following can be used to calculate inspiratory capacity?

TLC - FRC

A patient has just been intubated with a nasotracheal tube and is being manually ventilated. As the therapist ventilates the patient, he notices that there is no chest movement, minimal breath sounds and air escaping from the mouth as the bag is squeezed. A chest x-ray has determined that the endotracheal tube is in the correct position. What is the most likely cause of this situation?

The cuff ruptured during intubation

What techniques measure total lung capacity?

helium dilution body plethysmograph

The most significant problem associated with the use of the bronchoscope is?

hemoptysis

A 48 year old man is brought to the ED after collapsing in a restaurant. Auscultation reveals fine rales in both bases and the electrocardiogram shows a right axis deviation with significant Q waves in leads I and AVL. What is the most likely diagnosis for this patient?

myocardial infarction

A patient's electrocardiogram shows a depressed S-T segment and inverted T waves during an exercise tolerance test. This would indicate:

myocardial ischemia

The following data has been obtained from four patients who are receiving mechanical ventilation. Which patient meets the criteria for weaning from mechanical ventilation?

patient 3 MIP -22 QS/QT 18 VD/VT 40 P(A-a)O2 150 VT 450

A 10 year old patient with asthma needs to monitor his airflow improvement following each Beta-2 agonist treatment taken at home. Which of the following should the therapist recommend?

peak flow meter

All of the following could cause the high pressure alarm on a volume cycled ventilator to sound EXCEPT decrease in lung compliance increase in airway resistance peak flow setting of 80 L/min bronchospasm

peak flow setting of 80 L/min

Over the last hour a patient being ventilated with a volume cycled ventilator in the control mode has had a decrease in urine output from 35 mL/hour to 10 mL/hour. The most likely cause of this change would be an increase in the

peak pressure

All are true statements about spacers and holding chambers except: 1. They do not require patient cooperation with their breathing pattern. 2. They improve the efficiency of MDI. 3. They can e used for drug delivery by MDI to intubated and mechanically ventilated patients. 4. If a patient exhales immediately following activation of the inhaler, they will clear the medication from the device and waste the dose.

They do not require patient cooperation with their breathing pattern

A patient has a tracheostomy tube in place. The measured cuff pressure is 28 torr. Which of the following statements is/are true of this situation?

This pressure will most likely cause arterial occlusion. The pressure will cause tracheal necrosis if maintained.

A patient develops ascites and shortness of breath. Where is tissue edema most likely to show up first?

abdomen

A patient with a head injury has increased intracranial swelling. What drug should the therapist recommend to reduce the ICP?

acetazolamide (Diamox)

Measurement of the PD20% is significant for which of the following?

airway hyperreactivity

The distribution of ventilation in the lungs is measured by: 1. Phase III of the SBN2 Elimination test 2. N2 wash out time 3. Ventilation lung scan

all of the above phase III of the SBN2 elimination test N2 wash out time ventilation lung scan

Which drugs can be administered via an endotracheal tube? naloxone (Narcan) epinephrine (Adrenaline) diazepam (Valium)

all of them

The patient's P(A-a)O2 is calculated to be 410 torr. This should be interpreted as

an increased gradient

When initiating oxygen therapy on a patient with a nasal cannula, the therapist would need all of the following EXCEPT: A. physician's order for the liter flow B. a flowmeter C. no smoking and oxygen in use signs D. an oxygen analyzer

an oxygen analyzer

In order to reduce a patient's PaCO2 from 40 torr to 32 torr all of the following could be increased EXCEPT: tidal volume alveolar ventilation physiologic deadspae respiratory rate

physiologic deadspace

All of the following statements are true concerning NPPV ventilation EXCEPT A. breaths are pressure controlled B. two levels of CPAP are applied C. breaths are flow triggered D. it can be used for non-invasive ventilation

breaths are pressure controlled

During bedside assessment, the therapist auscultate the patient's chest and determines that the patient has bilateral inspiratory and expiratory wheezing. This would imply the patient has:

bronchospasm

The pulmonologist has ordered pulmonary function studies on a patient with severe kyphoscoliosis. Which method would be best to obtain the patient's height?

calculate using their arm span

Which artery should a therapist palpate when deciding whether to initiate chest compressions on an adult patient?

carotid

A patient with chronic ventilatory failure enters the ER. The following blood gases and vital signs are obtained while he is breathing room air: pH 7.36 - PaCO2 62 - PaO2 58 - HCO3 36 breath sounds - bilateral expiratory wheezing respirations 24/min pulse 108/min BP 142/84 temperature 37.5 C The patient is alert and oriented yet complaining of shortness of breath. What is the correct acid-base interpretation of these results?

compensated respiratory acidosis

The first parameter to measure when a mechanically ventilated patient is placed on PEEP is

compliance

Which drugs will increase cardiac output and decrease pulmonary vascular resistance? methyldopa (Aldomet) procainamide (Pronestyl) digitalis quinidine

digitalis

The following flow-volume loop was obtained from a 58 year old man... what is the most likely diagnosis?

emphysema

A patient has reduced lung compliance. Which of the following approaches to ventilation would decrease the risk of barotrauma?

flow cycled, pressure limited

A patient's chest x-ray reveals increased vascular engorgement emanating fro the hilar area in a bat-wing pattern. What is the most likely cause of this finding?

fluid overload

A therapist obtains the following information from a patient: age 35 - HR 98 - f 22/min - Vt 200 - wt 68 kg, 150 lb - ht 180 cm (5 ft 11 in) given this information, this patient:

has an increased headspace to tidal volume ratio

During oral endotracheal intubation, the tip of the Macintosh laryngoscope blade should be placed:

in the vallecula

While using a pressure cycled ventilator, an increase in the patient's static lung compliance will

increase the volume

A post operative patient appears tachypneic and anxious. The patient's PaCO2 is 40 torr and the PECO2 is 10 torr. What does this data indicate?

increased deadspace

Mycobacterium tuberculosis is spread primarily by:

inhalation of droplets

Which controls are available on a chest cuirass ventilator?

inspiratory time negative pressure

During CPR the physician is having difficult establishing an IV route to administer emergency medications. The therapist should recommend that the physician

instill the medications through the patient's endotracheal tube

Which of the following presents the greatest potential for nosocomial infection?

large reservoir nebulizer

Chest x-ray findings of a right shift of the mediastinum, hyper lucency of the left chest with absent vascular markings would be most likely caused by

left side pneumothorax

A patient requires mechanical ventilation as a result of multiple trauma sustained in an automobile accident several days ago. The current settings are as follows: Vt 850 f A/C 10 FIO2 .60 PEEP 25 VD 100 The following hemodynamic values have been obtained over the past 4 hours: MAP 89 85 91 CVP 10 11 13 MPAP 18 17 35 PWP 10 9 9 The most probable cause for the change in the pressure values would be

pulmonary embolus

Which of the following pieces of equipment would be LEAST appropriate for the victim of a house fire? A. pulse oximeter B. non-rebreather mask C. arterial blood gas kit D. CPAP system

pulse oximeter

Based on the P(A-a)O2 the respiratory therapist should inform the physician this patient most likely has a problem with

shunting

Which drug will lower blood pressure and decrease right ventricular preload by direct vasodilation?

sodium nitroprusside (Nipride)

The therapist receives an order for postural drainage and vibration. With the bed flat, the therapist places the patient in a prone position with pillows under his hips. Which lung segments are being treated with this position?

superior segment of the lower lobes

A patient with an artificial airway in place is being ventilated with a pressure cycled ventilator that will not cycle off at end inspiration. The most likely problem is

the cuff has ruptured

A fiberoptic light source is placed on an infant's right thorax. A lighted halo is seen around the point of contact. The light is then placed on the infant's left chest and no light can be seen. This would indicate that

the left hemidiaphragm is herniated.

What is the correct formula to measure the static lung compliance of a patient on a volume-limited ventilator?

tidal volume + (plateau pressure - PEEP)

Which drug should the therapist recommend for a patient with a serious gram negative infection?

tobramycin (Nebcin)