CHAPTER 2 - Pretest Assessment Flashcards
1
Q
Compute the mean arterial pressure (MAP) for a patient whose blood pressure is 140/80 torr.
A. 60 torr
B. 100 torr
C. 120 torr
D. 140 torr
A
B. 100 torr
2
Q
A CRT is using the device illustrated in Figure 2-1 as a flow meter.
What can be expected regarding the performance of
this device?
I. The patient will receive a flow rate less than that indicated by the needle on the gauge.
II. This type of flow meter must be operated only in an upright position.
III. A helium-oxygen gas mixture would be accurately indicated on the flow meter.
IV. This device becomes less accurate as the pressure in the compressed gas cylinder decreases.
A. I only
B. II, III only
C. IV only
D. I, II only
A
A. I only
3
Q
A patient with a cuffed tracheostomy tube is receiving
IPPB via a Bennett PR-2 with pressures of 25–30 cm
H2O. The ventilator will not cycle to exhalation. There is no leak around the cuff, and all the circuit connections are tight. The most likely solution to this problem is to
A. increase the peak flow rate.
B. lower the peak pressure.
C. inject more air to the cuff.
D. activate the terminal flow control
A
D. activate the terminal flow control.
4
Q
Determine an appropriate flow rate needed to deliver a 40-ml VT
to an infant receiving mechanical ventilation at a rate of 45 breaths/min. The desired I:E ratio is 1:2.
A. 150 ml/sec.
B. 126 ml/sec.
C. 120 ml/sec.
D. 90 ml/sec.
A
of sec./min. / ventilatory rate = TCT
D. 90 ml/sec.
STEP 1: 60 sec./min. / 45 breaths/min = 1.33 sec./breath
STEP 2: 1:2/1+2 = 3
STEP 3: 1.33 sec. / 3 = 0.443 sec. (TI)
STEP 4: VT / TI = VI , 40 ml / 0.44 sec.= 90 ml/sec
5
Q
Which of the following pathophysiological occurrences are amenable to oxygen therapy?
I. capillary shunting
II. low V ˙A /Q ˙ C units
III. diffusion impairments
IV. perfusion in excess of ventilation
A. II, III, IV only
B. I, II only
C. II, IV only
D. III, IV only
A
A. II, III, IV only
6
Q
A post-surgical 70-kg (IBW) patient is taken to the recovery room to be monitored while emerging from
post-surgical anesthesia. Positive pressure volume ventilation has been ordered. What tidal volume
should initially be set for this 30-year-old male?
A. 300 cc
B. 500 cc
C. 700 cc
D. 1,100 cc
A
C. 700 cc
7
Q
An 85-kg mechanically ventilated, adult male is orally intubated with a 7.0 mm I.D. endotracheal tube. The
CRT fills the cuff with air just until the airway is sealed. A cuff pressure manometer indicates an intracuff pressure of 60 mm Hg. Why is the intracuff pressure so high?
A. The endotracheal tube is too small for this patient’s airway.
B. The patient has excessive tracheobronchial secretions.
C. The patient is likely experiencing bronchospasm.
D. The one-way valve associated with the pilot balloon is malfunctioning.
A
A. The endotracheal tube is too small for this patient’s
airway.
8
Q
A 32-year-old asthmatic female with 10 yearsexperience using a metered dose inhaler (MDI) experiences little relief after usage for control of an acute episode.
The patient indicated that she did not feel like she was getting any medication. The MDI is kept in her purse for availability and worked properly earlier in the day.
The MDI was placed in water and the patient noticed that it was partially submerged with the nozzle end down. What is the most likely cause of this situation?
A. The MDI is empty.
B. A foreign object may be occluding the mouthpiece.
C. The MDI may not have been shaken prior to
activation.
D. The actuator orifice should be cleaned.
A
B. A foreign object may be occluding the mouthpiece.
9
Q
In the process of examining the chest radiograph of a patient, the CRT notices the right lung to be hyperlucent. Which of the following physical findings would the CRT likely obtain from the right side of this patient’s chest?
I. a dull percussion note
II. crepitations
III. absent or diminished breath sounds
IV. reduced tactile fremitus
A. III, IV only
B. I, II only
C. I, III only
D. I, III, IV only
A
A. III, IV only
10
Q
While monitoring a patient receiving mechanical ventilation, the CRT has determined that auto-PEEP is present. Which of the following ventilator adjustment can she make to rectify this situation?
I. Increase the ventilatory rate.
II. Lengthen the expiratory time.
III. Shorten the inspiratory time.
IV. Increase the tidal volume.
A. I, IV only
B. II, III only
C. II, III, IV only
D. II, IV only
A
B. II, III only
11
Q
Which of the following disease states would be typified by having an FEV1 /FVC ratio of less than 0.75?
I. sarcoidosis
II. chronic bronchitis
III. emphysema
IV. ascites
A. I only
B. II, III only
C. I, III only
D. I, II, III, IV
A
B. II, III only
12
Q
A nebulizer delivering 40% oxygen via a Briggs adaptor attached to a tracheotomized patient is operating at 8 L/min. With each patient inspiration, the aerosol completely disappears from the reservoir tubing attached to the distal outlet of the Briggs adaptor. What should the CRT do at this time?
A. Increase the flow rate from the nebulizer.
B. Add one to two lengths of aerosol tubing at the outlet of the Briggs adaptor.
C. Do nothing, because it is normal for the aerosol to disappear with each inspiration.
D. Instruct the patient to inhale more slowly.
A
A. Increase the flow rate from the nebulizer.
13
Q
While reviewing the radiographic findings contained
in a patient’s chart, the CRT notices that the latest chest radiograph results read as follows:“. . .complete opacification of the right thorax, accompanied by a leftward mediastinal shift and tracheal deviation. . .” How should these findings be interpreted?
A. The patient is experiencing atelectasis of the right lung.
B. The patient has a right-sided pneumothorax.
C. The patient has a right-sided pleural effusion.
D. The patient has bilateral interstitial lung disease.
A
C. The patient has a right-sided pleural effusion.
14
Q
The CRT is administering a beta-2 agonist to a chronic obstructive pulmonary disease (COPD) patient who has a reversible component to her obstructive airway disease. The patient is tense and anxious during the treatment. How should the CRT instruct her to breathe optimally during this treatment?
A. The patient should be allowed to assume a pattern suitable to herself.
B. The patient should inhale slowly and deeply, perform an inspiratory pause, and exhale passively through pursed lips.
C. The patient should inhale slowly and deeply, perform an inspiratory pause, and exhale rapidly.
D. The patient should be instructed to breathe normally
A
B. The patient should inhale slowly and deeply, perform an inspiratory pause, and exhale passively through pursed lips.
15
Q
Which of the following medications would be appropriate for the treatment of an asthmatic patient who exhibits daily symptoms of the disease?
I. inhaled corticosteroids
II. inhaled beta-2 agonists
III. oral theophylline
A. I, II, III
B. I only
C. II, III only
D. I, II only
A
A. I, II, III
16
Q
During the administration of an aerosolized adrenergic bronchodilator, the patient’s pulse increases from 88 beats/min. to 115 beats/min. What action should the
CRT take?
A. Stop the treatment and notify the physician.
B. Change the medication to normal saline.
C. Stop the treatment and put the patient in a reverse
Trendelenburg position.
D. Continue the treatment while monitoring the patient.
A
A. Stop the treatment and notify the physician.
17
Q
A CRT is performing a maximum inspiratory pressure (MIP) measurement on a patient. The patient is agitated, and the CRT cannot get a negative pressure reading. The setup is illustrated in Figure 2-2.
Which of the following statements is most appropriate?
A. The direction of the one-way valve should be
reversed.
B. The CRT is using the wrong type of manometer.
C. The CRT should reassure the patient and continue the test.
D. The thumb port should not be covered during this
measurement.
A
C. The CRT should reassure the patient and continue the test.
18
Q
A 25-year-old male with a history of asthma has been mechanically ventilated for 10 days. His secretions are thick, yellow, and difficult to suction. There is evidence of pulmonary infiltrates seen on a chest X-ray. To aid in
the removal of the secretions, what suggestions should the CRT make to the physician?
I. Aerosolize 20% Mucomyst.
II. Lavage with normal saline.
III. Administer 20% Mucomyst with a bronchodilator via a micronebulizer.
IV. Administer albuterol via a micronebulizer.
V. Administer racemic epinephrine via a micronebulizer.
A. I,V only
B. II, III only
C. II, IV only
D. II,V only
A
C. II, IV only
18
Q
A patient who has a tracheostomy needs oxygen therapy. Which of the following oxygen-delivery devices
would be most appropriate?
A. aerosol mask
B. face tent
C. tracheostomy collar
D. air entrainment mask
A
C. tracheostomy collar
19
Q
A patient receiving controlled mechanical ventilation via a volume-cycled ventilator has experienced a decreased pulmonary compliance. Which response would likely occur?
A. a minute ventilation decrease
B. a decrease in the delivered tidal volume
C. an increase in the flow rate
D. an increase in the peak inspiratory pressure (PIP)
A
D. an increase in the peak inspiratory pressure (PIP)
19
Q
The CRT has measured the intracuff pressure of a tracheostomy tube inserted in a mechanically ventilated patient to be 33 torr. What action should the CRT takeat this time?
A. No action is necessary, because this pressure is acceptable.
B. The pressure manometer needs to be calibrated.
C. Air needs to be aspirated out of the cuff.
D. Air needs to be injected into the cuff
A
C. Air needs to be aspirated out of the cuff.
19
Q
The CRT has obtained the following ABG and acid base data on a 57-kg patient who has just been successfully resuscitated and is now being mechanically ventilated.
PO2 74 mm Hg
PCO2 48 mm Hg
pH 7.53
HCO3 ¯ 14 mEq/liter
B.E. –12 mEq/liter
What recommendation should the CRT make?
A. Administer two ampules of sodium bicarbonate.
B. Increase the ventilatory rate.
C. Increase the FIO2
D. Repeat the ABG analysis using a different blood gas analyzer.
A
D. Repeat the ABG analysis using a different blood gas analyzer.
19
Q
The CRT observes a patient “fighting the ventilator.”
Which of the following conditions might account for this situation?
I. increased flow rate
II. insensitive demand valves
III. decreased inspiratory time
IV. patient irritability and agitation
A. I, II, III, IV
B. I, III only
C. II, IV only
D. I, II, IV only
A
C. II, IV only
19
Q
Which of the following actions would be helpful to teach an asthmatic the proper technique of using an MDI?
I. Have the patient verbalize the factors that make asthma worse.
II. Give the patient written instructions.
III. Demonstrate the procedure.
IV. Ask the patient why using a peak flow meter is important.
A. I, IV only
B. II, III only
C. I, II, III only
D. I, II, III, IV
A
B. II, III only
19
During percussion of the chest wall, a crackling sound and sensation are noted. Which of the following conditions do these findings suggest?
A. The patient has excess secretions.
B. Subcutaneous emphysema is present.
C. The patient has pneumonia.
D. A tumor is present in the area of the lung in which the sounds are heard.
B. Subcutaneous emphysema is present.
19
When a patient’s trachea is being intubated using a Macintosh laryngoscope blade, where should the blade be positioned for exposing the glottis?
A. under the epiglottis
B. either above or below the epiglottis
C. against the roof of the mouth
D. into the vallecula
D. into the vallecula
20
Aerosol therapy via ultrasonic nebulization has been ordered for the purpose of sputum induction. The patient has thick, copious secretions with frequent mucous plugging. Given that the patient is also asthmatic, what modification of the order should the CRT recommend?
I. Discontinue the ultrasonic order.
II. Add Mucomyst to the ultrasonic nebulizer.
III. Add a bronchodilator to the ultrasonic nebulizer.
IV. Use a small-volume nebulizer with a bronchodilator and Mucomyst.
A. III only
B. II only
C. I, IV only
D. I only
D. I only
21
A CRT inspects the bulk oxygen system near the construction site of a new hospital. He notices that the vaporizer is arranged in columns and is supplied with heat from an indirect source. What should he recommend to his supervisor?
A. that the vaporizer should not be arranged in columns
B. that a direct heat source must be installed
C. that the vaporizer must be electrically grounded
D. that the National Fire Protection Agency specifications appear to be in compliance
D. that the National Fire Protection Agency specifications appear to be in compliance
21
A patient, wearing a full face mask while receiving noninvasive positive pressure ventilation (NPPV) for ventilatory failure caused by pneumonia, is experiencing difficulty swallowing. Which of the following actions would be most suitable for the CRT to take at this time?
A. Apply NPPV using a nasal mask.
B. Fit the patient with a larger-size full face mask.
C. Monitor the patient closely to avoid aspiration.
D. Intubate and mechanically ventilate the patient.
D. Intubate and mechanically ventilate the patient.
21
During the administration of an IPPB treatment, the patient complains of dizziness and paresthesia. The CRT’s response should be to
A. instruct the patient to perform an inspiratory pause.
B. encourage the patient to cough.
C. coach the patient to breathe more slowly.
D. instruct the patient to breathe rapidly and deeply.
C. coach the patient to breathe more slowly.
21
Where on an adult victim’s sternum should a rescuer’s hands be positioned for external cardiac massage?
A. lower half of the sternum
B. middle third of the sternum
C. upper half of the sternum
D. lower third of the sternum
D. lower third of the sternum
21
A patient with supraventricular tachycardia is receiving advanced cardiac life support. The physician in tends to cardiovert the patient and asks the CRT when is the appropriate time during the cardiac cycle to apply the cardioversion. The CRT should respond by saying that cardioversion must be applied during the
A. R wave.
B. QRS complex.
C. C wave.
D. P-R interval.
A. R wave
21
Which of the following actions should be taken by the CRT in an effort to decrease the aerosol output of a jet nebulizer?
A. Decrease the FIO2 setting.
B. Shorten the tubing.
C. Heat the aerosol.
D. Decrease the flow rate of the gas
D. Decrease the flow rate of the gas
21
The results of three valid measurements of the FVC from the same subject are listed in If the predicted normal FEV1 for this subject is 4.20 liters, what is the percent predicted FEV1?
A. 74%
B. 81%
C. 86%
D. 100%
C. 86%
21
Although aggressive chest physiotherapy (CPT) is effective in mobilizing secretions, the patient, who is in end-stage COPD, finds the treatment extremely unpleasant. Who should ultimately decide whether to continue aggressive therapy in this case?
A. the medical team
B. the primary physician
C. the patient’s family
D. the patient
D. the patient
22
Ventilatory data obtained from a spontaneously breathing patient are shown as follows.
tidal volume: 500 ml ventilatory rate: 12 breaths/min. I:E ratio: 1:2
inspiratory time: 1 second
Which of the following Venturi mask adaptors would provide a sufficient inspiratory flow to meet this patient’s demands if the source flow is 3 L/min.?
A. 28% adaptor
B. 30% adaptor
C. 34% adaptor
D. 36% adaptor
A. 28% adaptor
22
Which of the following oxygen-delivery devices is/are most suitable in the home setting for extending the use of a portable liquid-oxygen unit?
I. a mask with a reservoir
II. a pendant reservoir cannula
III. a Briggs adaptor with 100 cc of reservoir tubing
IV. a nasal catheter
A. II only
B. III only
C. II, III only
D. I, IV only
A. II only
22
A CRT is ventilating an intubated patient with a manual resuscitator. The oxygen flow meter is set at flush. He notices that the valve does not seem to be moving normally, and the patient is not being allowed to exhale. The best course of action is to:
A. obtain another resuscitation bag.
B. disconnect the patient periodically to allow exhalation.
C. decrease the rate of ventilation to allow more time for exhalation.
D. reduce the gas flow to about 15 L/min.
D. reduce the gas flow to about 15 L/min.
22
An MDI is being used to administer medication to a mechanically ventilated patient through a ventilator MDI adaptor. When should the CRT actuate the MDI
to provide the most effective aerosol deposition?
A. immediately prior to a mechanical breath
B. immediately after the beginning of a mechanical breath
C. during the midportion of a mechanical breath
D. anytime during the ventilatory cycle
A. immediately prior to a mechanical breath
22
The CRT is summoned to evaluate a 24-hour, post-op thoracotomy patient. The patient complains of severe pain in the incisional area and difficulty obtaining a deep breath. Upon auscultation of the patient’s chest, it is determined that the patient’s breath sounds are bilaterally diminished. Which mode of therapy would be appropriate for the CRT to recommend at this time?
A. No therapy is needed—her breath sounds are diminished because of pain.
B. Administer IPPB, followed by CPT.
C. Administer metaproterenol sulfate via a small volume nebulizer.
D. Have the patient perform incentive spirometry and coughing maneuvers.
D. Have the patient perform incentive spirometry and coughing maneuvers.
22
The accuracy of pulse oximeters can be affected by
I. patient motion.
II. the intensity of the light transmission.
III. decreased perfusion.
IV. bright ambient lights.
A. I, II, III only
B. I, III, IV only
C. II, III, IV only
D. I, II, III, IV
D. I, II, III, IV
22
A COPD patient is being mechanically ventilated with the following settings:
* mode: assist-control
* tidal volume: 900 ml
* ventilatory rate: 10 breaths/min.
* FIO2
: 0.30
* I:E ratio: 1:2
* PEEP: 3 cm H2O
* peak inspiratory flow rate: 30 L/min. What ventilator setting change should the CRT recommend?
A. increasing the FIO2
B. decreasing the I:E ratio
C. increasing the tidal volume
D. increasing the set rate
B. decreasing the I:E ratio
22
Which of the following statements represent potential hazards associated with the use of an oropharyngeal airway that is too large for the patient?
I. This use may result in laryngeal obstruction.
II. Tracheobronchial aspiration may occur.
III. Gastric insufflation may result.
IV. Effective ventilation may be prevented.
A. I, II, III, IV
B. I, III, IV only
C. II, III only
D. I, IV only
A. I, II, III, IV
22
What should the CRT do after performing an arterial puncture for blood gas analysis?
A. Perform the Allen test to verify collateral circulation.
B. Apply a pressure bandage over the wound.
C. Pressurize the puncture site for a minimum of five minutes.
D. Hand warm the sample to mix the anticoagulant.
C. Pressurize the puncture site for a minimum of five minutes.
22
If the flow rate were to be decreased on a pressure preset ventilator, while all the other settings remained the same, what would be the result?
A. The delivered tidal volume would increase.
B. The ventilatory rate would increase.
C. The inspiratory time would decrease.
D. The inspiratory pressure would increase.
C. The inspiratory time would decrease.
22
A patient should be checked for orientation to___________ as a first step in assessing mental status.
I. time
II. place
III. person
A. I, III only
B. II, III only
C. I, II only
D. I, II, III only
D. I, II, III only
22
An infant who is being supported with nasal continuous positive airway pressure (CPAP) with prongs suddenly displays a decreased SpO2. The nurse indicates that otherwise the infant is stable and suggests a problem with the equipment. What is the most likely cause for this clinical deterioration?
A. dislodgment of the prongs from the infant’s nose
B. water in the circuit
C. separation of the prongs from the nasal block
D. pressure on the back of the neck from the strap
A. dislodgment of the prongs from the infant’s nose
22
While administering an IPPB treatment to a patient, the CRT notices the indicator needle on the pressure manometer deflecting from 0 cm H20 to –2 cm H2O as the patient inspires. What should the CRT do at this time?
A. Do nothing and continue with the treatment.
B. Adjust the sensitivity control to allow the machine to cycle on more easily.
C. Reduce the preset pressure to a level more tolerable for the patient.
D. Interrupt the treatment to encourage the patient to relax.
A. Do nothing and continue with the treatment.
22
A 93-year-old blind female is recovering from a broken hip. She assures the CRT that she has been blowing into her incentive spirometer every hour, as instructed. The most appropriate action for the CRT to take would be to
A. recommend CPT.
B. discontinue incentive spirometry.
C. review the instructions with the patient.
D. recommend blow bottles.
B. discontinue incentive spirometry.
23
A 65-kg patient is receiving mechanical ventilation.
His ventilator settings are as follows:
* mode: assist–control
* tidal volume: 900 ml
* FIO2
: 1.0
* ventilatory rate: 10 breaths/min.
His ABG data reveal:
PO2 45 torr
HCO3¯ 26 mEq/liter
PCO2 33 torr
SO2 86%
pH 7.52
What should the CRT recommend for this patient at
this time?
A. initiating control mode ventilation
B. instituting 5 cm H2O PEEP
C. nebulizing a bronchodilator in-line
D. increasing the patient’s tidal volume
B. instituting 5 cm H2O PEEP
24
Which of the following blood-pressure measurements would possibly cause difficulty in palpating a peripheral pulse?
A. 90/60 mm Hg
B. 100/80 mm Hg
C. 120/60 mm Hg
D. 150/80 mm Hg
B. 100/80 mm Hg
25
A patient is being maintained on a continuous-flow, mask CPAP system. Which of the following alarms is the most important to ensure maintenance of therapy?
A. high FIO2
B. low pressure
C. high ventilatory rate
D. low minute volume
B. low pressure
26
What is the purpose of the device pictured in Figure 2-4?
A. to increase the FIO2
B. to maintain a stable FIO2
C. to nebulize medication
D. to conserve oxygen
D. to conserve oxygen
27
While resuscitating an unresponsive, pulseless patient, the CRT notices the ECG pattern in Figure 2-5 appear on the monitor. What action should be taken at this time?
A. Administer 1.0 to 1.5 mg/kg of lidocaine I.V. push.
B. Defibrillate with 200 joules.
C. Administer 1 mg of epinephrine I.V. push.
D. Intubate the patient.
B. Defibrillate with 200 joules.
28
The audible alarm on a microprocessor ventilator sounds while the CRT is outside the immediate area. When the CRT arrives, there is no alarm. The orange caution light is illuminated, however, as are the high pressure limit, the I:E, and the high-ventilatory rate alarms. The patient seems free of distress. What should the CRT do at this time?
A. Disconnect the patient from the ventilator, begin manual ventilation, and call for assistance.
B. Auscultate the patient, suction if necessary, and reset the alarms.
C. Call for a replacement ventilator, because the caution light indicates that the ventilator will soon be
come inoperative.
D. Call the manufacturer for suggestions, because this situation is highly unusual.
B. Auscultate the patient, suction if necessary, and reset the alarms.
29
A patient has just returned from surgery where she had a septoplasty procedure performed. The surgeon has ordered a large-volume nebulizer for humidification of secretions. When the CRT attempted to apply the aerosol mask to the patient’s face, the patient refused to allow the mask to touch her nose. What recommen
dations should the CRT suggest to make this patient comfortable with her therapy?
A. Place the patient in a croupette.
B. Orally intubate the patient.
C. Replace the aerosol mask with a face tent.
D. Sedate the patient to make her more comfortable.
C. Replace the aerosol mask with a face tent.
30
Under what circumstances would a pulse oximeter provide a poor indication of oxygen delivery to body tissues?
A. when a patient has a hemoglobin concentration of
7 g/dl
B. when a patient has a PaO2
in excess of 100 mm Hg
C. when a patient has a bilirubin level of 6 mg/dl
D. when a patient is hyperthermic
A. when a patient has a hemoglobin concentration of
7 g/dl
31
A patient with congestive left-ventricular failure has developed a severe bilateral pneumonia that will require endotracheal (ET) intubation. The CRT has been
attempting to insert an ET tube for about 45 seconds, and the patient shows increased respiratory distress. What should the CRT do at this time?
A. Halt the intubation procedure and oxygenate the patient for at least three minutes.
B. Stop the intubation procedure, have the patient sit up, and oxygenate the patient for four minutes.
C. Interrupt the intubation procedure, suction the patient, and oxygenate him for at least three minutes.
D. Continue with the intubation procedure while holding open-ended oxygen tubing with a flow of
5 L/min. near the patient’s mouth.
B. Stop the intubation procedure, have the patient sit up, and oxygenate the patient for four minutes.
32
A patient is being evaluated for weaning from mechanical ventilation. Which of the following criteria indicate that the patient may be ready for weaning?
I. a P(A-a)O2 gradient of 380 mmHg after breathing 100% oxygen
II. a vital capacity of 30 ml/kg
III. a VD/VT of 0.65
IV. a maximum inspiratory pressure of –38 cm H2O
A. II, III only
B. I, IV only
C. I, II, IV only
D. II, IV only
D. II, IV only
33
A patient has been intubated with an 8.0 mm I.D. oral ET tube. The patient develops coarse breath sounds, and there are visible secretions in the ET tube. The CRT, using a 16 Fr suction catheter, begins to clear the tube after appropriately preoxygenating the patient. The patient now develops tachycardia and desaturation as determined by a pulse oximeter. What can the CRT do to try to prevent these developments?
A. Wait to suction the patient until the procedure is indicated.
B. Increase the amount of negative pressure applied to –150 mm Hg.
C. Turn off the pulse oximeter to prevent an alarm from sounding.
D. Use a 12 Fr suction catheter
D. Use a 12 Fr suction catheter
34
A family member seated at the bedside of a 24-year old motor vehicle accident patient asks the CRT to look at the humidification system. The CRT notes that the Briggs adaptor attached to the tracheostomy tube appears to be tugging on the tracheostomy tube. The patient moves about frequently and is active, but not alert. What modification should the CRT suggest?
A. No change is necessary, because this situation is normal.
B. Apply restraints to the patient.
C. Add more aerosol tubing.
D. Replace the Briggs adaptor with a tracheostomy collar.
D. Replace the Briggs adaptor with a tracheostomy collar.
35
Which of the following problems might cause an increase in peak inspiratory pressure on a ventilator attached to a patient with a tracheostomy tube?
I. mucous plugging
II. herniation of the cuff over the tube tip
III. cuff leakage
IV. biting of the tube
A. I only
B. I, II only
C. I, IV only
D. I, II, III, IV
B. I, II only
36
While performing ventilator rounds in the ICU, the CRT hears the high-pressure alarm continuously sounding and gurgling noises coming from the airway of one the
ventilator patients. What should she do at this time?
A. Administer an in-line bronchodilator.
B. Instill 5 cc of normal saline into the patient’s airway.
C. Perform tracheobronchial suctioning.
D. Recommend that a STAT chest X-ray be obtained.
C. Perform tracheobronchial suctioning.
37
Which of the following ventilator modes could be selected when it is desirable to maintain respiratory muscle strength?
I. IMV mode
II. assist–control mode
III. synchronized IMV mode
IV. control mode
A. I, II only
B. I, III only
C. I, II, III only
D. III, IV only
B. I, III only
38
The CRT is summoned to the emergency department to see a patient in respiratory distress. Upon arrival, the CRT notices that the patient has deep, rapid respirations, a ventilatory pattern known as Kussmaul’s breathing. Which of the following acid-base imbalances is this patient likely experiencing at this time?
A. metabolic alkalosis
B. respiratory acidosis
C. respiratory alkalosis
D. metabolic acidosis
D. metabolic acidosis
39
A patient should be instructed to breathe according to
which of the following patterns when performing a slow vital capacity maneuver?
A. Inhale slowly and sustain the inspiratory effort for three seconds.
B. Inhale as much as possible, followed by a fast, complete expiration.
C. Exhale completely and slowly, following a maximum inspiration.
D. Exhale forcefully and completely, following a three-second inspiratory hold
C. Exhale completely and slowly, following a maximum inspiration.
40
A 65-year-old man is presented to the emergency room with shortness of breath and a chief complaint of severe chest pain. He has always been in good health. He
does not take any medications and has not seen a physician for years. He reports being tired during the
past week and having intermittent chest discomfort with exertion over the last 2 days. The physician orders aspirin, an ECG, and 2 L/min. of nasal oxygen. Which of the following benefits of oxygen therapy are intended for this patient?
I. reduction of the work of breathing
II. reduction of the cardiopulmonary workload
III. correction of arterial hypoxemia
IV. prevention of absorption atelectasis
A. I, II only
B. II, III only
C. I, II, III only
D. II, III, IV only
A. I, II only
41
Which of the following findings or patient complaints could indicate a possible decreased diaphragmatic
function or paralysis?
I. inward movement of the abdomen on inspiration
II. shortness of breath when lying supine
III. intercostal or subcostal retractions
IV. decreased maximal inspiratory pressure
A. II, III only
B. I, III, IV only
C. I, II, IV only
D. I, IV only
C. I, II, IV only
42
An oriented, post-flail chest patient weighing 185 lbs (ideal body weight [IBW]) is being weaned from SIMV. His ventilator settings before the weaning process were:
* SIMV rate: 10 breaths/min.
* mechanical tidal volume: 850 cc
* FIO2 0.40
His new ventilator settings and spontaneous ventilatory measurements are as follows:
* SIMV rate: 6 breaths/min.
* spontaneous ventilatory rate: 18 breaths/min.
* spontaneous tidal volume: 400 cc
* mechanical tidal volume: 850 cc
* FIO2 0.40
This patient’s ABG and cardiovascular data are shown here:
* PO2 70 torr
* PCO2 33 torr
* pH 7.48
* HCO3¯ 24 mEq/liter
* BP 130/80 torr
* heart rate 85 beats/min.
After 15 minutes on the ventilator settings indicated previously, the CRT evaluates the patient and notes the following findings:
* spontaneous ventilatory rate: 26 breaths/min.
* spontaneous tidal volume: 350 cc
An ABG obtained at this time indicates:
PO2 68 torr;
PCO2 46 torr;
pH 7.32;
HCO3 ¯23 mEq/liter
The patient’s blood pressure and heart rate are 145/85 torr and 100 beats/min., respectively. What should the CRT do at this time?
A. Continue the weaning process and monitor the patient.
B. Increase the FIO2 to 0.60.
C. Increase the mandatory volume to 0.80 liter.
D. Increase the mechanical ventilatory rate to 8 breaths/min.
D. Increase the mechanical ventilatory rate to 8 breaths/min.
43
A mist tent at 40% oxygen has been ordered for a five year-old cystic fibrosis patient. While performing oxygen rounds, the CRT notices that the tent has a large hole cut out on the top and that the flow meter is set at 8 L/min. What should she do at this time?
A. Nothing needs to be done, because this device is set up and is functioning properly.
B. She should use a closed-top tent with an oxygen flow rate of 15 L/min.
C. She should increase the flow meter setting to 15L/min.
D. She should request that a large oxyhood be used.
. She should use a closed-top tent with an oxygen flow rate of 15 L/min.
44
After applying percussion and postural drainage to a patient’s lower lobes, the CRT hears increased aeration and a decrease in rhonchi over the posterior chest. What do these findings indicate in reference to the CPT?
A. The therapy is effective and should be continued.
B. These findings represent an adverse response to the treatment.
C. The therapy is ineffective and should be discontinued.
D. An aerosolized bronchodilator should be added to the regimen.
A. The therapy is effective and should be continued.
45
A patient on whom CPR has just been performed has the following blood gas values for a sample obtained from the femoral area:
PO2 55 torr; PCO2 47 torr; pH 7.33
An ear oximeter, however, indicates an SpO2 of 93%. The patient’s blood pressure and pulse are 130/80 torr
and 75 beats/min, respectively. What should the CRT recommend at this time?
A. obtaining another blood gas sample
B. administering bicarbonate
C. increasing the tidal volume delivered by the manual resuscitator
D. resuming external cardiac compressions
A. obtaining another blood gas sample
46
The CRT is monitoring the intracuff pressure of a tracheostomy tube inserted in a patient receiving mechanical ventilation. She observes the pressure manometer
indicating a pressure of 42 cm H2O. What should she do at this time?
A. Inject more air through the pilot balloon.
B. Release some of the air from the cuff.
C. Insert a new tracheostomy tube.
D. Do nothing because the cuff pressure reading is acceptable.
B. Release some of the air from the cuff.
47
A 28-year-old male diagnosed with Guillain–Barré has recently been intubated secondary to deteriorating vital capacity measurements. The physician has ordered a lateral-rotational bed and suctioning every 2 hours. Breath sounds are clear bilaterally but diminished at the bases, and attempts at suctioning yield scant white secretions. The CRT should recommend
A. placement of the patient on a Stryker frame.
B. initiation of CPT every hour.
C. changing the order to suctioning PRN.
D. changing to a closed-system, directional-tip, suction catheter.
C. changing the order to suctioning PRN
48
What is the significance of a pulmonary function test that reveals an FEV1 equal to the FVC? (Assume a valid test.)
A. mild obstructive
B. mild restrictive
C. severe restriction
D. severe obstruction
C. severe restriction
49
Which of the following devices could be used to confirm the accuracy of an aneroid manometer?
A. mercury sphygmomanometer
B. supersyringe
C. precision Thorpe tube
D. hygrometer
A. mercury sphygmomanometer
50
The CRT has just completed administering an aerosolized albuterol treatment to an asthmatic patient in the emergency department. If this patient experiences side effects from this medication, which of the following side effects would likely develop?
I. palpitations
II. drowsiness
III. tachycardia
IV. tachypnea
A. II, IV only
B. I, III only
C. I, III, IV only
D. I, II, III, IV
B. I, III only
51
An afebrile, postoperative, abdominal surgery patient is
receiving incentive spirometry (IS). The patient’s preoperative volume was 3.5 liters (10% of predicted). Two days after surgery, the patient has not achieved 3.5 liters. The patient has achieved a postoperative volume of 2.1 liters but is still complaining of abdominal pain around the incision site during the IS procedure. Which of the following recommendations should the CRT make?
A. Discontinue the IS.
B. Replace the IS treatments with IPPB therapy.
C. Terminate the IS treatments and institute CPT.
D. Continue the IS treatments and monitor the patient.
D. Continue the IS treatments and monitor the patient.
52
Which of the following levels of consciousness is characterized by the patient being confused, easily agitated, irritable, and hallucinatory?
A. confused
B. delirious
C. lethargic
D. comatose
B. delirious
53
What is the minimum flow rate that could be set on the flow meter to provide an adequate flow to a patient breathing via a 28% air-entrainment mask? The patient’s ventilatory status is indicated below.
* ventilatory rate (f): 20 breaths/min.
* inspiratory time (TI): 1 sec.
* expiratory time (TE): 2 sec.
* tidal volume (VT): 500 ml
A. 2 L/min.
B. 3 L/min.
C. 4 L/min.
D. 5L/min.
B. 3 L/min.
54
A patient brought into the emergency department has
an oropharyngeal airway in place. The emergency medical technician (EMT) explains that the patient has
significant (nearly complete) airway obstruction without the artificial airway. Although not completely conscious, the patient begins to gag. What should the CRT do to maintain the patient’s airway?
A. Remove the oropharyngeal airway and turn the patient on his side.
B. Leave the oropharyngeal airway in place, because the patient will be able to tolerate it shortly.
C. Leave the oropharyngeal airway in place and be ready to suction should the patient vomit.
D. Replace the oropharyngeal airway with a nasopharyngeal airway
D. Replace the oropharyngeal airway with a nasopharyngeal airway
55
An elderly 48-kg, severe COPD patient is receiving
mechanical ventilation for acute respiratory failure.
Her ventilator settings include:
* mode: assist–control
* ventilatory rate: 12 breaths/min.
* peak inspiratory flow rate: 30 L/min.
* tidal volume: 500 cc
* FIO2 0.40
The CRT notes that the patient cycles on the ventilator 24 breaths/min. The patient’s work of breathing (WOB) appears to be increasing. The physician asks
for the CRT’s recommendation but indicates that he does not want to change the ventilatory mode at this time. The CRT should recommend
A. decreasing the flow rate to decrease the inspiratory time.
B. increasing the tidal volume to decrease the inspiratory time.
C. increasing the flow rate to decrease the inspiratory time.
D. increasing the ventilatory rate to lengthen the expiratory time.
C. increasing the flow rate to decrease the inspiratory time.
56
Results of four hours of respiratory monitoring of a patient breathing oxygen via a nasal cannula indicate that expiratory time and airway resistance have increased. What scenario would be consistent with these trends?
A. The patient has switched from nasal ventilation to oral ventilation.
B. The patient has hyperactive airways and decreased forced expiratory flow rates.
C. The patient has been sleeping.
D. The patient has been swallowing the oxygen gas flow and has developed severe gastric distention.
B. The patient has hyperactive airways and decreased forced expiratory flow rates.
57
A patient who has disseminated intravascular coagulopathy is about to undergo fiberoptic bronchoscopy
for a lung biopsy. What types of tests or measurements need to be performed or obtained before the bronchoscopy is performed?
I. an activated partial thromboplastin time
II. a prothrombin time
III. a complete blood count
IV. a bleeding time
A. I, IV only
B. II, III only
C. I, II, IV only
D. I, II, III, IV
C. I, II, IV only
58
Which patient conditions would be compatible with the use of nasal CPAP?
I. a patient who is hypoxemic but normocarbic
II. a patient who is hypoxemic and hypercapneic
III. a patient who is heavily sedated
IV. a patient who is alert and cooperative
A. I, III only
B. II, III only
C. I, IV only
D. II, IV only
C. I, IV only
59
A patient is receiving mechanical ventilation with a pressure-cycled ventilator. The patient suddenly develops bronchospasm. What influences will this pathologic change have on the mechanical ventilator?
I. The ventilator will terminate inspiration earlier.
II. A reduced tidal volume will be delivered.
III. The inspiratory time will increase.
IV. The inspiratory flow rate will decrease.
A. I, II only
B. I, IV only
C. II, III, IV only
D. I, II, IV only
A. I, II only
60
An elderly patient in an extended-care facility has developed an aspiration pneumonia, with radiographic documentation of pulmonary atelectasis presumed to
be associated with secretion retention. The patient has a weak, ineffective cough, and attempts at suctioning have yielded scant amounts of thick, tenacious secretions. All of the following modifications could be done
to improve the clearance of secretions EXCEPT:
A. increasing the duration of application of suction to 20 seconds
B. instilling sterile normal saline for irrigation
C. ensuring correct positioning of the patient
D. increasing the frequency of suctioning
A. increasing the duration of application of suction to 20 seconds
61
A pneumatically powered, pressure-cycled ventilator
would be most appropriate to use for ventilatory support for which of the following patients?
A. five-year-old patient with status asthmaticus
B. 18-year-old patient suffering from narcotic overdose
C. 20-year-old patient with bilateral pulmonary contusions
D. 66-year-old patient with bullous emphysema
B. 18-year-old patient suffering from narcotic overdose
62
A patient is receiving oxygen therapy via a simple mask operated at a flow rate of 15 L/min. The CRT observes this patient having a nonproductive cough. Additionally, the patient is complaining of a dry mouth, nose, and throat. What should the CRT do at this time?
I. Check the humidifier water level.
II. Decrease the oxygen flow rate.
III. Replace the apparatus with a small-volume nebulizer.
IV. Suggest a Mucomyst treatment.
A. II only
B. I, II only
C. I, IV only
D. III, IV only
B. I, II only
63
A 32-year-old craniotomy patient has just returned from the recovery room and is still anesthetized. She is receiving mechanical ventilation on the following settings:
* mode: SIMV
* ventilatory rate: 8 breaths/min.
* tidal volume: 800 ml
* FIO2: 0.60
* PEEP: 5 cm H2 O
Her ABG and acid-base data are as follows:
PO2 90 torr; PCO2 32 torr; pH 7.49; HCO3¯ 23 mEq/liter
If the physician wishes to achieve a PaCO2 of 25 torr for the patient, the CRT should recommend
I. decreasing the ventilatory rate.
II. changing to the assist–control mode.
III. increasing the tidal volume.
IV. adding mechanical dead space.
V. increasing the ventilatory rate.
A. I, III only
B. II, IV only
C. II only
D. III,V only
D. III,V only
64
A patient with COPD has coarse rhonchi and a minimally productive cough. What therapy is indicated to
mobilize his secretions?
A. IPPB
B. incentive spirometry
C. CPT and percussion
D. aerosolized bronchodilators
C. CPT and percussion
65
A patient is receiving 10 cm H2O CPAP via a mask. The CRT notes a 5 cm H2O pressure drop during each
spontaneous breath. To decrease the amount of inspiratory pressure drop, the CRT should
A. instruct the patient to breathe more slowly.
B. increase the CPAP setting to compensate for the
pressure drop.
C. increase the gas flow going to the patient.
D. incorporate an additional one-way valve into the
system.
C. increase the gas flow going to the patient.
66
A hospitalized COPD patient has been allowed to eat lunch in the cafeteria. If she takes a full E cylinder operating at 3 L/min. and leaves at 11 A.M., by what time must she return to avoid running out of oxygen? (Hospital policy states that she must return with a reserve of at least 500 psig in the tank.)
A. 2:25 P.M.
B. 2:05 P.M.
C. 1:35 P.M.
D. 1:25 P.M
C. 1:35 P.M.
67
Which of the following notations would be appropriate
to make in the chart following an IPPB treatment?
I. date and time therapy was administered
II. dose of medications and diluents placed in the
nebulizer
III. amount of negative pressure needed to trigger the
machine
IV. volume achieved during the treatment
A. I, II only
B. I, II, III only
C. I, II, IV only
D. III, IV only
C. I, II, IV only
68
Which of the following changes in a patient’s PaO2 would best be detected by a pulse oximeter?
A. 450–550 mm Hg
B. 250–325 mm Hg
C. 125–175 mm Hg
D. 75–100 mm Hg
D. 75–100 mm Hg
69
What is the best position to maintain optimum oxygenation for a patient who has both right-middle and right-lower lobe pneumonia?
A. Place the patient in a high Fowler’s position.
B. Position the patient so the right lung is dependent.
C. Position the patient so the left lung is dependent.
D. Place the patient in a reverse Trendelenburg position.
C. Position the patient so the left lung is dependent.
70
Paramedic personnel are performing CPR on a motor
vehicle accident victim brought into the emergency department. In assessing adequacy of chest compressions, which artery is most appropriate for the CRT to
palpate?
A. carotid artery
B. radial artery
C. ulnar artery
D. brachial artery
A. carotid artery
71
A 58-year-old male COPD patient has the following respiratory care orders: Atrovent (ipratropium bromide) MDI: two puffs QID
albuterol MDI: two puffs QID
postural drainage with chest percussion QID The physician requests that the CRT “space out the therapy to maximize the benefits.” Which of the following
sequence of therapies would be most appropriate?
I. albuterol at 7 A.M., 11 A.M., 3 P.M., and 7 P.M.
II. Atrovent at 9 A.M., 1 P.M., 5 P.M., and 9 P.M.
III. postural drainage to immediately follow each al
buterol treatment
IV. postural drainage to immediately precede each
Atrovent treatment
A. I, III only
B. II, IV only
C. I, II, III only
D. II, III only
C. I, II, III only
72
Which of the following assessments should be made immediately following attaching a Passy–Muir valve to a patient’s tracheostomy tube?
I. Assess the patient’s ability to cough.
II. Assess the patient’s ability to speak.
III. Assess the patient’s ability to ventilate.
IV. Assess the patient’s breath sounds.
A. I, II, III, IV
B. I, III only
C. II, III, IV only
D. I, II, III only
A. I, II, III, IV
73
A patient is receiving NPPV via a nasal mask for the treatment of respiratory failure associated with cardiogenic pulmonary edema. The CRT notices that the nasal mask does not fit the patient well. Which of the following measures should be taken?
A. Intubate the patient and administer oxygen with a T-piece.
B. Intubate the patient and apply continuous positive airway pressure.
C. Intubate and initiate conventional mechanical ventilation.
D. Use a full face mask.
D. Use a full face mask.
74
Regarding before-and-after bronchodilator studies, what percent improvement in the FEV1 is generally considered significant for determining reversible air
flow obstruction?
a. >5%
b. >10%
c. >15%
d. >25%
c. >15%
75
A seven-year-old patient recovering from chest trauma has been prescribed incentive spirometry using a modified adult device. The parents say the child will not perform the maneuver at home because she thinks it is boring. What can be recommended to encourage the child to comply with the treatment ordered?
I. Talk to the child and explain the need for therapy.
II. Change to a pediatric device with balloons and clowns.
III. Tell the parents to make her do it.
IV. Ask the physician to discontinue the therapy.
A. I, III, IV only
B. I, II only
C. II, IV only
D. III, IV only
B. I, II only
76
Which of the following characteristics of sputum should the CRT document in the patient’s medical record?
I. color of the sputum
II. amount of material expectorated by the patient
III. consistency of the sputum
IV. odor of the sputum
A. I, II only
B. II, III only
C. I, III only
D. I, II, III, IV
D. I, II, III, IV
77
A patient who has been experiencing increasing premature ventricular contractions has been placed in the coronary care unit (CCU) for observation. The cardiologist asks the CRT to recommend an oxygen-delivery device for this patient. Which of the following oxygen appliances would be appropriate for this patient?
A. a partial rebreathing mask at 8 L/min.
B. a nasal cannula operating at 2 L/min.
C. a simple oxygen mask at 8 L/min.
D. an air-entrainment mask delivering 40% oxygen
B. a nasal cannula operating at 2 L/min.
78
Upon entering the emergency department, the CRT notices a patient receiving oxygen via an E cylinder connected to a Bourdon gauge flow meter and lying alongside the patient. What should the CRT do at this time?
A. Obtain an oxygen analyzer and analyze the patient’s FIO2 .
B. Obtain an E cylinder cart and place the cylinder upright.
C. Replace the Bourdon gauge with a compensated Thorpe flow meter.
D. Do nothing, because this situation is acceptable.
D. Do nothing, because this situation is acceptable.
79
IPPB with albuterol has been ordered for an asthmatic patient postoperatively. Upon preliminary assessment, the patient is noted to have a vital capacity of 17 cc/kg. What recommendation should the CRT make regarding therapy?
A. Substitute incentive spirometry for IPPB.
B. Administer albuterol by hand-held nebulizer.
C. Administer analgesics prior to IPPB.
D. Follow IPPB with CPT.
B. Administer albuterol by hand-held nebulizer.
80
When considering the assist control mode for mechanically ventilating a patient, the CRT should be cognizant of which of the following potential conditions and/or changes as the patient is managed on the ventilator?
I. changes in acid-base status caused by fluctuations in the patient’s ventilatory rate
II. decreased venous return as the patient’s ventilatory rate increases
III. failure to ventilate if the patient ceases spontaneous breathing
IV. increased demand-valve sensitivity causing increased WOB
A. I, II only
B. II, III only
C. I, II, IV only
D. III, IV only
A. I, II only
81
When scheduling CPT for an infant who is being gavage fed every three hours, what is the best time to per
form the treatment in relation to feeding times?
A. one hour before
B. three hours before
C. three hours after
D. one hour after
A. one hour before
82
Which of the following errors is likely when analysis by co-oximetry is performed on arterial blood from a premature infant?
I. falsely low SaO2
II. falsely high COHb%
III. falsely low MetHb%
IV. falsely low reduced hemoglobin concentration
A. I, II only
B. III only
C. II, IV only
D. I, II, III only
A. I, II only
83
A CRT notes that a mechanically ventilated patient intubated with a 7.0 mm (I.D.) oral ET tube experiences episodes of desaturation, bradycardia, and hypotension with each suctioning event. What should the CRT recommend?
A. using a size 14 French suction catheter
B. switching to a size 8.0 mm I.D. ET tube
C. incorporating a closed-suction catheter system
D. changing the ventilatory settings before each suctioning event
C. incorporating a closed-suction catheter system
84
A physician is performing a tracheostomy on an orally intubated patient and asks the CRT to assist by removing the patient’s endotracheal tube. When should the CRT remove the endotracheal tube in conjunction with the tracheostomy procedure?
A. immediately before the tracheostomy procedure begins
B. at the time the trachea is surgically entered
C. as soon as the tracheostomy tube is inserted
D. just before the tracheostomy tube is inserted
D. just before the tracheostomy tube is inserted
85
During bag-mask ventilation of an obese, comatose patient, the airway remains partially obstructed despite neck extension with mandibular traction. What device should be used to alleviate this problem?
A. tracheal button
B. transtracheal catheter
C. oropharyngeal airway
D. esophageal obturator
C. oropharyngeal airway
86
The CRT is preparing to perform endotracheal suctioning on a mechanically ventilated patient and observes the ECG tracing (Figure 2-7) below. During the suctioning procedure, she notices the ECG pattern in Figure 2-8 displayed on the cardiac monitor. Which of the following actions should she perform at this time?
A. Continue suctioning and monitor the patient.
B. Remove the suction catheter immediately.
C. Adjust the vacuum pressure to read –115 mm Hg.
D. Instill 3–5 cc of normal saline into the tracheo bronchial tree.
B. Remove the suction catheter immediately.
87
A 60-kg status asthmaticus patient is being mechanically ventilated via a positive pressure ventilator. The
ventilator settings are as follows:
* mode: SIMV
*V ˙E : 16.2 L/min.
* f: 18 breaths/min.
* TI %: 33%
* FIO2: 0.40
*V ˙ I: 50 L/min.
Upon applying the end-expiratory pause feature on the ventilator, the CRT notices that an auto-PEEP of 12 cm H2 O registers on the pressure manometer. What should the CRT do at this time?
A. Increase the ventilatory rate.
B. Decrease the peak inspiratory flow rate.
C. Institute PEEP.
D. Decrease the inspired oxygen concentration.
C. Institute PEEP.
88
What is the function of the piece of equipment labeled A in Figure 2-9?
A. It helps maintain a constant water level in the humidifier reservoir.
B. It functions as a backup humidifier when water in the heated humidifier becomes depleted.
C. It serves as a water trap for condensation occurring in the breathing circuit.
D. It acts as an oxygen reservoir to maintain a constant FIO2
delivered to the patient
C. It serves as a water trap for condensation occurring in the breathing circuit.
89
A patient with a history of asthma is receiving volume cycled mechanical ventilation. The PIP has been 25
cm H2O but now has increased to 45 cm H2 O. Which of the following medications would be appropriate to nebulize in-line to the patient?
I. Alupent
II. albuterol
III. Ventolin
IV. Bronkosol
A. I, II only
B. II, IV only
C. I only
D. I, II, III, IV
D. I, II, III, IV
90
A CRT is ventilating an intubated patient with a resuscitation bag during CPR. The CRT notices no chest excursion on the left side and an increase in the pressure needed to ventilate the patient. Which of the following actions would be the most appropriate response to this situation?
A. Use a demand valve.
B. Reintubate the patient with a larger tube.
C. Insert a nasogastric tube.
D. Withdraw the ET tube somewhat.
D. Withdraw the ET tube somewhat.
91
Conditions that clearly demonstrate clinical indications for CPT include all of the following EXCEPT:
A. lung abscess
B. bronchiectasis
C. cystic fibrosis
D. empyema
D. empyema
92
The CRT is removing the suction catheter of a closed suction catheter system from the ET tube of a mechanically ventilated patient. What should she do before reinserting the suction catheter for another suctioning attempt?
A. Ventilate the patient with room air via a manual resuscitator.
B. Manually ventilate the patient for a few breaths with the ventilator-established FIO2.
C. Ventilate the patient for a few breaths using 100% oxygen through the ventilator.
D. Ventilate the patient with 100% oxygen using a manual resuscitator.
C. Ventilate the patient for a few breaths using 100% oxygen through the ventilator.
93
The CRT, while performing ICU ventilator rounds, notices that a Bourdon gauge is attached to an ET tube cuff-pressure measuring device. What should he do at this time?
A. Replace the Bourdon gauge with a back-pressure, compensated Thorpe tube.
B. Replace the Bourdon gauge with an aneroid barometer.
C. Do nothing because the Bourdon gauge will adequately measure the cuff pressure.
D. Inject 1–2 cc of air into the cuff to determine
whether the Bourdon gauge works
B. Replace the Bourdon gauge with an aneroid barometer.
94
An MA-1 ventilator has been adapted for use with a continuous-flow IMV system. The ventilator settings include:
* PEEP: 10 cm H2O
* tidal volume: 1,000 ml
* mechanical ventilatory rate: 6 breaths/min. As the patient begins to inspire, the pressure manometer needle indicates –5 cm H2 O, and the orange indicator light at the top or the ventilator illuminates. Which of the following conditions does this situation represent?
I. The IMV flow rate is inadequate.
II. The ventilator’s sensitivity control has not been turned off.
III. The safety pop-in valve in the IMV system is not opening.
IV. Too much PEEP is being applied, and the reservoir bag cannot maintain the pressure.
A. I, II, III only
B. II, III only
C. III, IV only
D. II, IV only
A. I, II, III only
95
Which of the following equipment would be useful to obtain when preparing to perform orotracheal intubation on an adult patient?
I. stylette
II. Miller laryngoscope blade
III. Magill forceps
IV. Yankauer suction tube
A. II, III only
B. I, II, IV only
C. I, IV only
D. I, III, IV only
B. I, II, IV only
96
Which of the following questions would be most effective in eliciting information about a patient’s emotional state?
A. Are you depressed?
B. Do hospitals scare you?
C. What medications are you taking for nerves? Have you ever had emotional problems in the past?
D. How are you feeling about being in the hospital?
D. How are you feeling about being in the hospital?
97
The CRT is asked to percuss and drain a patient’s lingula. How should the patient be positioned?
A. Place the patient on the right side, one-quarter turn from supine, in a slight head-down position.
B. Place the patient on the left side in a slight head down position.
C. Position the patient on the right side, one-quarter turn from prone, in a slight reverse Trendelenburg position.
D. Place the patient on the left side, three-quarters turn from supine, in a slight Trendelenburg position
A. Place the patient on the right side, one-quarter turn from supine, in a slight head-down position.
98
A CRT is called to evaluate a 62-year-old COPD patient who has been admitted to the medical floor for treatment of pneumonia. Physical examination reveals a thin male with a barrel chest. The patient appears to be asleep. He is difficult to arouse for assessment. Auscultation reveals inspiratory crackles in the right lower lobe. The patient is currently receiving oxygen at 6 liters per minute via a simple mask. The pulse oximeter indicates an SpO2 of 97%. With regard to the present therapy, what is the most likely cause of the patient’s lethargy?
A. oxygen-induced absorption atelectasis
B. retinopathy of prematurity
C. oxygen-induced hypoventilation
D. pulmonary oxygen toxicity
C. oxygen-induced hypoventilation
99
A physician is planning to orally intubate a patient and asks the CRT to prepare the equipment necessary for the procedure. Which of the following equipment preparations are appropriate?
I. Lubricate the stylette.
II. Attach the laryngoscope blade to the handle.
III. Set the suction pressure to an appropriate setting.
IV. Ensure that the bulb on the laryngoscope blade is
secure.
A. I, IV only
B. III, IV only
C. II, III, IV only
D. I, II, III only
B. III, IV only
100
After connecting one tube on a Luken’s trap to a suction catheter and the other tube to the connecting tubing leading to the suction manometer, the CRT notes that she can no longer generate a vacuum when placing her thumb over the thumb port. Which of the following actions should she take at this time?
A. Ensure that all connections are secure.
B. Empty the Luken’s trap.
C. Fill the Luken’s trap with normal saline.
D. Eliminate the Luken’s trap from the suction system.
A. Ensure that all connections are secure.
101
The CRT is performing endotracheal suctioning on an unconscious patient who suddenly becomes pulseless and displays the ECG tracing on the monitor as shown
in Figure 2-10:What action is appropriate at this time?
A. Perform a precordial thump.
B. Shake and attempt to arouse the patient.
C. Administer 100% oxygen via a manual resuscitation bag.
D. Begin applying chest compressions at a rate of 80 to 100 per minute.
A. Perform a precordial thump.
102
A four-year-old boy with a known history of cystic fibrosis has been admitted for respiratory distress and a presumed diagnosis of bacterial pneumonia. His ABG data on room air indicate:
PO2 42 mm Hg; PCO2 55 mm Hg; pH 7.34; HCO3 ¯ 29 mEq/liter
His ventilatory rate is 28 breaths/min., and he is using accessory muscles of breathing with mild retractions. Auscultation reveals bilateral wheezes and crackles. Which of the following therapies are appropriate at this time?
I. aerosol treatment with a beta-adrenergic agent
II. postural drainage with percussion and vibration
III. oxygen by nasal cannula at 1L/min.
IV. pediatric mist tent
A. I only
B. I, III only
C. I, II, III only
D. I, II, III, IV
C. I, II, III only
103
When a patient is nasally or orally intubated, generally how much time should elapse before a tracheotomy is considered?
A. If the patient is comatose, a tracheotomy should be done 24 hours after the patient is intubated.
B. A tracheotomy should be done immediately if tracheobronchial secretions are thick.
C. If the patient appears to be in further need of the artificial airway, a tracheotomy should be done 72 hours after intubation.
D. Because each clinical condition and situation is different, the decision to perform a tracheotomy is an individualized medical determination.
D. Because each clinical condition and situation is different, the decision to perform a tracheotomy is an individualized medical determination.
104
The CRT is having a patient perform a before-and after bronchodilator FVC maneuver. Two puffs of an MDI dispensing ipratropium bromide have been administered. How long should the CRT wait before the postbronchodilator effort is conducted?
A. 15 minutes
B. 20 minutes
C. 30 minutes
D. more than 30 minutes
D. more than 30 minutes
105
A patient who sustained a C-2 fracture in a motorcycle accident is being prepared for transport to the regional spinal cord rehabilitation unit after spending the initial
48-hours postinjury in a local hospital. Although a heat-moisture exchanger was being used during the initial two days of mechanical ventilation, the patient developed thick, difficult-to-suction secretions. Which of the following therapeutic modalities should the
CRT recommend?
A. Initiate CPT.
B. Administer an intravenous (I.V.) fluid bolus.
C. Instill 3–5 ml of normal saline solution before suctioning.
D. Lubricate the suction catheter with water-soluble gel before suctioning.
C. Instill 3–5 ml of normal saline solution before suctioning.
106
The CRT is preparing to place a nasal cannula operating at 3 L/min. on a patient who has the following spontaneous breathing measurements:
* tidal volume: 450 ml
* ventilatory rate: 12 breaths/min.
* I:E ratio: 1:2
Estimate the FIO2 delivered by this device under these conditions.
A. 0.36
B. 0.39
C. 0.43
D. 0.45
A. 0.36
107
Accessory muscle use during quiet breathing may be apparent in patients with all of the following conditions EXCEPT:
A. pleurisy
B. neuromuscular disease
C. spinal cord injury
D. severe COPD
A. pleurisy
108
An adult respiratory distress syndrome (ARDS) patient has been changed from the control mode via a volume ventilator to the pressure-control mode with a resulting increase in the mean airway pressure. Which of the following statements are true regarding an in
creased mean airway pressure?
I. Increased mean airway pressure can result in a reduced risk of cardiovascular side effects.
II. Increased mean airway pressure can reduce the risk of barotrauma.
III. The mean airway pressure will increase with a longer expiratory time.
IV. Increased mean airway pressure can result in better arterial oxygenation.
A. IV only
B. I, II only
C. III, IV only
D. I, III only
A. IV only
109
An oxygen blender is being used to deliver 40% O2 through a jet nebulizer for humidification. How should the CRT set the jet nebulizer in this situation?
A. The jet nebulizer must be set at the same FIO2 as the blender.
B. 100% O2 must be set on the jet nebulizer.
C. Setting the jet nebulizer at an FIO2 of 0.40 or less would be acceptable.
D. Because the blender is delivering precisely 40% O2 , the jet nebulizer can be adjusted to any FIO2 setting.
B. 100% O2 must be set on the jet nebulizer.
