Exam 1 Flashcards
A patient reports that he has difficulty breathing while lying in a supine position and prefers to sleep sitting in a chair. The respiratory therapist should record this complaint in the medical record as
A.orthopnea.
B.platypnea.
C.eupnea.
D.Kussmaul breathing.
A.orthopnea.
What size endotracheal tube would be appropriate for an adult female patient?
A.6.0 to 6.5 mm
B.6.5 to 7.0 mm
C.7.0 to 7.5 mm
D.7.5 to 8.0 mm
C.7.0 to 7.5 mm
While providing patient education to patients who will be discharged home on oxygen therapy, the respiratory therapist explains the hazards associated with oxygen delivery equipment in the home. This instruction should include all of the following EXCEPT
A.liquid oxygen burns when refilling portable tanks.
B.how to properly secure oxygen cylinders for transport.
C.use of grounded 3-prong outlets for electrical equipment.
D.emergency procedure to deal with gas explosions.
D.emergency procedure to deal with gas explosions.
A home care patient calls in the middle of the night and reports that the oxygen supply tubing will not stay attached to her transtracheal catheter. The flow rate to the transtracheal catheter is set at 0.5 L/min. The patient has attempted to flush the catheter with saline and push a cleaning rod through it without success. The respiratory therapist should instruct the patient to
A.tape the connection securely.
B.increase the flow to the catheter.
C.decrease the flow to the catheter.
D.switch to a nasal cannula.
D.switch to a nasal cannula.
A trauma patient in the ED is spontaneously breathing oxygen via nasal cannula at 2 L/min. Vital signs are heart rate 110/min, respiratory rate 32/min, blood pressure 90/60 mmHg. The pulse oximeter is reading 88%. Which of the following should the respiratory therapist recommend to maximize the patient’s FIO2?
A.Simple oxygen mask at 8 L/min
B.Non-rebreathing mask at 15 L/min
C.CPAP at 10 cmH2O and 0.60 FIO2
D.NPPV of 18/5 cmH2O and 0.60 FIO2
B.Non-rebreathing mask at 15 L/min
A 33 year-old patient with trauma has been ventilated at the current settings for 24 hours. While reviewing ventilator data from the patient, the respiratory therapist notes the following:
This information would indicate that
A.airway resistance is decreasing.
B.lung compliance is increasing.
C.the patient needs suctioning.
D.the patient can begin weaning.
C.the patient needs suctioning.
Which of the following values should the respiratory therapist report as indicative of pulmonary embolism in a patient with acute dyspnea?
A.QS/QT of 10%
B.VD/VT of 60%
C.CL of 60 mL/cm H2O
D.RAW of 2.4 cm H2O/L/sec
B.VD/VT of 60%
A 68 year-old patient with advanced emphysema is receiving oxygen by nasal cannula at 1 L/min. The physician has ordered that the patient’s SpO2 be maintained at 90%. ABG on 1 L/min are pH 7.34, PaCO2 65 torr, PaO2 55 torr, HCO3 35 mEq/L. What should the respiratory therapist recommend FIRST?
A.Initiate NIPPV
B.Titrate oxygen flow to the nasal cannula
C.Change to a simple mask
D.Change to a non-rebreather mask
B.Titrate oxygen flow to the nasal cannula
After performing spirometry on a patient in the pulmonary clinic, the respiratory therapist notes that both the inspiratory and expiratory flow portion of the flow-volume loop is flattened. The therapist should interpret the condition demonstrated on the flow-volume loop as a/an
A.normal tracing.
B.obstructive pattern.
C.restrictive pattern.
D.large airway obstruction.
D.large airway obstruction.
Upon review of the chest radiograph after an elective intubation, the respiratory therapist notes that the distal tip of the endotracheal tube is 3 cm above the carina. How should the therapist interpret this finding?
A.The tube is above the recommended position.
B.The tube is too long for this patient.
C.The tube is in the proper position.
D.The tube is below the proper position.
C.The tube is in the proper position.
A patient with a history of asthma presents to the ED in severe respiratory distress and increased accessory muscle use. Vital signs are heart rate 110/min, respiratory rate 32/min and SpO2 of 88% on room air. Bilateral expiratory wheezes are heard on auscultation. The respiratory therapist should recommend initiating
A.Xopenex® by MDI
B.Pulmacort® by small volume nebulizer
C.Salmeterol® by DPI
D.Ventolin ® by continuous nebulization
D.Ventolin ® by continuous nebulization
The respiratory therapist is working with a patient with COPD in a smoking cessation program. The patient complains of recent weight gain. The therapist should explain that this is not unusual and is a result of
A.an increasing feeling of loss of self-control.
B.over-reliance on nicotine replacement therapy.
C.a need for a prescription for lorazepam.
D.a decrease in the patient’s metabolism.
D.a decrease in the patient’s metabolism.
The primary source of infection in the health care setting is
A.use of medical equipment for multiple patients.
B.poor handwashing techniques of personnel.
C.food and/or water intake by the patient.
D.patient rooms not cleaned appropriately.
B.poor handwashing techniques of personnel.
The physician has asked the respiratory therapist to monitor the effectiveness of bronchodilator therapy in a patient with asthma. What is the most appropriate parameter to monitor?
A.Improvement in level of dyspnea
B.Blood gas analysis results
C.Serial peak flow measurement
D.Improvement in chest x-ray
C.Serial peak flow measurement
Which of the following short-acting beta agonists can be delivered via aerosol therapy?
A.levalbuterol (Xopenex®)
B.tiotropium (Spiriva®)
C.dornase alpha (Pulmozyme®)
D.salmeterol (Serevent®)
A.levalbuterol (Xopenex®)
A patient in the ICU receiving mechanical ventilation has just undergone a fiberoptic bronchoscopy procedure in which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT
A.hypoxemia.
B.pneumothorax.
C.pulmonary hemorrhage.
D.bronchospasm/laryngospasm.
A. hypoxemia.
Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right?
A. Perform chest physiotherapy
B. Administer an IPPB treatment
C. Insert an endotracheal tube
D. Insert a chest tube
D. Insert a chest tube
All of the following are goals of bronchial hygiene therapy EXCEPT
A.reverse the underlying disease process.
B.improve mobilization of retained secretions.
C.improve pulmonary gas exchange.
D.reduce the work of breathing.
A.reverse the underlying disease process.
Pre- and post-bronchodilator spirometry is performed on a patient and yields the following results:
The respiratory therapist should recommend the initiation of
A.continuous mechanical ventilation
B.intermittent positive pressure breathing
C.bronchodilator therapy
D.incentive spirometry
C.bronchodilator therapy
At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned?
A.4 & 8
B.5 & 9
C.5 & 10
D.6 & 10
D.6 & 10
While reviewing quality control data for the blood gas lab, the respiratory therapist notes the following data plot for the pH electrode:
Which of the following should the therapist recommend?
A.Repeat the previous control analysis
B.Remove the analyzer from service
C.Reset the analyzation module on the analyzer
D.Recalibrate the pH electrode
A.Repeat the previous control analysis
Which of the following factors are determinants of cardiac output?
A.ventricular filling and heart rate
B.stroke volume and heart rate
C.stroke volume and respiratory rate
D.heart rate and tidal volume
B.stroke volume and heart rate
A 52 year-old post-operative cholecystectomy patient’s breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend
A. continuing the therapy until breath sounds improve.
B. administering dornase alpha.
C. administering albuterol therapy.
D. deep breathing and coughing to clear secretions.
D. deep breathing and coughing to clear secretions.
A 19-year-old patient is brought to the emergency department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient?
A.Obtain a sputum specimen.
B.Obtain an ABG.
C.Measure peak expiratory flow.
D.Determine the Glasgow Coma Score.
B.Obtain an ABG.
A patient in the ICU is being ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. The respiratory therapist notes that the patient’s SpO2 is 92% and PETCO2 is 25 torr. The pressure-volume waveform reveals over-distension. The therapist should
A.decrease the respiratory rate.
B.decrease the PEEP.
C.increase the expiratory time.
D.decrease the inspiratory pressure.
D.decrease the inspiratory pressure.
Which of the following patients would most likely benefit from pressure support ventilation?
A. An intubated patient with an absent respiratory drive.
B.A patient on SIMV with a set rate of 12/min and total rate of 24/min.
C. A patient with acute lung injury.
D. A patient who requires short-term post-operative ventilatory support.
B. A patient on SIMV with a set rate of 12/min and total rate of 24/min.
A pulse oximeter provides an accurate indication of a patient’s oxygenation status in which of the following situations?
- Polycythemia
- Pulmonary hypertension
- Congestive heart failure
- Carbon monoxide poisoning
A.1 & 4 only
B.2 & 3 only
C.1, 2, & 3 only
D.1, 2, 3, & 4
- Polycythemia
- Pulmonary hypertension
- Congestive heart failure
- Carbon monoxide poisoning
C.1, 2, & 3 only
A 52 year-old post-operative patient’s chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position?
A.Head down, patient supine with a pillow under knees
B.Patient prone with a pillow under head, bed flat
C.Patient supine with a pillow under knees, bed flat
D.Head down, patient prone with a pillow under hips
D.Head down, patient prone with a pillow under hips
Noninvasive Positive Pressure Ventilation (NPPV) is contraindicated in the management of which of the following conditions?
A.Acute exacerbation of COPD
B.Cardiogenic pulmonary edema
C.Adult respiratory distress syndrome (ARDS)
D.Premature extubation
C.Adult respiratory distress syndrome (ARDS)
A 36 year-old fireman was trapped and subsequently rescued from the collapse of a burning building. Which of the following devices would be appropriate to accurately assess his oxygenation status?
A.capnograph
B.pulse oximeter
C.blood gas analyzer
D.hemoximeter
D.hemoximeter
A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the RT recommend?
A.Helium dilution study
B.DLCO
C.Plethysmography
D.Bronchial provocation
D.Bronchial provocation
A 59 year-old post CABG patient has a C(a-v)O2 that has increased from 5 mL/dL to 8 mL/dL. The respiratory therapist should report to the physician that the patient’s
A.hemoglobin is increasing.
B.cardiac output is decreasing.
C.VD/VT ratio has increased.
D.oxygen consumption has decreased.
B.cardiac output is decreasing.
A patient with chronic bronchitis is seen in the pulmonary clinic with complaints of frequent cough and secretion production. Despite completing a round of Keflex® as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend?
A.thoracentesis
B.polysomnography
C.flexible bronchoscopy
D.plethysmography
C.flexible bronchoscopy
Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation?
A.20 torr
B.30 torr
C.40 torr
D.50 torr
D.50 torr
What is the most appropriate position for a female patient who is 5’3” tall, weighs 200 kg and is complaining of difficulty breathing?
A.Sims
B.Trendelenburg
C.lateral Fowlers
D.Fowlers
C.lateral Fowlers
The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to
A.notify the charge nurse.
B.apply a pressure dressing.
C.apply pressure to the site.
D.perform a modified Allen’s test.
C.apply pressure to the site.
Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube?
A.8 Fr
B.10 Fr
C.12 Fr
D.14 Fr
C.12 Fr
The physician asks the respiratory therapist to set a mechanically ventilated patient’s PEEP at an optimal level. The PEEP level is optimal when
A.PEEP levels are less than 18 cm H2O.
B.PaO2 is 60 torr or greater.
C.Oxygen delivery to the tissues is maximal.
D.C(a-v)O2 is decreasing.
C.Oxygen delivery to the tissues is maximal.
A 65 year-old female patient with advanced emphysema comes to the ED and is placed on a nasal cannula at 6 L/min. On inspection, the respiratory therapist finds that the patient has become drowsy and less responsive since the oxygen therapy was initiated an hour ago. ABG on 6 L/min are: pH 7.33, PaCO2 64 torr, PaO2 85 torr, HCO3 35 mEq/L. Which of the following should the therapist recommend?
A.Leave the patient on the cannula and continue to monitor.
B.Change to a 24% Venti-mask and repeat ABG.
C.Change to a simple oxygen mask and repeat ABG.
D.Prepare the patient for endotracheal intubation.
B.Change to a 24% Venti-mask and repeat ABG.
A sputum sample from an intubated patient with pneumonia has an offensive odor and is described as green and mucopurulent. The respiratory therapist should suspect that this condition is caused by
A.a gram positive bacteria.
B.respiratory syncytial virus.
C.Pseudomonas aeruginosa.
D.Pneumocystis jiroveci.
C.Pseudomonas aeruginosa.
Bronchial breath sounds heard over the lung periphery indicate
A.narrowed airways.
B.obstructed bronchi.
C.lung consolidation.
D.pulmonary edema.
C.lung consolidation.
A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend?
A.Insert a laryngeal mask airway (LMA) to facilitate suctioning.
B.Discontinue nasotracheal suctioning for 24 hours and reassess the patient.
C.Insert a nasopharyngeal airway after bleeding has been controlled.
D.Insert an oral endotracheal tube to allow for better airway access
C.Insert a nasopharyngeal airway after bleeding has been controlled.
A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff?
A.Enough to achieve a pressure of 25-35 cmH2O.
B.Enough to achieve a minimal occluding volume.
C.A minimum of 20 mL.
D.Until firm tension is felt in the pilot balloon.
A.Enough to achieve a pressure of 25-35 cmH2O.
A well-penetrated chest X-ray has which of the following qualities?
A.Air bronchograms are prominently displayed.
B.Heart borders and pleural spaces are clearly visible.
C.Lung parenchyma is black without blood vessels.
D.Vertebrae are just visible behind the heart.
D.Vertebrae are just visible behind the heart.
The respiratory therapist has just assisted the pulmonologist with a bedside fiberoptic bronchoscopy procedure in the ICU. In order to clean and disinfect the bronchoscope, the therapist should
A.rinse with sterile water and steam autoclave for 15 minutes.
B.wipe with Betadine and pasteurize for 30 minutes.
C.sterilize with ethylene oxide.
D.soak in alkaline glutaraldehyde for 10 hours.
D.soak in alkaline glutaraldehyde for 10 hours.
A patient’s breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem?
A.Diabetes insipidu
B.Renal failure
C.Metabolic acidosis
D.Elevated intracranial pressure
D.Elevated intracranial pressure
The respiratory therapist obtains a SpO2 reading of 90% on a patient receiving oxygen therapy via 50% venti-mask. This would indicate a PO2 value of approximately
A.55 torr
B.60 torr
C.65 torr
D.70 torr
B.60 torr
A patient admitted to the ED is noted to have pulse and blood pressure variations with respirations. This is most indicative of
A.cardiac tamponade.
B.severe pneumonia.
C.congestive heart failure.
D.large pleural effusion.
A.cardiac tamponade.
A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from
A.pulmonary embolism.
B.gastroesophageal reflux.
C.myocardial infarction.
D.valvular stenosis
C.myocardial infarction.
Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following?
A.flail chest on right thorax
B.right tension pneumothorax
C.endobronchial intubation
D.subcutaneous emphysema
C.endobronchial intubation
A 44 year-old patient who suffered a cerebral vascular accident has been moved from Neuro-ICU to the step-down unit. He becomes diaphoretic and his SpO2 suddenly drops from 95% to 88% on a 32% tracheostomy collar. His heart rate is 115/min, respiratory rate is 42/min and his breath sounds are very diminished. The respiratory therapist is unsuccessful in attempting to pass a 12 Fr suction catheter. The therapist should
A.increase the suction pressure to 120 mm Hg.
B.change to a 10 Fr suction catheter.
C.replace the tracheostomy tube.
D.orally intubate the patient.
C.replace the tracheostomy tube.
A 55 year-old male patient is being evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should
A.reduce the speed of the bike
B.administer supplemental oxygen.
C.gradually reduce the workload and monitor closely.
D.terminate the procedure immediately.
D.terminate the procedure immediately.
While making oxygen rounds, the respiratory therapist hears a high-pitched sound coming from a bubble humidifier. The patient is receiving oxygen by air-entrainment mask at 28% and the oxygen flowmeter is set at 12 L/min. The therapist should
A.replace the cracked humidifier.
B.increase the FIO2 on the air-entrainment mask.
C.increase the flow from the flowmeter.
D.eliminate the bubble humidifier.
D.eliminate the bubble humidifier.
The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered?
A.0.25 mL
B.0.50 mL
C.1.25 mL
D.2.5 mL
B.0.50 mL
A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist should recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT:
A.coordinating coughing with pain medication.
B.performing serial coughs.
C.applying pressure to patient’s abdomen during exhalation.
D.“splinting” the incision area.
C.applying pressure to patient’s abdomen during exhalation.
Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at frequencies of 100 to 250/min?
A.intrapulmonary percussive ventilation
B.autogenic drainage
C.high-frequency chest wall compression device
D.positive expiratory pressure breathing
A.intrapulmonary percussive ventilation
As the respiratory therapist assesses a patient who is in a semi-fowler position, he/she finds that the patient’s jugular vein extends approximately 7 cm above his sternal angle. The therapist should recommend initiation of which therapy?
A.positive inotrope
B.antibiotic
C.long-acting Beta-agonist
D.hyperinflation
A.positive inotrope
The respiratory therapist is assisting in the elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST?
A.Check the inlet valve.
B.Check the patient valve.
C.Replace the manual resuscitation bag.
D.Check for excessive oxygen flow.
C.Replace the manual resuscitation bag.
The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor
- electrocardiogram.
- electroencephalogram.
- nasal air flow.
- chest wall impedance.
A.1 and 2 only
B.3 and 4 only
C.2, 3, and 4 only
D.1, 2, and 3 only
- electrocardiogram.
- electroencephalogram.
- nasal air flow.
- chest wall impedance.
B.3 and 4 only
A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time?
- Tidal volume
- Respiratory Rate
- Inspiratory flow
- Sensitivity
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
- Tidal volume
- Respiratory Rate
- Inspiratory flow
- Sensitivity
A. 1, 2, and 3 only
Which of the following physiologic values would be present in a patient who has proper fluid balance?
A.PCWP of 22 mm Hg
B.CVP between 3 and 6 mm Hg
C.urine output of 20 mL/hr
D.increase in body weight
B.CVP between 3 and 6 mm Hg
While monitoring a newborn utilizing a transcutaneous monitor, you notice a change in PtcO2 from 60 to 142 torr and simultaneously the (PtcCO2) changes from 37 to 2 torr. What is the most likely explanation for these changes?
A.Upper airway obstruction
B.Poor peripheral perfusion
C.Air leak around the sensor
D.Device is out of range
C.Air leak around the sensor
A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PvO2 46 torr PCWP 19 mm Hg PAP (mean) 10 mm Hg CVP 12 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend
- IV fluid challenge
- positive inotropic agent
- inhaled nitric oxide
- diuretic therapy
A.1 and 3
B.2 and 4
C.3 and 4
D.1 and 2
- IV fluid challenge
- positive inotropic agent
- inhaled nitric oxide
- diuretic therapy
B.2 and 4
While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the
A.peak flow meter is clogged.
B.patient’s asthma has worsened.
C.patient is fatigued.
D.peak flow meter is accurate.
A.peak flow meter is clogged.