TMC PRACTICE1 Flashcards
Current settings
IPAP 20 cm H20
EPAP 10 cm H20
ABG : pH 7.32/ PaC02 47/ Pa02 115 /Sa02 100%
What changes must be done to correct this ABG?
A. Increase IPAP to 22
B. Decrease IPAP to 18
C. Decrease EPAP to 8
D. Increase EPAP to 12
THE CORRECT ANSWER IS C AS YOU LOOK AT THIS BLOOD GAS YOU MAY SAY WOW I NEED TO ADJUST THE IPAP RIGHT AWAY SO PATIENT BLOW OFF THE C02, BUT IF YOU LOOK CLOSELY THIS PATIENT IS OVER OXYGENATING , IN ORDER TO DO SO YOU MUST ADJUST AND LOWER THE EPAP FROM 10 TO 8 , DECREASING THE EPAP YOU WILL LOWER THE Pa02 AND WILL INCREASE THE DISTANCE BETWEEN THE IPAP AND EPAP( DELTA P) PRESSURES AND IN THIS CASE IT WILL CORRECT BOTH OXYGENATION AND UNDER VENTILATION
Arterial Hemoglobin saturation ( % Hb02) should be kept above what level in order to guarantee adequate oxygen delivery to the tissues?
A. 65%
B. 70%
C. 90%
D. 75%
THE CORRECT ANSWER IS C. 90% NORMAL Sa02 SHOULD BE MORE THAN 95% BREATHING IN ROOM AIR, ANY LEVELS BELOW 90% INDICATES NEED FOR OXYGEN.
You observe a sudden drop in the peak inspiratory pressure when monitoring a patient on volume targeted ventilaton, Which of the following may explain this change?
I. A defective exhalation valve
II. A burt endotracheal tube cuff
III. A high VT setting
IV. Patient disconnect
A. II and IV only
B. III only
C. I,II, IV
D. II, III, IV
THE CORRECT ANSWER IS C A DEFECTIVE EXHALATION VALVE, A BURST ETT CUFF AND PATIENT DISCONNECT , A SUDDEN DECREASE FALL IN PIP CAN BE CAUSED BY IMPROVED COMPLIANCE IN THE LUNGS OR RESISTANCE , DECREASE IN VOLUME OR FLOW OR PATIENT VENTILATOR LEAKS.
A patient with a size 6 tracheostomy tube is being suctioned by the RN , while suctioning the patient you observe several PVC’s on the monitor, You should recommend to the RN :
A. Use larger suction catheter
B. Pre OX with 100%
C. Sedate the patient prior to suction
D. Suction less often
THE CORRECT ANSWER IS B, ALWAYS PRE OXYGENATE YOUR PATIENTS PRIOR TO SUCTIONING , SUCTIONING IS AN INVASIVE PROCEDURE ,HYPOXIA AND MECHANICAL STIMULATION OF THE MYOCARDIUM CAN LEAD INTO PVC’S. USING LARGER CATH, SEDATION OR SUCTIONING LESS WILL NOT PREVENT HYPOXIA AND PVC’S CAUSE BY THE HYPOXIA ITSELF.
Which of the following test should you recommend for a patient with suspected jaundice while being mechanically ventilated?
A. PTT
B. PT
C. Hepatic function panel
D. Cardiac Enzymes
THE CORRECT ANSWER IS C. HEPATIC FUNCTION PANEL WILL RULE OUT ANY TYPE OF LIVER DISEASE ( AST/ALT ETC) CARDIAC ENZYMES ARE INDICATED IF PATIENT HAD A SUSPECTED MI AND PTT AND PT ARE INDICATED FOR CLOTTING TIME AND FACTORS.
.When using a pulse oximetry device, the most common source of error and false alarms is:
A. Patient motion artifact
B. Presence of HbCO
C. Presence of vascular dyes
D.Ambient light detection
THE CORRECT ANSWER IS A MOTION ARTIFACT , YOU MUST SECURE THE SENSOR PROPERLY OR RELOCATE THE SENSOR TO AN EARLOBE, TOE OR EXTERNAL NARIS TO HELP MINIMIZE THESE ISSUES.
Patient in ICU intubated, PAC in place displaying the following data:
Vent settings: AC 12 500 + 18 PEEP, 50% Fi02, PIP 41
CVP 8
PAP 18
PCWP: 20
C.I. 2.0
Where or what is the problem here with your patient?
A. Right heart failure
B. Fluid overload
C. Cor Pulmonale
D. Left heart failure
THE CORRECT ANSWER IS D LEFT HEART FAILURE ,WITH AN ELEVATED WEDGE PRESSURE ALWAYS ALWAYS WILL BE LEFT HEART FAILURE , PATIENTS WILL LEFT HEART FAILURE WILL HAVE SEVERAL PATHOLOGIES SUCH AS MITRAL VALVE STENOSIS , PULMONARY EDEMA , CHF OR HIGH PIP OR PEEP LEVELS CAN CAUSE LEFT HEART FAILURE
A resident ask for your help in calculating the static lung compliance for an ICU patient receiving volume cycled ventilation, The patient has the following setting and monitoring data:
VT 700ml Rate: 12 Peak Pressure 50 cm H20 Plateau Pressure 30 cmH20 PEEP 10 cmH20 Mechanical Deadspace 100mL The patient's static lung compliance is? ( ml/cmH20)
A. 18
B. 35
C. 22
D. 26
THE CORRECT ANSWER IS B VT/ PLAT PRESS- PEEP THIS FORMULA IS NORMALLY IN ALL THE NBRC EXAMS,
The pulmonologist ask you to assess airway responsiveness during a PFT, the MD wants to rule out Chronic Bronchitis from Asthma in a patient complaining of nocturnal wheezing , you should consider all the following test except:
A. Histamine challenge test
B. TGV - Thoracic Gas Volume
C. Methacholine Challenge
D. Graded Exercise Test
THE CORRECT ANSWER IS B TGV DOES NOT ASSESS FOR AIRWAY RESPONSIVENESS AND REACTIVITY THE REST OF THE TEST WILL BE RULE THOSE DISEASES AND DISTINGUISH HOW TO TREAT EACH OF THEM. The graded exercise test is also used to rule out exercise induced asthma or asthma upon exertion. We do these test to provoke airway reactivity. If you know what TGV is is basically the body box in the PFT lab which measures airway resistance only and the question is asking EXCEPT
80kg male patient with aspiration pneumonia on SIMV in ICU, current blood gases are:
pH 7.28 PaC02 52 Pa02 62 HC03 25 Sa02 92% Vent settings: SIMV 12 500 50% +5 PEEP
As the RT for this patient what should you do first?
A. Increase Fi02 60%
B. Increase VT
C. Add PS
D. Increase PEEP
THE CORRECT ANSWER IS B : INCREASE THE VT, VENTILATION COMES FIRST AND MUST BE YOUR PRIORITY TO CORRECT FIRST THEN OXYGENATION. THE OTHER ANSWERS WERE DISTRACTORS.
A respiratory therapist is preparing to assist with a bronchoscopic biopsy of a patient with a solitary pulmonary nodule. The therapist should assure that which of the following tests have been performed? A. arterial blood gas B. electrolytes and creatinine C. cardiac enzymes D. PT and PTT
D IS CORRECT! You must know if bleeding may occur at any site during the procedure. In order to check this, PT and PTT tests are required!
A 24-year-old patient is comatose and receiving mechanical ventilation following a heroin overdose. The following arterial blood gas results are obtained: pH: 7.26 PaCO2: 58 PaO2: 75 HCO3: 26 BE: -2 Which of the following should the respiratory therapist do? A. Initiate PEEP. B. Decrease the inspiratory flow. C. Maintain the current therapy. D. Increase the minute ventilation
D IS THE CORRECT ANSWER! In order to balance the pH, the first thing that should come to mind here is to increase the minute ventilation!
Which of the following arterial blood gas results would be most representative of a patient who has advanced COPD?
A. 7.37/41/55/24
B. 7.38/59/56/32
C. 7.41/45/79/25
D. 7.50/56/57/21
B IS CORRECT! I think you all already have a pretty good grasp on your ABG’s, notice how the bicarb counteracts the elevated CO2 in order to balance this patient’s pH
A male patient who is 180 cm (5 ft 11 in) tall and weighs 75 kg (165 lb) is intubated with an endotracheal tube with the 21-cm mark at his teeth. The cuff pressure is currently 30 mm Hg. Which of the following should a respiratory therapist do?
A. Remove air from the cuff until a slight leak is heard.
B. Reintubate the patient with a larger endotracheal tube.
C. Deflate the cuff until the cuff pressure equals 25 mm Hg.
D. Advance the endotracheal tube to the 25-cm mark.
A IS CORRECT AND A WHOLE LOT OF FIST BUMPS TO BE HAD FOR THE FIRST QUESTION! When intubating a patient, it is crucial that you protect their airway should they be extubated within a short time frame, to do this, using the minimal leak technique ensures the tube is secure and you achieving adequate tidal volume!
About how many hours will and H cylinder of oxygen last if it has 1100psig and is emptying a flow of 8L/min?
A. 0.6 hrs
B. 8.2 hrs
C. 7.2 hrs
D. 0.8 hrs
THE CORRECT ANSWER IS C! 7.2 HRS CALCULATION AND FORMULA: DURATION OF FLOW= ( CYLINDER FACTOR X PSIG) / FLOW THE FACTOR FOR H CYLINDERS IS 3.14 THEN PLUG INTO FORMULA (3.14X1100) / 8= 432 MINS / 60 = 7.2HRS
USING THE NEW STANDARDS OF THE NBRC FOR THE 2015 EXAM
USING THE LOWER VT FORMULA 6-10ml/Kg . Choose the best ventilator setting for this patient.
A 62 year old male 76kg ( 164 lbs), 172 cm with diffuse bilateral infiltrates is receiving 02 via non rebreather post surgery , after you drawn an ABG:
pH 7.27 PaC02 54 Pa02 51 HC03- 22 BE -4 Patient is to receive VC ventilation with an Fi02 of 100% what would you recommend for this patient initial ventilator settings?
A. AC 14 650 PEEP +5
B. SIMV 20 350 PEEP +5
C. AC 8 700 PEEP +10
D. SIMV 24 250 PEEP + 5
THE CORRECT ANSWER IS B ( DONT SCREAM ) READ MY EXPLANATION CAREFULLY AND I HOPE YOU ALL READ THE HEADER OF THIS QUESTION. SO WE NEED TO DETERMINE IF THIS PATIENT IS OBESE OR NOT OBVIOUSLY HES NOT OVER 20 LBS FROM HIS GOAL WEIGHT,SO THEREFORE USING THE 76 KG IS OK FOR NOW TO USE TO CALCULATE THE VT. NOW MUST CALCULATE HIGH AND LOW VT’S FOR THIS PATIENT ALSO THE P/F RATIO DUE TO BILATERAL INFILTRATES WHICH INDICATES THAT THIS PATIENT HAS EITHER ALI OR ARDS - REFER TO YOUR ABG AND FI02 GIVEN OK SO THE PF RATIO IS AROUND 50 THEREFORE THIS PATIENT HAS ARDS YOU WILL NEED TO USE THE 4-6ML/KG ARDS PROTOCOL FOR VENTILATION ALTHOUGH I SAID USING THE NEW 6-10ML/KG THE QUESTION IS ASKING TO VENTILATE AN ARDS PATIENT. LOW VT RANGE 304ML AND HIGH VT 456ML SO A GOOD VT FOR THIS PATIENT IS 304- TO 456. HOPE YOU CAN SEE THIS EVERYONE
An 8-year-old boy with cystic fibrosis has copious, tenacious, purulent secretions. He is receiving 2.5 mg albuterol every 4 hours and dornase alfa (Pulmozyme) once a day. Laboratory results on a sputum sample indicate the patient has a Pseudomonas infection. Which of the following is most appropriate?
A. Increase albuterol to 5 mg every 4 hours.
B. Change dornase alfa (Pulmozyme) to every 4 hours.
C. Administer 3 mL of 10% acetylcysteine every 4 hours.
D. Add 300 mg aerosolized tobramycin (TOBI) twice a day
D IS CORRECT! Tobramycin is indicated for the treatment of pseudomonas in the cystic fibrosis population
What is the normal blood pressure for a 29 week gestation infant?
A. 100/60
B. 50/30
C. 40/20
D. None of the above
THE CORRECT ANSWER IS B, ACCORDING TO NBRC MATRIX ANY PRE TERM INFANT WILL HAVE A BP AROUND 50/30 , THIS WILL VARY FROM PATIENT TO PATIENT , A IS COMPLETELY OUT C CAN BE ALSO CORRECT BUT BY NBRC STANDARDS IS AROUND 50/30 AND FOR TERM IS 60/40.
You can use a fluid column pressure manometer for all the following except:
A. To measure atmospheric pressure
B. To measure static pressure
C. To calibrate other manometers
D. To measure rapid pressure changes
THE CORRECT ANSWER IS D : FLUID COLUMN PRESSURE MANOMETERS ARE USED TO MEASURE ATM PRESSURE STATIC - CVP , BP AND ALSO USED TO CALIBRATE OTHER PRESSURING DEVICES , THEY ARE NOT SUITED FOR MEASURING RAPID CHANGING PRESSURES , THEIR ACCURACY DEPENDS ON POSITION AND THEY CAN BE MESSY AND HAZARDOUS IF MERCURY IS USED.
A patient is producing large amounts of purulent, fetid sputum. When left to rest, the sputum separates into three distinct layers. Which of the following is the most likely diagnosis for this patient? A. asthma attack B. pulmonary edema C. chronic bronchitis D. bronchiectasis
D IS CORRECT! Layering and foul smelling should tip you off immediately to bronchiectasis!
Which of the following values is most helpful in assessing a patient suspected of having a pulmonary embolus? A. shunt ( Qs/Qt) B. dead space (VD/VT) C. static compliance (Cst) D. airways resistance (Raw)
B IS THE CORRECT ANSWER! Here’s why:
dead space is the volume of air which is inhaled that does not take part in the gas exchange, either because it either remains in the conducting airways, or reaches alveoli that are not perfused or poorly perfused
A shunt occurs when ventilation fails to supply the perfused region
A 4-day-old, 35-week gestational age infant with symptoms of respiratory distress syndrome is receiving an FIO2 of 0.28 and nasal CPAP at 8 cm H2O. His vital signs, appearance, and fluid output have been stable for 12 hours. The results of a blood gas analysis obtained from an umbilical artery catheter are below:
pH 7.43 PaCO2 42 PaO2 129 HCO3 27 BE +3
Which of the following should a respiratory therapist recommend?
A. Maintain the present therapy and monitor the infant.
B. Discontinue CPAP and increase the FIO2 to 0.40.
C. Decrease CPAP to 5 cm H2O.
D. Decrease the FIO2 to 0.21.
C IS 100% CORRECT! Due to the hazards of increased CPAP over the hazards of increased FIO2, it should be your first priority to decrease the CPAP first before decreasing the FIO2. The reason why you would want to wean the CPAP first in this situation is due to the stress placed on the heart as well as the fact that 0.28 FIO2 could be a lot easier to wean
A patient is receiving PSV at 5 cm H2O with a PEEP of 5 cm H2O. The patient has shown no signs of distress, and vital signs have been stable for the last hour. Which of the following should the respiratory therapist do?
A. Obtain an arterial blood gas sample.
B. Extubate the patient.
C. Initiate a T-piece trial.
D. Maintain current settings.
THE ANSWER HERE IS B! This patient is ready to be extubated, the fact that their vital signs are stable, they are in no distress and have been on PSV for at least an hour (maybe more). In this case, it is safe to assume that a blood gas will be stable, in this case, extubate your patient.
A patient receiving long term positive pressure ventilation support exhibits a progressive weight gain and a reduction in hematocrit to 20, which of the following is most likely the issue?
A. Leukocytosis
B. Chronic Hypoxemia
C. Water retention
D. Leukocytopenia
THE CORRECT ANSWER IS C! FIRST LEUKOCYTOPENIA AND LEUKOCYTOSIS ARE POLAR OPPOSITES AND ACT AS DISTRACTOR FOR THIS QUESTION. THESE ARE TERMS WHICH YOU CAN IDENTIFY IF PATIENT HAS AN INFECTIOUS PROCESS. HYPOXEMIA INCREASES HCT LEVEL NOT DECREASES SO THE ONLY CHOICE IS WATER RETENTION.
A patient is admitted to the ER comatose with suspected smoke inhalation, after you have confirmed airway patency, which of the follow should you do first?
A. Measure Sp02
B. Initiate 100% 02
C. Obtain an ABG stat
D.Repeat CXR stat
THE CORRECT ANSWER IS B
A respiratory therapist is reviewing the report from a patient’s most recent PA chest radiograph. The right heart border can be identified and the right diaphragm is obscured. How should the patient be positioned for postural drainage and percussion over the affected area?
A. supine with pillow under the knees
B. lying on left side with head down 15 degrees and rotated 1/4 turn backward
C. in a semi-Fowler’s position
D. in a prone position with head down 25 degrees
THE CORRECT ANSWER HERE IS D. One tip to pass your boards is to know your landmarks on chest x-rays. Because the diaphragm is obscured, you should already be thinking about the lower segments of the lung. In this case, the right lower lobe may have an infiltrate of some kind. In order for the patient to obtain good airway clearance along with postural drainage, you must position them prone with the head down 25 degrees!
All of the following could cause suctioning to stop suddenly during tracheobronchial aspiration except:
A. Disconnected tubing
B. Clearance of secretions
C. A full suction reservoir
D. A mucous plug in the catheter
THE CORRECT ANSWER IS B: CLEARANCE OF SECRETIONS, GOOD JOB , WATCH FOR THOSE WORDS EXCEPT!!!
A Physician specifies in her respiratory therapy orders the following objective : RT to help, assess and overcome the patients humidity deficit , which of the following aerosol generators should you select for this patient?
A. Small volume sidestream jet nebulizer
B. Large reservoir heated jet nebulizer
C. SPAG
D. MDI
THE CORRECT ANSWER IS B: THE LARGE RESERVOIR AIR ENTRAINMENT JET NEB IS THE PRIMARY GAS POWERED AEROSOL GENERATOR USED TO PROVIDE HUMIDIFICATION TO THE RESPIRATORY TRACT.
68 year old male 192 lbs -87kg (185 cm )is in ICU due to respiratory failure, Vitals are normal , Sp02 on monitor is 98% on 50% Fi02. MD wants to institute mechanical ventilation. Using the new revised VT for the upcoming exam 6-10ml /kg determine this patient ventilator settings.
A. SIMV 10 500 60% PEEP +3
B. AC 14 700 50% +5 PEEP
C. SIMV 12 600 50% +5 PEEP
D. AC 8 900 40% +5 PEEP
THE CORRECT ANSWER IS C LETS BREAK THIS DOWN, THE PATIENT SHOULD WEIGH 184 NOT 192 , PATIENT NOT CONSIDERED OBESE ,HES NOT OVER 20LBS FROM HIS IBW , NOW YOU CAN CALCULATE LOW VT RANGE AND HIGH VT RANGE USING THE 6-10ML/KG THE RANGES ARE 522 TO 870ML , FOR THIS PATIENT ANY MODE WILL WORK, NOW SINCE PATIENT WAS PREVIOUSLY ON 50% FIO2 YOU SHOULD KEEP THE SAME FIO2 TO CONTINUE TO OXYGENATE THIS PATIENT ,ANY PEEP UNDER 10 WILL WORK TO START. REMEMBER THIS IS THE NBRC HOSPITAL, LOOK AT THE ENTIRE PICTURE AND SMALL DETAILS SUCH AS OXYGEN %* why not B? THE RATE IS IN THE UPPER LIMITS AND THERES NO INDICATION FOR THIS PATIENT TO HAVE RATE OF 14 , YOU WANT TO START CONSERVATIVELY WITH RATES WITH THE NBRC 10-14 NORMALLY 12 IS A GOOD PLACE TO START*
A patient receiving volume limited ventilation with a VT of 600mL and 10 of PEEP , PIP 45 cmH20 and a Pplat of 30 cm H20.Calculate this patients static compliance.
( ml/cm H20)
A. 30
B. 20
C.13
D.15
THE CORRECT ANSWER IS A : 600/ 30-10 =30ml/cmH20
An adult patient who suffered a cerebral contusion leading into massive cerebral edema status post MVA currently on mechanical ventilation in the trauma bay, MD orders ABG stat
pH 7.38 PaC02 42 Pa02 91 Total C02 content 25 BE 0 Sa02 96%
What would you recommend for this patient?
A. Maintain present settings
B.Change to pressure control ventilation
C. Increase minute volume on ventilator
D. Increase Fi02
THE CORRECT ANSWER IS C : INCREASING THE MINUTE VOLUME. ALTHOUGH THE ABG VALUES ARE WITHIN RANGE SOME EVIDENCE SUGGESTS THAT HYPERVENTILATING CLOSED HEAD TRAUMAS CAN BE BENEFIT TO THESE PATIENTS DURING THE FIRST 24-48 HRS OF THEIR MANAGEMENT, YOU WANT TO TARGET A PaCO2 of 25-30 AVERAGE THIS WILL LEAD INTO CEREBRAL VASOCONSTRICTION THEREFORE REDUCING ICP AND SWELLING.
A NICU nurse calls you to check an infant on a Tp02/Pc02 monitor due to rapid rise in Ptc02 and concurrent fall in PtcC02 to below 10 torr, The most likely cause of this issue is?
A. The presence of peripheral vasoconstriction
B. A defective sensor or sensor membrane
C. Interference due to bright ambient light
D. Air leakage around the sensor adhesive ring.
THE CORRECT ANSWER IS D: THE MOST COMMON PROBLEM WITH TRANCUTENOUS MONITORING IS AIR LEAKS AROUND THE ADHESIVE RING. AIR LEAK WILL CAUSE A FALL IN PtcC02 , IF LEAK IS LARGE THE PtC02 and PtcC02 VALUES WILL MIMIC THOSE IN THE ROOM AIR ( P02-150 TORR/ PC02 -0 TORR) SO THEREFORE REAPPLY THE SENSOR USING A NEW ADHESIVE RING.
Which obstructive disease will have a decreased DLCO?
A. Asthma
B. Sarcoidosis
C. Cystic Fibrosis
D. Emphysema
THE CORRECT ANSWER IS D , THE ONLY OBSTRUCTIVE DISEASE WITH A LOW DLCO IS EMPHYSEMA, THIS MAY BE A QUESTION ON YOUR BOARDS BE ON GUARD.
Patient arrived into the ED. You are paged stat. Patient has a history of kidney failure and CHF a Swan is inserted and PAP reads 32 mmHg
CXR reveals batwing pattern this patient is most likely to have ?
A. COPD Exacerbation
B. Bilateral Pneumonia
C. Pulmonary Embolism
D. Cardiogenic pulmonary edema
THE CORRECT ANSWER IS D, CARDIOGENIC PULMONARY EDEMA , THIS CAN BE DEADLY IF NOT TREATED APPROPIATELY SEEN IN PATIENTS WITH CHF AND LEFT VENTRICULAR FAILURE THEY PRESENT AT TIMES WITH FROTHY SECRETIONS INCREASE PAP , TREATMENT INCLUDE 100% 02 , CPAP OR BIPAP AND DIGOXIN TO INCREASE CONTRACTILITY OF THE LEFT HEART., DO NOT CONFUSE THIS WITH NON CARDIOGENIC PULMONARY EDEMA WHICH IS TOTALLY DIFFERENT NON CARDIOGENIC IS ASSOCIATED WITH ALI OR ARDS.
22 year old male arrives into the trauma bay intubated due to drug induced respiratory failure. Romazicon given IV push stat patient remains unconscious
ABG
pH 7.26
PaCO2 70
SaO2 96%
Fellow needs your expertise in in which VT to choose for this patient. You will recommend
A. VT > 10ml/kg
B. VT 8ml/kg
C. VT
THE CORRECT ANSWER IS B. IN THIS CASE THE ONLY OPTION IS A VT OF 8ML/KG , A IS TOO HIGH AS WELL AS D,
As you assess your ICU patient you notice in the monitor is not showing the normal dicrotic notch and possible that the Swan Ganz catheter is obstructed. What is this called?
A. wedge
B. Pressure dampening
C. pulmonic valve is closed
D. ballon is deflated
THE CORRECT ANSWER IS B PRESSURE DAMPENING THIS CAN BE CAUSE BY MULTIPLE THINGS BLOOD CLOTS , KINKS, BUBBLES , IF YOU SUSPECT OF A BLOOD CLOT FIRST ASPIRATE, FLUSH THE CATHERER AND LAST ROTATE.
Name one advantage of an UAC ( umbilical artery catheter)
ADVANTAGES INCLUDE BP MONITORING, LAB ANALYSIS- ABG’S AND CAN BE USE IF BABY NEEDS A TRANSFUSION,
A 6'4" 200 LBS male with normal lungs has a VT of 680ml and his current respiratory rate is 15. What is this patient alveolar ventilation? (L/min) A. 1.2 B. 7.5 C. 3.2 D. 7.2
THE CORRECT ANSWER D 7.2L/MIN. CALCULATION: VA = F X( VT - VD) 15 X ( 680-200) VA= 15X 480 VA= 7200mL or 7.2L/min
MD orders HeliOX for you patient STAT he orders 80%/20% mixture through a non- rebreather mask at 9 L/min, what is the actual gas flow to set this patient?
A. 12L/min
B. 14L /min
C. 15L/min
D. 18L /min
THE CORRECT ANSWER IS D , USING THE 1.8 MIXTURE FACTOR WILL GIVE YOU 16.2 WHICH IS LESS THAN NEEDED FOR 80/20 HELIOX MXITURE, THEREFORE 18L/MIN IS THE CORRECT ANSWER. you normally want a flow > 10L/min or flush with a mixture of 80/20 for a non rebreather mask so in this case you will take 10 x1.8 ( the mixture factor) = 18L/min, THE ACTUAL FLOW OF THE GAS MIXTURE IS MUCH HIGHER THAN THE ONE INDICATED IN THE FLOW METER, SO FOR THE EXAM THEY GIVE YOU A FLOW OF 12 AND A MIXTURE OF 80/20 THEN MULTIPLY 12 X 1.8 = 22L/MIN
Pulmonologist orders 0.25mL of 2.25% of racemic epi in 3mL NS via SVN for a child with croup in the ER. How many mg of racemic epi are you delivering for this child?
A. 5.6mg
B. 6.8 mg
C. 5.9mg
D. 5.0mg
THE CORRECT ANSWER IS A : 2.25% solution = 22.5 mg/ml. 22.5/4 (0.25ml) = 5.62mg
