Random Flashcards
What is the most effective treatment for central sleep apnea?
A. CPAP
B. tracheostomy
C. bi-level
D. weight loss
Bi-level
Explanation :
Bi-level is most helpful as it can provide ventilation with inspiratory and expiratory pressure. Bi-level may also be given with rate.
An adult patient has a respiratory rate of 28, a pulse of 138, and a blood pressure of 85/65 mm Hg. Breath sounds are absent on the left and diagnostic percussion reveals hyperresonance on that same side. The respiratory therapist should FIRST recommend?
A. insert a chest tube in the left chest
B. radiographic examination of the chest
C. insert a 14-guage needle into the left chest
D. schedule a V/Q scan
C. insert a 14-guage needle into the left chest
Explanation :
The data shown here, especially pulse and blood pressure, indicate an emergent condition. Hyperresonance and absent breath sounds is suggestive of a tension pneumothorax. Because the tension is likely building, the patient is experiencing hemodynamic degradation that is dangerous. This is manifested by the low blood pressure. This problem should be remedied in an emergent way. This can be done by inserting a 14-gauge needle into the left chest, in between ribs. This will allow immediate venting of air and minor amounts of fluid to be ejected from the lung space and will provide immediate hemodynamic improvement.
A patient with significant pulmonary shunting is receiving volume-controlled ventilation on the following settings and has the following arterial blood gas results:
Mode Assist/control Mandatory rate 18 VT 500 mL FIO2 0.70 PEEP 25 cm H2O C.O. 3.2 L/min Heart rate 118 pH 7.36 PaCO2 45 torr PaO2 54 torr HCO3- 26 mEq/L BE +2 mEq/L The therapist should decrease which of the following?
A. FIO2
B. flow
C. PEEP
D. rate
C. PEEP
Explanation :
This patient is hypoxic. To correct this either PEEP or FIO2 should be increased. However, closer examination of hemodynamic data, namely cardiac output, shows instability. Normal cardiac output is 4-8 L/min. This patient has low cardiac output most likely brought about by excessive levels of PEEP. The most appropriate action, in spite of hypoxemia, is to decrease PEEP.
A patient with asthma monitors their peak flow in the morning and documents that peak flow is 40% of his usual baseline. Based on the NAEP and the patient’s asthma action plan, the patient should?
A. contact the patient’s physician
B. take a short-acting bronchodilator, check peak flow in 1 hour
C. report to the emergency room
D. take a corticosteroid MDI
A. Contact physician
Explanation :
According to the national asthma guidelines, a self monitored peak flow of 40% of baseline is an indication for the patient to contact their physician
What is the minimum flow rate that should be set on a volume-controlled ventilator with the following settings?
Rate 20 VT 700 mL I:E 1:3 FIO2 0.50 PEEP 5 cm H2O
A. 40 L/min
B. 50 L/min
C. 30 L/min
D. 60 L/min
D. 60 L/min
Explanation :
Minimum flow rate on a ventilator is determined by the following formula: (I+E) x minute ventilation. In this case, (1 + 3) = 4. Minute ventilation = 700 mL x 20 = 14 L. Minimum flow = 4 x 14 L = 56 L. Of the options offered only 60 L/min will exceed the inspiratory demand of the patient.
After completing four flow-volume loops on a bedside pulmonary function screening device, the therapist notices that the volume reported with all FVC maneuvers are less than all of the SVC maneuvers. The therapist should
A. repeat the FVC maneuvers
B. repeat the entire flow-volume loop maneuver
C. repeat the SVC maneuvers
D. accept the results
D. Accept the results
Explanation :
Essentially, this question is demonstrating normal results relative to FVC and SVC volumes. In other words, SVC volumes should always be higher than FVC volumes. Therefore the respiratory therapist should accept the results.
Quality control test results of a recently certified 3.0 Liter calibration syringe used in conjunction with a spirometer are as follows:
Vol 1 Vol 2 Vol 3
2.65 L 2.69 L 2.58 L
Which of the following is accurate according to ATS standards?
A. The procedure was performed incorrectly.
B. The spirometer is inaccurate.
C. The spirometer lacks precision.
D. The calibration syringe is defective.
B. The spirometer is inaccurate
Explanation :
The spirometer is considered accurate if the results are no more than 3% above or 3% below the 3 L calibration syringe. This means the accuracy range is 2.85 L -3.15 L. In this case all values are outside the range and therefore the spirometer is considered to be inaccurate.
A patient is receiving bi-level therapy to decrease work of breathing. Current settings and blood gas results are:
IPAP 18 cm H2O
EPAP 10 cm H2O
FIO2 0.21
pH 7.32 PaCO2 48 torr PaO2 110 torr HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should make which of the following changes?
A. decrease EPAP to 8 cmH2O
B. increase both IPAP and EPAP by 2 cmH2O
C. increase EPAP to 12 cmH2O
D. increase IPAP to 22 cmH2O
A. Decrease EPAP to 8 cmH2O
Explanation :
Blood gases reveal hypoventilation and over oxygenation. We can correct both of these problems with one change in the BiPAP settings. Because ventilation is determined by the distance between the IPAP and EPAP settings, we can simply lower EPAP. A decrease in expiratory positive airway pressure will decrease oxygenation but also increase ventilation because the distance between inspiratory pressure and expiratory pressure is increased.
A patient who is receiving volume-controlled ventilation is showing signs of ventilatory distress. The low return volume alarm is sounding and there is excessive bubbling found in the water-seal compartment of a three-chamber chest tube drainage system. The respiratory therapist should first
A. clamp the tubing between the collection chamber and the water-seal chamber
B. clamp the chest tube at the patient’s chest
C. decrease tidal volume
D. decrease suction pressure at the wall
B. Clamp the chest tube at the patient’s chest
Explanation :
When these two conditions are observed, low return volume and excessive bubbling in the water seal compartment, the primary concern is that there is a perforation in the lung tissue. However, the excessive bubbling may be coming from a leak in the chest tubes between the patient and the collection chambers. To determine if this is the case, one starts by clamping the chest tubes at the patient’s chest and observing for a decrease in bubbling in the water seal compartment. If bubbling does not decrease, the clamp is moved towards the chambers to determine if there is a leak in other parts of the tubing. However, if bubbling stops or decreases when the clamp is placed on the tubes where they exit the patient’s body, the leak must be inside the patient and would suggest a perforated lung.
Which of the following would NOT be an indication for implementing mechanical ventilatory support?
A. respiratory rate of 4 per minute
B. MIP -28 cm H2O
C. tidal volume < 4 mL/kg
D. no chest movement
B. MIP -28 cmH2O
Explanation :
A respiratory rate of 4/min or less, a tidal volume of less than 5 mL per kilogram, and no chest movement are all indications the patient is in need of mechanical ventilatory support. An MIP of -28 cmH2O is consistent with independent ventilatory ability.
A patient receiving supplemental oxygen at home with a molecular sieve device reports appropriate flow coming from her cannula, but does not believe she is receiving enough oxygen. The therapist should advise the patient to
A. change out the oxygen tubing.
B. call 911.
C. increase the flowrate by 1 L/min.
D. change to E-cylinder oxygen and evaluate.
D. Change to E-cylinder oxygen and evaluate
Explanation:
When a patient reports difficulty getting air or oxygen through one oxygen delivery device, before troubleshooting, the most appropriate first action is to ensure adequate ventilation by changing to a different, reliable device. In this case switching to an E cylinder is most appropriate while the oxygen concentrator is assessed.
Which of the following should be closely monitored in a patient receiving diuretic medication?
A. serum electrolytes
B. CBC
C. blood urea nitrogen
D. ABGs
A. Serum electrolytes
Explanation :
Because diuretic medication causes the body to expel electrolytes, which are inseparable with body fluids, it is important to closely monitor potassium, sodium, chloride, and other electrolytes. In some cases, as fluid is being discharged, some electrolytes may require replenishment. Electrolytes are important because they facilitate muscle contraction in the body, and most notably contraction of the heart.
Which of the following is used to evaluate a patient for fluid imbalance?
A. minute ventilation
B. cerebral perfusion pressure
C. P50
D. pitting edema
D. Pitting edema
Explanation :
Fluid imbalance may result in pitting edema, changes in sensorium, and altered capillary refill time. Minute ventilation, P50, and CPP is not helpful.
The respiratory therapist suspects a patient’s ET tube has been moved immediately after competing a transfer of the patient from nuclear medicine to the ICU. The therapist should first
A. advance the ET tube and re-secure
B. reintubate the patient with new airway
C. check breath sounds
D. obtain a chest radiograph
C. Check breath sounds
Explanation :
Checking BS would be the quickest way to determine if the ET tube is correctly positioned.
A patient is receiving volume-controlled ventilation. Which of the following blood gas results is a clear indication for an increase in minute ventilation?
A. pH 7.50, PaCO2 30 torr, PaO2 82 torr
B. pH 7.35, PaCO2 60 torr, PaO2 65 torr
C. pH 7.55, PaCO2 26 torr, Pao2 88 torr
D. pH 7.25, PaCO2 55 torr, PaO2 51 torr
D. pH 7.25, PaCO2 55 torr, PaO2 51 torr
Explanation :
The need to increase minute ventilation can be determined by examining arterial CO2. In this question, two options have an elevated PaCO2, indicating a need to increase ventilation. However one of these options shows a corrected pH, suggesting that the elevated CO2 is normal for that patient. Therefore, the correct answer is the blood gas results that show elevated CO2 with an uncompensated pH. This is called uncompensated respiratory acidosis.
For an unconscious apneic patient, what should the responding respiratory therapist do FIRST?
A. Provide manual breaths
B. Call for help
C. Check for a pulse
D. Open the airway
The correct answer is : D
Explanation :
When a patient is unconscous and not breathing, ventilation is of the highest concern. Sometimes spontaneous ventilation will occur by simply opening the airway. This is because the airway is sometimes obstructed. Therefore, prior to assessing the patient’s breathing status, or providing assisted ventialtion, one should open the airway.
Following a full cardiopulmonary arrest and successful resuscitation, the patient has received dopamine to raise blood pressure. The respiratory therapist his having difficulty obtaining arterial blood from the radial artery due to hypotension. From which of following sites should the therapist attempt to perform an arterial puncture?
A. femoral artery
B. pedal artery
C. carotid artery
D. umbilical artery
The correct answer is : A
Explanation :
During cardiopulmonary resuscitation blood pressure exists because of cardiac compressions and is usually low. Palpation of pulse, therefore, is difficult in the usual locations such as the radial or brachial arteries. When blood gases are needed during a code with a patient who has very low blood pressure, the femoral artery is the location of choice.
End inspiratory crackles are heard upon auscultation of a post operative hip patient with no known pulmonary history. The patient is febrile. These signs are indicative of
A. hypovolemia.
B. dehydration.
C. atelectasis.
D. subcutaneous emphysema.
The correct answer is : C
Explanation :
Late inspiratory crackles, or end-inspiratory crackles are commonly auscultated with a patient experiencing atelectasis. Crackles are also known as rales. Atelectasis is the presence of fully or partially collapsed alveoli.
A patient complaining of shortness of breath with exercise has the following pre/post bronchodilator results. Which is the most meaningful indicator that a bronchodilator is effective?
A. Patient reports the maneuver is easier after the bronchodilator
B. 10% improvement in FEV1/FVC%.
C. 9% improvement in FVC
D. 15% improvement in FEV1
The correct answer is : D
Explanation :
Improvement with bronchodilator therapy is considered significant if flows increase by 12% or more, or if FEV1 increases by at least 200 mL. In this example we see a 15% improvement in FEV1, well beyond the 12% threshold.
A physician discovers a patient has a bronchopleural fistula and decides to employ independent lung ventilation. In preparation for the oral intubation, the respiratory therapist should recommend which of the following devices to assist with the plan to ventilate the lungs independently?
A. combitube
B. fenestrated tracheostomy tube
C. double-lumen endotracheal tube
D. laryngeal mask (LMA)
The correct answer is : C
Explanation :
Independent lung ventilation may be accomplished by using a double-lumen endotracheal tube. This device allows the use of two mechanical ventilators to provide different pressures and different volumes to each lung.
A respiratory therapist is asked to determine the gestational age of an infant delivered 10 minutes ago. Which of the following techniques should be used?
A. Mallampati
B. APGAR
C. Ballard
D. Silverman-Anderson
The correct answer is : C
Explanation :
Of the options listed, a Ballard assessment is used to determine gestational age of an infant. Silverman/Anderson scoring is used to determine the degree of ventilatory difficulty and does not relate to gestational age. Apgar is used to determine the patient’s overall vital stability in the first 1 and 5 min. after birth. Mallampati is a method used on adults to quantify the degree of difficulty of intubation and is not relevant in this case.
The respiratory therapist is determining the proper size of an oropharyngeal airway on a patient who is orally intubated. Which of the following methods will be helpful in properly estimating the appropriate size of the airway?
A. examine the distance between the earlobe and nasal septum
B. examine the distance between the angle of the jaw and tip of the chin
C. determine the patient’s ideal body weight in kilograms
D. determine the age and sex of the patient
The correct answer is : B
Explanation :
The way to determine the proper length of an oral pharyngeal airway is to measure and match the distance between the angle of the jaw and the tip of the chin.
A spontaneously breathing patient has the following arterial blood gas results:
pH 7.38
PaCO2 42 mmHg
PaO2 76 mmHg
HCO3- 24 mEq/L
BE 0 mEq/L
Which of the following supplemental oxygen levels is most appropriate?
A. 5 L/min nasal cannula
B. Venturi mask at 30%
C. 2 L/min nasal cannula
D. non-rebreathing mask
The correct answer is : A
Explanation :
A patient who is showing signs of hypoxemia should receive supplemental oxygen. If the patient is not a COPD patient and the situation is not an emergency, then the proper supplemental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options available only 5 L/min nasal cannula will approach this. Other options are either insufficient or too much.
Using the formula for calculation of cardiac index, how would a morbidly obese patient’s C.I. compare to that of a person at ideal body weight?
A. cardiac index would be lower
B. cardiac index would be unpredictable
C. cardiac index would remained unchanged
D. cardiac index would be higher
The correct answer is : A
Explanation :
Cardiac index is determined by dividing cardiac output by body surface area. As body surface area is increased (from obesity) the cardiac index calculation will be less than a patient at ideal body weight.
A patient who is receiving mechanical ventilation is scheduled for fiberoptic bronchoscopy to investigate a lesion in the right mainstem bronchus. Which of the following represents the most significant threat to ventilation during the procedure?
A. airway obstruction
B. excessive airway resistance
C. stimulation of the vagal nerve and bradycardia
D. loss of PEEP through suctioning
The correct answer is : A
Explanation :
Although a bronchoscopy procedure is necessary to investigate deep pulmonary problems, such as lesions, the procedure itself can cause problems because of the width of the scope relative to the size of the airway. During the procedure the scope acts as a large airway obstruction. If the patient is receiving mechanical ventilatory support, it is likely that the high-pressure alarm will sound during this procedure. Therefore, it is appropriate to temporarily increase the high-pressure limit until the procedure is complete.
A respiratory therapist is asked to assess whether incentive spirometry is effective for a post-operative patient with a fever of 101 degrees. How would this be accomplished?
A. arterial blood gas
B. assessment of breath sounds before and after a cycle of SMI
C. chest X-ray
D. presence of fever
The correct answer is : B
Explanation :
The optimal response is auscultation of breath sounds before and after sustained maximum inspiration (SMI) efforts. This is affordable and effective.
A physician orders an increase in the I:E ratio for a patient diagnosed with ARDS. Which of the following is consistent with this change?
Decreased flow rate Increased expiratory time Increase in inspiratory time I:E of 1:2 to 1:4
- Yes No No Yes
- Yes Yes No No
- Yes No Yes No
- No No Yes Yes
A. 3
B. 2
C. 4
D. 1
The correct answer is : A
The laboratory results of a sputum culture and sensitivity have returned for a patient who has bilateral bacterial pneumonia. The culture reveals streptococcus, a gram-positive bacteria. The medical records indicates the patient is allergic to penicillin. Which of the following should the respiratory therapist recommend?
A. Nafcillin
B. Methacillin
C. Cephalexine (Keflex)
D. Amoxicillin
The correct answer is : C
Explanation :
Normally gram-positive bacteria may be killed by penicillin-type antibiotics. But, because the patient is allergic to penicillin, a suitable drug is cephalexine. Nafcillin and methacillin are suitable antibiotics when a patient is penicillin-resistant but not when they are allergic.
A respiratory therapy supervisor is responsible for quality improvement in the respiratory department. Which of the following represents an appropriate quality improvement focus?
A. daily patient charges
B. total number of procedures done per hour
C. number of blood gases done per shift
D. incidence of ventilator acquired pneumonia
The correct answer is : D
Explanation :
Quality improvement is about improving patient care. Tracking daily patient charges, the total number of procedures done per hour, or the number of blood gases per shift does not improve quality of care to patients. Tracking the incidence of ventilator acquired pneumonia, however, may be helpful in directing the department’s efforts to manage infection control more effectively. This has a direct result on patient care.
A patient is on 60%/40% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min?
A. 18 L/min
B. 14 L/min
C. 10 L/min
D. 16 L/min
The correct answer is : B
Explanation :
When helium-oxygen mixtures are run through flow meters that are intended for oxygen only, the indicated flow on the flow meter is inaccurate. This is because the helium-oxygen mixture is less viscous and does not push the indicator ball up as much as does oxygen. In this case, a correction factor must be used depending upon the mixture percentages. For an 80/20% mixture a correction factor of 1.8 must be used. A 70/30% mixture has a correction factor of 1.6 and a 60/40% mixture has a correction factor of 1.4. In this problem the 60/40% mixture factor of 1.4 must be multiplied by the indicated flow on the oxygen flow meter to calculate actual total gas flow. When we do this we get a total gas flow of 14 L/min.
A patient has undergone overnight oximetry. Data shows several episodes of oxygen desaturation throughout the night. The respiratory therapist would expect orders for which of the following kind of testing?
A. V/Q scan
B. 24-hour Holter monitoring
C. pulmonary function testing
D. polysomnography
The correct answer is : D
Explanation :
The use of overnight oximetry is often used to detect oxygen desaturation during the night that may be associated with central or obstructive sleep apnea. Because data indicates some periodic desaturation, the practitioner should suspect possible sleep apnea and should order diagnostic testing that will confirm or rule out the suspicion. This kind of sleep testing is also called polysomnography.
Which of the following can safely be combined with inhaled albuterol?
A. Pirbuterol
B. Phosphodiesterase inhibitor
C. Ipratropium Bromide
D. Xopenx
The correct answer is : C
Explanation :
Xopenex should not be combined with albuterol because both are front-door bronchodilators. It is not appropriate to combine multiple front-door bronchodilators.
While performing oxygen rounds, the respiratory therapist visits a patient who is ordered to receive 5 L/min by nasal cannula with a bubble humidifier. The therapist finds the oxygen flow meter is reading 0 L/min, even though the knob is not in the off position, and there is no flow to the patient. Which of the following may cause this?
A. loose humidifier bottle
B. clogged down-tube
C. low water level in the humidifier
D. large hole in the cannula
The correct answer is : B
Explanation :
The most likely cause of the flow meter reading zero is a clogged down-tube. A low water level or loose humidifier bottle would not cause the flow meter to read zero.
A spontaneously breathing patient has the following arterial blood gases:
pH 7.25
PaCO2 55 torr
PaO2 54 torr
HCO3- 25 mEq/L
BE -1 mEq/L
Which of the following should the respiratory therapist recommend?
A. VC AC ventilation
B. Bi-level therapy, IPAP of 15 cm H2O, EPAP of 5 cm H2O
C. supplemental oxygen by nonrebreathing mask
D. supplemental oxygen by partial rebreathing mask
The correct answer is : A
Explanation :
This patient is in acute ventilatory failure, as shown by an increased CO2 and a pH of 7.25 or less. When acute ventilatory failure is present, the patient would benefit most from positive pressure ventilation, such as mechanical ventilation.
Which of the following will provide a continuous elevation of baseline pressure during inspiration and expiration on a patient who is breathing spontaneously?
A. CPAP
B. NAVA
C. IPPB
D. APRV
The correct answer is : A
Explanation :
The description provided in this question is most consistent with CPAP, also called continuous positive airway pressure.
A 52-year old male presents in the emergency department with the following arterial blood gas results while receiving supplemental oxygen at FIO2 0.5 via an air-entrainment oxygen device.
pH 7.49 PaCO2 30 torr PaO2 100 torr HCO3 - 22 mEq/L BE -2 mEq/L The respiratory therapist should conclude which of the following regarding the patient's condition?
A. right-to-left shunt
B. decreased pulmonary vascular resistance
C. ventilation/perfusion mismatch
D. metabolic alkalosis is present
The correct answer is : C
Explanation :
An FIO2 of 0.5 would cause the oxygen tension in the alveoli to be about 300 mmHg. When we calculate the A-a gradient (PAO2 - PaO2) we get 200 mmHg, which is consistent with ventilation/perfusion mismatch. A gradient of greater than 300 mmHg is consistent with pulmonary shunting, also called venous admixture.
A pregnant patient presents to the emergency room with shortness of breath. Her arterial blood gas results reveal a COHb of 6.1%. Possible causes are:
A. sickle cell anemia
B. Exposure to automobile exhaust or exposure to second hand cigarette smoke
C. cystic fibrosis
D. exposure to radiation
The correct answer is : B
Explanation :
Basically, anything that burns produces carbon monoxide. When a patient inhales carbon monoxide, carboxyhemoglobin (COHb) levels increase. Exposure to cigarette smoke, gasoline engine exhaust, or various types of heating systems can result in dangerous carbon monoxide levels.
Capillary blood gases are obtained on a 35 weeks-of-gestation neonate who is pink and is maintaining a SAT of 95% on FIO2 0.24.
pH 7.35
PcCO2 44 torr
PcO2 47 torr
The respiratory therapist should conclude which of the following? A. inadequate ventilation B. normal findings C. febrile conditions D. arterial hypoxemia
The correct answer is : B
Explanation :
Capillary PO2 values should not be trusted as oxygen levels in the capillary bed have difficulty reaching equilibrium during gas exchange at the tissue level. PCO2 and pH, however, equilibrate much more readily and thus can be trusted to assesse ventilation. In this question, data other than PcO2 (oxygen) should be used to evaluate the oxygenation status of the patient.
The respiratory therapist assesses a 78-year-old COPD patient who has a history of chronic carbon dioxide retention and has a 90-pack-year smoking history. The patient is placed on a 40% air-dilution mask. Twenty minutes after the placement of oxygen the patient seems more relaxed but ventilations are becoming shallow. The respiratory therapist should
A. Switch to a 4 L/min nasal cannula
B. Change to a partial rebreathing mask
C. Place on a non-rebreathing mask
D. Switch FIO2 to 0.28 via an air-dilution mask
The correct answer is : D
Explanation :
Because this patient is COPD, oxygen delivery greater than 28% is inappropriate. When excessive oxygen is delivered to a COPD patient the result can be reduced depth and rate of respiration. The appropriate action is to decrease FIO2 to 28% or below or 1-2 L/min by nasal cannula.
A 12-year-old female asthmatic patient is having trouble coordinating the actuations of an MDI with deep inhalation. What should a respiratory therapist recommend to improve medication delivery?
A. Double the dose of the MDI and have the patient rinse her mouth after use.
B. Change to nebulizer therapy.
C. Ask a family member actuate the canister.
D. Add a spacer.
The correct answer is : D
Explanation :
An aerosol holding chamber, commonly known as a spacer, not only improves medication delivery when added to a metered-dose inhaler, but also reduces the significant amount of coordination required to properly self-administer an MDI.
Results of a quality control maneuver for a spirometer using a 3.0 L calibration syringe as follows:
Volume 1 2.65 L
Volume 2 2.68 L
Volume 3 2.66 L
According to ATS Standards, the spirometer is
A. lacking in precision
B. operating correctly
C. inaccurate
D. proof that the syringe requires calibration
The correct answer is : C
Explanation :
These calibration results are all very close together, indicating the machine is very precise. However, the results are too far from the 3.0 L of gas introduced by the calibration syringe. The maximum variance is 2.85 L - 3.15 L. Therefore, although the machine is precise, it is considered inaccurate and should not be used for patient testing and reporting.
A 35-year old that is receiving VC, SIMV ventilation has the following parameters:
f 6/min Total rate 28/min VT (set) 450 mL VT (spont) 160 mL FIO2 0.45 PS 5 cm H2O
Which of the following would be an appropriate change? A. increase PS to 10 cm H2O B. increase set VT to 500 mL C. increase rate to 10/min D. decrease set VT to 400 mL
The correct answer is : A
Explanation :
The presence of a low spontaneous VT (likely well below 5 mL/kg) suggests that the patient requires additional pressure support. This will help to lower total rate and generally decrease the work of breathing.
A patient is admitted to the emergency room (ER) after being found unconscious in a closed garage with an automobile running. A note was also found at the scene. Which of the following therapies would be most helpful to the patient?
A. oxygen therapy with a partial-rebreathing mask
B. mechanical ventilation with high levels of PEEP
C. hyperbaric oxygen therapy
D. oxygen therapy with a non-rebreathing mask
The correct answer is : C
Explanation :
This patient most likely has carbon monoxide poisoning. The treatment for this is maximum supplemental oxygen and the use of hyperbaric oxygen therapy.
A patient who suffers from head trauma has an ICP of 25 mm Hg and is receiving mechanical ventilatory support in control mode. The patient is sedated and paralyzed. To best manage intracranial pressure, which of the following medications would be most helpful?
A. Exosurf
B. Neostigmine
C. Diamox (Acetazolamide)
D. Lasix (furosemide)
The correct answer is : C
Explanation :
The medication Diamox is a cerebral diuretic. This will lower the ICP. The other medications on this list do not relate. Be sure to research them and know how they’re used.
A patient complains of double vision and dysphasia. The respiratory therapist observes droopy eyelids and facial muscles. Which of the following conditions is consistent with these observations?
A. brain-stem herniation
B. CNS depression secondary to barbiturate overdose
C. myasthenia gravis
D. Guillain-Barre Syndrome
The correct answer is : C
Explanation :
Double vision, droopy eyelids and facial muscles are associated with myasthenia gravis.
A patient is found sleeping in a car that has an apparent exhaust leak inside the vehicle cabin. COHb is 45%. Which of the following is true statement about this situation?
A. the patient smokes cigarettes
B. CaO2 is decreased
C. C(a-v)O2 is decreased
D. the patient is hyperoxemic
The correct answer is : B
Explanation :
An elevated CO HB results in hypoxemia. But the hypoxemia is not derived from the PaO2 from the blood gas but rather is caused by the lack of hemoglobin available to carry oxygen. In fact, the patient may have plenty of hemoglobin but their oxygen-carrying capacity is diminished because the hemoglobin are bound with carbon monoxide. Consequently this results in a reduction of arterial oxygen content which results in hypoxemia.
A patient experiencing exacerbation of asthma is receiving small volume nebulizer treatments with albuterol via aerosol mask. The patient suddenly complains of nausea, tingling of the digits and seems very anxious. The best course of action would be to
A. continue current therapy
B. change to a mouthpiece
C. instruct the patient to breathe less deeply during the treatment
D. discontinue therapy and report your findings to the doctor
The correct answer is : D
Explanation :
Nausea, tingling of the digits, and anxiousness indicate that the patient is not tolerating the medication being delivered. The therapy should be discontinued and the physician should be notified.
The respiratory therapist is asked to estimate the alveolar minute ventilation on a spontaneously breathing 91 kg (200 lb) male who is receiving oxygen therapy by air-entrainment mask at FIO2 0.50. The following data is available
Exhaled VT 500 mL SpO2 92% PetCO2 30 torr PaO2 70 torr Minute ventilation 10 L/min The therapist should report an alveolar minute ventilation of: A. 12.0 L/min B. 6.0 L/min C. 4.0 L/min D. 8.2 L/min
The correct answer is : B
Explanation :
To determine alveolar ventilation, dead space should be subtracted from each tidal volume. The amount of dead space per tidal volume is equivalent to 1 mL/lb of ideal body weight. In this case, the patient weighs 200 lbs and therefore has 200 mL of dead space for every inhaled tidal volume. The amount of gas that goes to the alveoli is, therefore, 300 mL per breath or 6.0 L per minute. This is calculated by subtracting 200 mL from 500 mL (the patient’s VT) and then multiplying the result by the respiratory rate. The respiratory rate is not givin here but can be determined by dividing the minute ventilation by the exhaled tidal volume.
A neonatal patient exhibits a heart murmur upon auscultation one hour after birth. The respiratory therapist is having difficulty maintaining adequate oxygenation saturation in spite of increasing FIO2. Which of the following should the respiratory therapist recommend?
A. transillumination
B. echocardiography
C. cardiac angioplasty
D. diagnostic chest percussion
The correct answer is : B
Explanation :
Although it is common for a neonate to exhibit a cardiac murmur right after birth, when considered in connection with other signs, such as poor oxygenation in spite of increasing oxygen delivery, the respiratory therapist should suspect congenital cardiac abnormalities. The best way to broadly assess for this kind of congenital issue is to perform echocardiography.
A COPD patient who has bilateral expiratory wheezing would benefit most immediately from which of the following medications?
A. Budesonide (Pulmicort)
B. Tilade (Nedocromil)
C. Acetylcysteine (Mucomyst)
D. Albuterol
The correct answer is : D
Explanation :
A COPD patient would benefit most from short-term bronchodilation because the patient is currently wheezing. Of the options listed, only albuterol is considered to be a bronchodilator.
In preparation for a patient who will be receiving oxygen by nasal cannula at 2 L/min at home, the respiratory therapist should recommend which of the following devices for primary oxygen delivery?
A. 3-5 E cylinders
B. bank and manifold of H tanks
C. bulk liquid oxygen conversion system
D. molecular sieve device
The correct answer is : D
Explanation :
Patients who are in need of low-flow oxygen at home (between 1-6 L/min) are best served by using an oxygen concentrator. This is also called a molecular seive device.
How would the respiratory therapist conclude that bedside spirometry results are reproducible?
A. FEV1 + FVC gradually increase with each effort.
B. FEV1/FVC is at least 75%.
C. Repeated efforts are within 5%.
D. The patient appears to be giving his best effort.
The correct answer is : C
Explanation :
The gold-standard to determine reproducibility in bedside spirometry is to ensure that at least three results are within 5% of one another.
A patient on the medical floor is receiving supplemental oxygen at 4 L/min by nasal cannula. A pulse oximeter is showing an SPO2 of 74% with a heart rate of 68 bpm. The respiratory therapist determines the pulse by palpation is 98 bpm. The therapist should
A. increase flow rate to 5 L/min
B. replace the electrode with a new one
C. switch the patient to 50% Venturi mask
D. try a different location with the pulse ox probe
The correct answer is : D
Explanation :
When a pulse oximeter is reading a low oxygen saturation but has a different heart rate compared to that which can be palpated, the oxygen saturation reading is in error and should not be reported. The cause for this is likely poor peripheral perfusion caused by a number of factors. But, the solution is to first try a different location with the pulse ox probe.
For which of the following conditions is PEP therapy most beneficial?
A. Postoperative recovery
B. ARDS
C. myasthenia gravis
D. pneumonia
The correct answer is : D
Explanation :
PEP therapy is beneficial at removing secretions. Of the options given, only pneumonia is a disease where secretions are a primary concern.
While providing manual ventilation to an adult male patient in full pulmonary arrest, the respiratory therapist observes the expectoration of gastric contents into the mask. The respiratory therapist should do which of the following prior to continuing manual ventilation?
A. clear the mask, suction the mouth, and turn the patient to his side
B. obtain a new bag and resume ventilation
C. nothing, continuing ventilation
D. change the mask and resume ventilation
The correct answer is : A
Explanation :
When a patient vomits into a mask while receiving manual ventilation, aspiration is the primary concern. To prevent aspiration the mask should be cleared before attempting additional ventilations and the patient should be turned to the side to help clear secretions from the oropharynx.
A patient on long-term supplemental oxygen via a transtracheal oxygen catheter is hospitalized on a general observation floor. The patient complains of shortness of breath and indicates the device is not functioning properly. The respiratory therapist should
A. begin supplemental oxygen delivery by nasal cannula
B. suction the catheter, recheck oxygen saturation
C. administer aerosolized Ipratropium Bromide (Atrovent) by mask
D. remove the transtracheal catheter, begin mechanical ventilation
The correct answer is : A
Explanation :
When a patient complains of shortness of breath or complains that the oxygen delivery equipment is not working properly, the best first option is to ensure oxygenation by changing to another device and then troubleshooting the problem.
Immediately following oral endotracheal intubation, the respiratory therapist should confirm proper placement by doing which of the following?
A. Assess end-tidal CO2 with a colorimetric capnometer
B. Auscultate the neck
C. Obtain a anterior-posterior chest radiograph
D. Ensure tube markings are between 20-24 at the teeth
The correct answer is : C
Explanation :
To determine the location and placement of an endotracheal tube a chest x-ray is appropriate. Because the patient is intubated it is not likely that the patient is ambulatory and therefore must undergo a chest x-ray in bed. When shooting a chest x-ray bed, the proper technique is called an AP chest radiograph, or anterior-posterior x-ray.
Which of the following signs indicate the immediate need for intubation?
A. moderate inflammation in the hypopharynx
B. moderate use of accessory muscles
C. barking cough in a toddler
D. marked high pitched sound in upper airway
The correct answer is : D
Explanation :
The word “marked” signifies a severe or emergent situation and must be responded to aggressively to establish an immediate airway. Subglottic edema seen in a toddler’s neck x-ray indicates acute epiglottitis and also requires prompt intubation. In order to protect the airway of a drug overdose victim who is snoring with shallow respirations intubation should also take place. A barking cough by a toddler is more indicative of croup (larygotracheobronchitis), and rarely requires intubation.
A spontaneously breathing patient has the following arterial blood gas results:
pH 7.40 PaCO2 39 mm Hg PaO2 78 mm Hg HCO3- 24 mEq/L BE 0 mEq/L Which of the following supplemental oxygen levels is most appropriate?
A. nasal CPAP of 5 cmH2O
B. non-rebreathing mask
C. air-entrainment mask at 40%
D. 2 L/min nasal cannula
The correct answer is : C
Explanation :
A patient who is showing signs of hypoxemia should receive supplemental oxygen. If the patient is not a COPD patient and the situation is not an emergency, then the proper supplemental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options available only 5 L/min nasal cannula will approach this. Other options are either insufficient or too much.
A patient with acute respiratory distress syndrome is receiving PC, A/C ventilation and is showing signs of distress. The ET tube is 20 cm at the teeth. A chest radiograph shows the tip of the ET tube is 7 cm above the carina and gurgling can be heard coming from the patient’s mouth. The respiratory therapist should
A. withdraw the ET tube 2 cm.
B. advance the ET tube 3 cm.
C. add 5 mL of air to the ET tube cuff.
D. remove the ET tube and reintubate.
The correct answer is : B
Explanation :
The ET tube should be 2-5 cm above the carina, or positioned with the ET tube markings at 21 to 25 cm at the teeth.
A patient experiencing exacerbation of asthma is receiving small volume nebulizer treatments with albuterol via aerosol mask. The patient suddenly complains of nausea, tingling of the digits and seems very anxious. The best course of action would be to
A. continue current therapy
B. change to a mouthpiece
C. instruct the patient to breathe less deeply during the treatment
D. discontinue therapy and report your findings to the doctor
The correct answer is : D
Explanation :
Nausea, tingling of the digits, and anxiousness indicate that the patient is not tolerating the medication being delivered. The therapy should be discontinued and the physician should be notified.
The respiratory therapist is asked to estimate the alveolar minute ventilation on a spontaneously breathing 91 kg (200 lb) male who is receiving oxygen therapy by air-entrainment mask at FIO2 0.50. The following data is available
Exhaled VT 500 mL SpO2 92% PetCO2 30 torr PaO2 70 torr Minute ventilation 10 L/min The therapist should report an alveolar minute ventilation of: A. 12.0 L/min B. 6.0 L/min C. 4.0 L/min D. 8.2 L/min
The correct answer is : B
Explanation :
To determine alveolar ventilation, dead space should be subtracted from each tidal volume. The amount of dead space per tidal volume is equivalent to 1 mL/lb of ideal body weight. In this case, the patient weighs 200 lbs and therefore has 200 mL of dead space for every inhaled tidal volume. The amount of gas that goes to the alveoli is, therefore, 300 mL per breath or 6.0 L per minute. This is calculated by subtracting 200 mL from 500 mL (the patient’s VT) and then multiplying the result by the respiratory rate. The respiratory rate is not givin here but can be determined by dividing the minute ventilation by the exhaled tidal volume.
A neonatal patient exhibits a heart murmur upon auscultation one hour after birth. The respiratory therapist is having difficulty maintaining adequate oxygenation saturation in spite of increasing FIO2. Which of the following should the respiratory therapist recommend?
A. transillumination
B. echocardiography
C. cardiac angioplasty
D. diagnostic chest percussion
The correct answer is : B
Explanation :
Although it is common for a neonate to exhibit a cardiac murmur right after birth, when considered in connection with other signs, such as poor oxygenation in spite of increasing oxygen delivery, the respiratory therapist should suspect congenital cardiac abnormalities. The best way to broadly assess for this kind of congenital issue is to perform echocardiography.
A COPD patient who has bilateral expiratory wheezing would benefit most immediately from which of the following medications?
A. Budesonide (Pulmicort)
B. Tilade (Nedocromil)
C. Acetylcysteine (Mucomyst)
D. Albuterol
The correct answer is : D
Explanation :
A COPD patient would benefit most from short-term bronchodilation because the patient is currently wheezing. Of the options listed, only albuterol is considered to be a bronchodilator.
In preparation for a patient who will be receiving oxygen by nasal cannula at 2 L/min at home, the respiratory therapist should recommend which of the following devices for primary oxygen delivery?
A. 3-5 E cylinders
B. bank and manifold of H tanks
C. bulk liquid oxygen conversion system
D. molecular sieve device
The correct answer is : D
Explanation :
Patients who are in need of low-flow oxygen at home (between 1-6 L/min) are best served by using an oxygen concentrator. This is also called a molecular seive device.
How would the respiratory therapist conclude that bedside spirometry results are reproducible?
A. FEV1 + FVC gradually increase with each effort.
B. FEV1/FVC is at least 75%.
C. Repeated efforts are within 5%.
D. The patient appears to be giving his best effort.
The correct answer is : C
Explanation :
The gold-standard to determine reproducibility in bedside spirometry is to ensure that at least three results are within 5% of one another.
A patient on the medical floor is receiving supplemental oxygen at 4 L/min by nasal cannula. A pulse oximeter is showing an SPO2 of 74% with a heart rate of 68 bpm. The respiratory therapist determines the pulse by palpation is 98 bpm. The therapist should
A. increase flow rate to 5 L/min
B. replace the electrode with a new one
C. switch the patient to 50% Venturi mask
D. try a different location with the pulse ox probe
The correct answer is : D
Explanation :
When a pulse oximeter is reading a low oxygen saturation but has a different heart rate compared to that which can be palpated, the oxygen saturation reading is in error and should not be reported. The cause for this is likely poor peripheral perfusion caused by a number of factors. But, the solution is to first try a different location with the pulse ox probe.
For which of the following conditions is PEP therapy most beneficial?
A. Postoperative recovery
B. ARDS
C. myasthenia gravis
D. pneumonia
The correct answer is : D
Explanation :
PEP therapy is beneficial at removing secretions. Of the options given, only pneumonia is a disease where secretions are a primary concern.
While providing manual ventilation to an adult male patient in full pulmonary arrest, the respiratory therapist observes the expectoration of gastric contents into the mask. The respiratory therapist should do which of the following prior to continuing manual ventilation?
A. clear the mask, suction the mouth, and turn the patient to his side
B. obtain a new bag and resume ventilation
C. nothing, continuing ventilation
D. change the mask and resume ventilation
The correct answer is : A
Explanation :
When a patient vomits into a mask while receiving manual ventilation, aspiration is the primary concern. To prevent aspiration the mask should be cleared before attempting additional ventilations and the patient should be turned to the side to help clear secretions from the oropharynx.
A patient on long-term supplemental oxygen via a transtracheal oxygen catheter is hospitalized on a general observation floor. The patient complains of shortness of breath and indicates the device is not functioning properly. The respiratory therapist should
A. begin supplemental oxygen delivery by nasal cannula
B. suction the catheter, recheck oxygen saturation
C. administer aerosolized Ipratropium Bromide (Atrovent) by mask
D. remove the transtracheal catheter, begin mechanical ventilation
The correct answer is : A
Explanation :
When a patient complains of shortness of breath or complains that the oxygen delivery equipment is not working properly, the best first option is to ensure oxygenation by changing to another device and then troubleshooting the problem.
Immediately following oral endotracheal intubation, the respiratory therapist should confirm proper placement by doing which of the following?
A. Assess end-tidal CO2 with a colorimetric capnometer
B. Auscultate the neck
C. Obtain a anterior-posterior chest radiograph
D. Ensure tube markings are between 20-24 at the teeth
The correct answer is : C
Explanation :
To determine the location and placement of an endotracheal tube a chest x-ray is appropriate. Because the patient is intubated it is not likely that the patient is ambulatory and therefore must undergo a chest x-ray in bed. When shooting a chest x-ray bed, the proper technique is called an AP chest radiograph, or anterior-posterior x-ray.
Which of the following signs indicate the immediate need for intubation?
A. moderate inflammation in the hypopharynx
B. moderate use of accessory muscles
C. barking cough in a toddler
D. marked high pitched sound in upper airway
The correct answer is : D
Explanation :
The word “marked” signifies a severe or emergent situation and must be responded to aggressively to establish an immediate airway. Subglottic edema seen in a toddler’s neck x-ray indicates acute epiglottitis and also requires prompt intubation. In order to protect the airway of a drug overdose victim who is snoring with shallow respirations intubation should also take place. A barking cough by a toddler is more indicative of croup (larygotracheobronchitis), and rarely requires intubation.
A spontaneously breathing patient has the following arterial blood gas results:
pH 7.40 PaCO2 39 mm Hg PaO2 78 mm Hg HCO3- 24 mEq/L BE 0 mEq/L Which of the following supplemental oxygen levels is most appropriate?
A. nasal CPAP of 5 cmH2O
B. non-rebreathing mask
C. air-entrainment mask at 40%
D. 2 L/min nasal cannula
The correct answer is : C
Explanation :
A patient who is showing signs of hypoxemia should receive supplemental oxygen. If the patient is not a COPD patient and the situation is not an emergency, then the proper supplemental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options available only 5 L/min nasal cannula will approach this. Other options are either insufficient or too much.
A patient with acute respiratory distress syndrome is receiving PC, A/C ventilation and is showing signs of distress. The ET tube is 20 cm at the teeth. A chest radiograph shows the tip of the ET tube is 7 cm above the carina and gurgling can be heard coming from the patient’s mouth. The respiratory therapist should
A. withdraw the ET tube 2 cm.
B. advance the ET tube 3 cm.
C. add 5 mL of air to the ET tube cuff.
D. remove the ET tube and reintubate.
The correct answer is : B
Explanation :
The ET tube should be 2-5 cm above the carina, or positioned with the ET tube markings at 21 to 25 cm at the teeth.
