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
What’s another name for OHS - obesity hypoventilation syndrome?
PICKWICKIAN SYNDROME
Which method is used to wean patients from APRV?
A. Drop and Stretch Method
B.Lower peak and mean airway pressures
C. Wean Fi02 to 30%
D. Increase P -low to 4 cm H20
THE CORRECT ANSWER IS A THE DROP AND STRETCH METHOD IS USED TO WEAN PATIENTS TO CPAP 10/PS 5-10 CMH20 , MUST DROP P-HIGH BY 1-2 CM H20 INCREMENTS AND T-HIGH ( INSPIRATORY PHASE) BY 0.5 SECS FOR EVERY 1 CM OF YOUR P-HIGH , THIS IS DONE EVERY 2 HRS IF ITS DONE TOO FAST IT CAN CAUSE ALVEOLI TO COLLAPASE. THEREFORE ONCE YOUR P-HIGH IS SET TO 10 CMH20 AND T-LOW IS 12-15 SECS THEN PLACE PATIENT ON CPAP 10/PSV 5-10CMH20. WIDELY USE FOR PATIENTS IN ARDS. APRV IS A BETTER CPAP MODE OR PEEP RELEASES THE PRESSURE INTERMITTENTLY, ALSO SIMULATES PCV AND INVERSE THIS IS WHY IS WIDELY USED IN ARDS ALI T-E FISTULAS ETC APRV ALSO USES A LONG INSPIRATORY TIME TO IMPROVE ALVEOLAR RECRUITMENT AND INCREASE GAS EXCHANGE FOR THOSE PATIENTS WITH REFRACTORY HYPOXEMIA.
The initial setting in APRV for your P-high should be a pressure of ?
A. < 35 cm H20
B. > 35 cm H20
C. 45 cm H20
D. > 45 cm H20
THE CORRECT ANSWER IS A. YOUR P-HIGH ( INSPIRATORY PRESSURE) ALMOST LIKE PRESSURE CONTROL VENTILATION MUST BE SET AT < 35CM H20 OR DESIRED Paw +3 CM H20
An ARDS patient is receiving ventilatory support with 100% Fi02 and 18 cm H20 PEEP with a plateau pressure of 32 cm H20 but still showing refractory hypoxemia,Which of the following methods should you recommend to the pulmonologist to improve oxygenation?
A. Switch to Inverse
B. Give a paralytic agent stat
C. Prone patient
D. Increase pressure limit
THE CORRECT ANSWER IS C: PRONE PATIENT IMMEDIATELY ( HIGHLY DISCUSSED DURING THE AARC CONFERENCE 2014) PATIENTS WITH GENERALIZED DECREASED IN LUNG VOLUME LIKE ARDS USE THE PRONE POSITION TO IMPROVE THEIR REFRACTORY HYPOXEMIC STATE. THE PRONE POSITION SHIFTS THE BLOOD FLOW TO REGIONS OF THE LUNG THAT ARE LESS SEVERELY INJURED AND BETTER AERATED. WITH PROPER PRONING BEDS , BY PLACING PATIENT IN ABDOMEN FACILITATES DIAPHARGM MOVEMENT AND WITH POSTIVE PRESSURE VENTILATION CAN DECREASE FURTHER INJURY IN OTHER PARTS OF THE LUNG.
While giving a treatment with an ultrasonic nebulizer you need to increase the mist and output for medication deliver and deposition what should do as an RT?
A. Decrease the amplitude
B. Increase Amplitude
C. Decrease blower flow
D. Check for high fluid level
THE CORRECT ANSWER IS B INCREASE THE AMPLITUDE, BY INCREASING THE AMPLITUDE WHICH IS YOUR VOLUME YOU WILL INCREASE OUTPUT.
You’ve just intubated a patient in the ICU with a using a Macintosh 4, and size 8 ET tube. What is the first tube confirmation technique?
A) Chest X-Ray
B) Observation
C) Colorimetric Co2 detector
D) Auscultation
THE CORRECT ANSWER IS B)
TRIGGER WORD “FIRST”. THIS IS DIFFERENT FROM ‘BEST’ OR ‘RELIABLE’
OBSERVATION IS THE FIRST THING THAT HAPPENS. THIS INCLUDES VISUALIZING THE TUBE PASSING THROUGH, AS WELL AS BILATERAL CHEST MOVEMENT
What flow rate will be required to achieve an I:E ratio of 1:4 with a VT of 500mL and rate of 12 in the SIMV/PSV mode?
A. 80L/min
B. 60L/min
C. 30 L/min
D. 45 L/min
THE CORRECT ANSWER IS 30L/MIN LETS CALCULATE THIS FORMULA ( VT 500 X 12 RATE) X ( I:E RATIO 1:4 = 1+4 =5) 6000 X 5 = 30,000 ROUND UP 30L/MIN
What is the inflection point? Discuss
THE CORRECT ANSWER IS AN ABRUPT CHANGE IN THE DIRECTION IN VENTILATOR LOOPS, ALSO IT DETERMINES THE BEST PEEP OR OPTIMAL PEEP FOR YOUR PATIENT. ,UPI AND LIP. UPPER INFLECTION POINT AND LOWER INFLECTION POINT.
Which of the following can negatively impact the accuracy of pulse oximetry
I Dark Nail Polish II Poor Perfusion III Bright light IV Low Light V Movement VI Carbon Monoxide
A) I,II,IV,V,VI
B) III,IV,V
C) VI
D) I,II,III,V,VI
THE CORRECT ANSWER IS D)
The only one that wouldn’t negatively impact would be low lighting. Low lighting can actually improve readings in some situations.
FOLLOW UP QUESTION:
WHICH ONE OF THESE IS MOST DANGEROUS?
CARBON MONOXIDE
Three days after intubation, a patient is extubated to 30% cool aerosol.
15 minutes later you notice marked stridor and mild sternal retractions.
Auscultation reveals diminished breath sounds. Pulse Ox 95%
What is the next appropriate intervention
A) Wait and see
B) Racemic Epi Treatment
C) Reintubation
D) Bipap
CORRECT ANSWER C)
TRIGGER WORD ‘MARKED’
THE NBRC CONSIDERS MARKED TO BE AN EMERGENCY SITUATION.
WHEN TAKING THE EXAM YOU WON’T BE ABLE TO RELY ON NORMAL PHYSICAL EXAMINATION TECHNIQUES. TERMINOLOGY IS KEY!!!
Using the modified Ramsay Scale, patient arrives into the ED being unable to assess location, name or time, unable to move upper or lower limbs with a 4 cm laceration in his head. which level is this patient upon arrival?
A. Level 3
B. Level 1
C. Level 4
D. Level 5
THE CORRECT ANSWER IS D,LEVEL 5 WILL DETERMINE PATIENT IS NOT ABLE TO TELL YOU HOW THEY FEEL OR IDENTIFY THEMSELVES. LEVEL 3 PATIENT WILL RESPOND TO VERBAL COMMANDS , LEVEL 1 PATIENT EXHIBITS ANXIOUNESS, AND RESTLESSNESS , LEVEL 4 NORMALLY THEY HAVE A BRISK RESPONSE TO STIMULI AND LEVEL 2, PATIENTS ARE CALM AND RESPONDING TO QUESTIONS.
Which of the medications should not be given to a patient with a recent diagnosis of Cushings Syndrome?
A. Spiriva
B. Ipratropium Bromide
C. DNAse
D. Budesonide
THE CORRECT ANSWER IS D. PATIENTS WITH CUSHINGS OR ADDISONS SHOULD AVOID GLUCORTICOSTERIODS OR CORTICOSTEROIDS WHICH MAY LEAD INTO ADRENAL SUPPRESSION IN THESE TYPE OF PATIENT
What law is utilized by pulse oximetry to measure saturation?
A) Boyle’s Law
B) Beer’s Law
C) Dalton’s Law
D) Cole’s Law
THE CORRECT ANSWER IS
B) Beer’s Law: Amount of light absorbed is proportional to the concentration of the light absorbing substance
THIS IS WHY LIGHT EFFECTS READINGS
BOYLE’S LAW STATES
THE ABSOLUTE PRESSURE EXERTED BY A GIVEN MASS OF AN IDEAL GAS IS INVERSELY PROPORTIONAL TO THE VOLUME IN OCCUPIES IF THE TEMPERATURE AND AMOUNT OF GAS REMAIN UNCHANGED WITHIN A CLOSED SYSTEM.
After completing a sleep study on a patient with central sleep apnea which respiratory stimulant will you recommend to the physician?
A. Meperdine
B. Hydrocortisone
C.Dopram
D. Flumazenil
THE CORRECT ANSWER IS C DOPRAM AS WELL AS MEDROXYPROGESTERONE , AMINOPHYILLINE , THEO AND CAFFEINE ARE GIVEN TO TREAT CSA. NORMALLY YOU GIVE FLUMAZENIL TO REVERSE THE EFFECTS OF BENZOS. SUCH AS ATIVAN,XANAX VERSED ETC.
Which side effect must you be aware when your ventilated patient is given Diamox?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
THE CORRECT ANSWER IS C METABOLIC ACIDOSIS, DIAMOX WHICH IS A CARBONIC ANHYDRASE INHIBITOR IS CONTRAINDICATED IN RENAL FAILURE OR THOSE PATIENTS IN RESPIRATORY FAILURE CAUSING EXCRETIONS OR BICARBONATE IONS CAUSING METABOLIC ACIDOSIS.
Which is the best way to control secretions in patients?
A. Mucolytics
B. Pulmozyme
C. Good Hydratrion
D. Sodium Bicarb
THE CORRECT ANSWER IS C. GOOD HYDRATION IS THE KEY TO CONTROL SECRETIONS IN PATIENTS, NOW IF YOU WANT TO MOBILIZE SECRETIONS YOU MUST GIVE MUCOLYTICS TO MOBILIZE SECRETIONS FROM THE AIRWAY.
Patient with AIDS presents to the ED and admitted to ICU, respiratory cultures reveal pneumocystis carinii, which medication do you recommend to treat this patient to the 2nd year resident?
A. Ancef IV
B. Amikicin IV
C. Toby via neb
D. Pentamindine
THE CORRECT ANSWER IS D, PENTAMINDINE NEBS , MUST MONITOR VITAL SIGNS CLOSELY WHILE GIVING THIS MEDS ALSO MUST USE A ONE WAY VALVE TO PREVENT CONTAMINATION TO OTHER HEALTH CARE WORKERS.
Which drug will decrease the cyclic GMP in COPD patients?
A. Tiotropium Bromide
B. Albuterol Sulfate
C. Fluticasone Propinate
D. Pirbuterol
THE CORRECT ANSWER IS A. TIOPROPIUM BROMIDE IS A PARASYMPATHOLYTIC WITH WORK AGAINST THE BRONCHOCONSTRICTION. ALL THESE DRUGS IN THIS CLASS BLOCK THE CHOLINERGIC PARASYMPATHETIC PATHWAY AND THE RECEPTORS.
Your ICU patient has a BP 68/42,HR 61, RR 25,on the vent SIMV 10 VT550 + 5 PEEP PSV 10 Fi02 45% Sp02 98% MD is asking for your recommendations to increase this patients blood pressure, which drug will you recommend?
A. Amiodarone IV
B. Atropine IV
C. Dopamine IV
D. Aldoment IV
THE CORRECT ANSWER IS C DOPAMINE AND DOBUTAMINE AND LEVOPHED ARE VASOPRESSORS IN WHICH INCREASE CONTRACTILITY AND CARDIAC OUTPUT THEREFORE INCREASING BP.,LEVOPHED IS WIDELY USED FOR THOSE PATIENTS IN CARDIOGENIC SHOCK.
Patient with a hyperkalemia at 7.8, which drug can lower this patients potassium level?
A. EPI
B. Atrovent continuous nebs
C. Albuterol continuous nebs
D. Tobramycin via neb
THE CORRECT ANSWER IS C ALBUTEROL CAN LOWER K LEVEL IN DOSES GREATER THAN 15MG.
Albuterol works to lower potassium concentrations by stimulating the release of insulin. This release of insulin shifts the potassium into the cells thus lowering the potassium level. Albuterol also stimulates the Na/k+ pump causing potassium to be shifted into the cells.
During an aerosol treatment with albuterol, a patient complains of dizziness and lightheadedness. The patient’s pulse increases from 70 to 85/min during the treatment. Which of the following notes should be recorded in the patient’s chart?
- The patient had tachycardia as a result of the medication.
- The patient was instructed to breathe more slowly during therapy.
- The patient complained of dizziness and lightheadedness.
- The nurse was notified of the patient’s response to therapy.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
HR of 85 is not tachycardic, you should however documents the patient’s response and their effort level. D is correct!!
A 34-week gestational age infant is receiving mechanical ventilation and the chest is being transilluminated. The transillumination device produces a small halo appearance at the point of contact with the skin. Which of the following does this indicate?
A. pneumothorax
B. pneumomediastinum
C. pneumopericardium
D. normal lung appearance
D IS CORRECT! I’ll explain why the others are not:
A is NOT because: When there is excessive air or fluid present, light transmission will be increased. Transillumination of the air-filled chest in the neonate with a pneumothorax results in lighting up the affected side of the chest.
B is NOT because: Transillumination will light up the chest in patients with pneumomediastinum
C is NOT because: Transillumination is not used to determine pneumopericardium
Halo is normal. …relate with Jesus if religious
A 27-year-old patient has a carboxyhemoglobin (COHb) level of 10.3% on admission to the burn unit. Oxygen by nonrebreathing mask should be
A. utilized until the patient’s COHb level returns to the normal range.
B. utilized until the patient’s oxygen saturation (SpO2) is >91%.
C. weaned to obtain an oxygen saturation (SpO2) >94%.
D. discontinued if the patient has concomitant COPD.
A IS CORRECT! CO has 200 times more affinity to hemoglobin than oxygen. 100% oxygen must be provided until the CO has been displaced. The patient’s Sp02 may show up as 100% on the monitor, but that DOES NOT MEAN their blood is saturated with oxygen in this case.
If a chest cuirass is hissing and unable to reach a max pressure ,what does this indicate?
A. too much pressure
B. low pressure
C. leaks
D. incorrect size shell for patient
THE CORRECT ANSWER IS C. IF YOU HEAR THIS SOUND IS INDICATIVE OF A LEAK IN THE SYSTEM. TROUBLESHOOT THE ISSUE
What is the correct flow for an OxyHood?
A. 1-6Lpm
B. 2Lpm
C. 7-14Lpm
D. 5Lpm
THE CORRECT ANSWER IS C 7-14LPM. YOU NEED HIGH FLOW O2 to WASH CO2
Patient with massive plate like atelectasis in both lungs Intubated
Settings AC VC 12 500 +5 PEEP 60%. Physician is asking for your recommendation to resolve this patients atelectasis what would you recommend?
A. Switch to PC
B. Increase PEEP to 10
C. Switch to SIMV PSV
D. Increase FiO2 to 70%
THE CORRECT ANSWER IS B. BY INCREASING PEEP YOU RECRUIT ALVEOLI. PRETTY BASIC MECHNICAL VENTILATION QUESTION. SWITCHING TO PC OR SIMV PSV WILL NOT IMPROVE THE PATHOLOGY WHICH IS ATELECTASIS OR INCREASING THE FIO2.
What value on a serum electrolyte panel approximates the bicarbonate level?
A. Anion Gap
B. Base Excess
C. Carbon Dioxide
D. Ammonia
Carbon dioxide approximates the bicarbonate level in blood chemistry. So, if you are drawing venous labs and you get a CO2 just like if it was a ABG CO2 are measured. HCO3 is measured based off the CO2.
What does P.I.S.S. stand for?
A. Pen Index Safety System
B. Point Index Safety System
C. Pin Index Safety System
D. All of the above
THE CORRECT ANSWER IS C. PIN INDEX SAFETY SYSTEM. USED IN HIGH PRESSURE AND COMMONLY SEEN IN E CYLINDERS.
When you place a patient on a Timed-cycled ventilator, automatically which type of patient will you be ventilating?
Adult or Infant?
INFANT!
**Adults are Volume Control Assist Controlled or PC pressure controlled with manipulated I:E ratio
Which of the following information may be obtained from a forced expiratory spirogram?
- FVC
- FEV1
- FRC
- RV
A. 1 and 2 only
B. 1 and 3 only
C. 2 and 4 only
D. 3 and 4 only
A IS CORRECT!! This is very easily collected as your equipment is very minimal, however, you must make sure the patient is giving their best effort!
The spirometry of a patient shows a 20% increase in forced expiratory volume in 1 second (FEV1) after receiving short-acting beta2 bronchodilator therapy. This indicates:
A. reversible obstructive airways disease.
B. restrictive lung disease.
C. insignificant response to bronchodilator.
D. fixed upper airway obstruction.
A! The increase indicates that the obstruction of the airways responds to short-acting beta-adrenergic agents
What is the correct Air to 02 ratio and factor for an Fi02 of 70%
A. 6:1, 1.6
B. 0:1, 1
C. 4:6.1, 5.3
D. 25:1, 26
THE CORRECT ANSWER IS A. EASY WAY TO RECALL 6+1=7 6:1 RATIO =70%
Or YOU CAN USE THE MAGIC BOX. 100-X/ X-20 where X = FIO2
A Thorpe tube flowmeter is not pressure compensated.
TRUE OR FALSE?
THE ABOVE STATEMENT IS FALSE. A THORPE TUBE FLOWMETER IS PRESSURE COMPENSATED AND THEY ARE CALIBRATED AT 50 PSI WITH GAS.
When a flowmeter is attached to a reducing valve is called________.?
THE CORRECT ANSWER IS REGULATOR!!
The purpose of cracking of the tank valve in an E cylinder is to?
A. Prevents debris from entering the regulator
B. To release pressure
C. Check performace
D. To determine tank is full
THE CORRECT ANSWER IS A!!
On a Bourdon Gauge flowmeter is the needle does not return to zero what does this indicate?
A. Nothing
B. Worn spring or spring fatigue
C. valve seat needs to be replaced
D. housing is working well
THE CORRECT ANSWER IS B !!
Which agent can cause MetHb?
A. Lidocaine
B. Prostacylins
C. Lasix
D. Levophed
THE CORRECT ANSWER IS A: METHB SYMPTOMS CAN BE CAUSE BYDRUGS SUCH AS NITRATES, DAPSONE, BENZACAINE SPRAY, AND LIDOCAINE, TREATMENT IS METHYLINE BLUE IV.
When you obtain an Sp02 measurement on a patient of 80% , assuming this is accurate measure of hemoglobin saturation , what is the patients approximate Pa02?
A. 40 torr
B. 50 torr
C. 60 torr
D. 70 torr
THE CORRECT ANSWER IS B. FOLLOWING THE LOGIC OF THIS QUESTION A AND D SHOULD BE ELIMINATED RIGHT AWAY , IF YOU ARE FAMILIAR WITH THE 40-50-60/70-80-90 RULE OF THUMB MIGHT RECOGNIZE ITS APPLICATION TO THIS QUESTION RIGHT AWAY AND KNOW THAT 80% SATURATION WILL GIVE YOU AN APPROX Pa02 OF 50 TORR.
When would you use a Bodaii adapter ?
THE MAIN PURPOSE OF A BODAII ADAPTER IS TO PREVENT LOSS OF VT, PEEP OR PRESSURE DURING BRONCH
While reviewing a PFT on a 56 year old smoker with emphysema and chronic bronchitis , you would expect the following findings?
A. Increased airway resistance and decreased lung compliance
B. Increased airway resistance and increased lung compliance
C. Decreased airway resistance and decreased lung compliance
D. Decreased airway resistance and increased lung compliance
THE CORRECT ANSWER IS B: AS YOU ALL KNOW PATIENTS WITH EMPHYSEMA AND CHRONIC BRONCHITIS WILL HAVE HIGH AIRWAY RESISTANCE THEREFORE ELIMIATE C AND D, NOW YOU HAVE 50/50 CHANCE HERE, AS YOU ALL KNOW AS WELL THAT EMPHYSEMA PATIENTS DO NOT HAVE DECREASED LUNG COMPLIANCE THEN YOU HAVE ELIMINATE A AND C MAKING YOUR ANSWER B!
A respiratory therapist reviews the ventilator flow sheet for a patient who is receiving VC ventilation. The ventilator settings have not been changed. The plateau and peak pressures are recorded below:
8PM PLAT 30cmH2O, PIP 35cmH2O
11PM PLAT 44cmH2O PIP 50cmH2O
Which of the following is indicated by this information?
A. The patient is ready to be weaned from the ventilator.
B. Water is accumulating in the patient circuit.
C. Airways resistance is increasing.
D. Lung compliance is decreasing.
D is Correct! Take a look at both the PIP and the Plateau Pressures, the increased PIP would at first make you think that airway resistance is increasing. Looking at the plateau pressure, however, we find this is also increased, indicating that lung compliance is decreasing
A 65-year-old patient who is 12 hours post-CABG complains of leg and chest pain and shortness of breath during incentive spirometer therapy. Breath sounds reveal coarse rhonchi in the lower lobes. The following data are available:
Which of the following should the respiratory therapist do?
- Recommend a chest radiograph.
- Administer oxygen at 4 L/min via nasal cannula.
- Notify the nurse of the patient’s complaints.
- Discontinue incentive spirometry.
A. 1, 2, and 3 only
B. 1, 2, and 4 only
C. 1, 3, and 4 only
D. 2, 3, and 4 only
A is the correct answer here!! Be aware, discontinuing incentive spirometer will not benefit the patient in the long run, especially a post-CABG patient. They need to be encouraged to deep breathe and cough. Their shortness of breath could be one of three things and it is up to you and the nurse to assess your patient for these: airway resistance (wheezing), pain (ask the patient), obstruction (secretions in the airways). Never discontinue deep breathing and coughing!
A patient is intubated for airway patency after a motor vehicle crash. A respiratory therapist then observes asymmetrical chest movement during inspiration, but no crepitus. Breath sounds are diminished on the left. Which of the following should the therapist immediately do?
A. Administer sigh breaths and suction the airway.
B. Decompress the left pleural space with a needle.
C. Stabilize fractured ribs in the left chest with weights.
D. Withdraw the endotracheal tube 2 centimeters.
D!! Immediately following intubation, asymmetrical chest movement should tip you off that right main stem intubation may have occurred (always order a chest X-Ray after you withdraw the tube!!)
A respiratory therapist collects the following data on a 58-year-old male who has been receiving VC, A/C ventilation for the past 24 hours following thoracic surgery:
The patient is alert and oriented. He has an SpO2 of 98% while receiving ventilation with the following settings:
The best weaning method for this patient is
A. a spontaneous breathing trial.
B. SIMV mode, mandatory rate 14, and tidal volume 600 mL.
C. PS ventilation at 20 cm H2O.
D. PC ventilation at 25 cm H2O and mandatory rate of 12.
A IS THE CORRECT ANSWER. Because this patient is post op for cardiac surgery with no mention of COPD or CHF, this patient should be weaned quickly from the ventilator. To assess readiness to wean, perform a spontaneous breathing trial.
According to the change of shift report, a patient in the ICU is receiving an FIO2 of 0.40 and PEEP of 5 cm H2O. Arterial blood gases are stable and weaning is being considered. While assessing the patient, a respiratory therapist notes the FIO2 is 0.60 and PEEP is 10 cm H2O. Which of the following actions should the therapist take FIRST?
A. Return the patient to the reported settings and document the findings.
B. Report the findings to the physician and complete an incident report.
C. Report the findings to the supervisor and complete an incident report.
D. Assess the patient and determine if the settings are appropriate.
D IS CORRECT! The therapist should have previously reviewed the orders for changes, but, if not done, the first obligation is to determine if the parameters are correct based on patient assessment!!
Patient has an RBC 6 mill/cu mm what is this patient’s estimated hemoglobin?
A. 12
B. 15
C. 18
D. 20
THE CORRECT ANSWER IS C. RULE OF 3. 6x3= 18 WHICH WILL GIVE YOU THE ESTIMATED HEMOGLOBIN LEVEL.
Which type of X-ray is best to detect a deep sulcus sign?
A. Lordotic
B. Anterior posterior
C. Oblique
D. Posterior Anterior
THE CORRECT ANSWER IS B ANTERIOR POSTERIOR CXR WILL USED TO DETECT A DEEP SULCUS SIGN OR ANOTHER WORD IS A PNEUMOTHORAX
What is the current treatment for a patient with rhabdomylosis?
A. Methylene blue
B. IVF with HCO3-
C. IV Dextrose
D. IVF only
THE CORRECT ANSWER IS B. RHABDOMYLOSIS IS A CONDITION WHICH INVOLVES THE BREAKDOWN OF MUSCLE TISSUE DUE TO SOME TYPE OF TRAUMA OR INACTIVITY. THIS CAN OCCUR WITH ALOT OF YOUR PATIENTS IN ICU. THE TREATMENT OF CHOICE IS IVF WITH BICARBONATE. Very common to developed in your ICU patients. Look at their urine output for dark urine.if you see this notify the RN because the patient is developing rhabdomylosis
What is the normal magnesium level? mEq/L
A. 1.4-2.0
B. 3.0-4.5
C. 1.0-1.3
D. 5.0-6.7
THE CORRECT ANSWER IS A!!
What's the normal BNP level (B-Type Natriuretic Peptide)? pg/mL A. More than 400 B. Less than 300 C. More than 200 D. Less than 520
THE CORRECT ANSWER IS B < 300. THE BNP INDICATES OR RULES OUT MI IN EMERGENT CARDIAC ISSUES.
45 year old male s/p MVA
being mechanically ventilated on PC. His pulmonary compliance has decreased over the past 3 days. Inverse ratio ventilation has been initiated.
Diagnostic studies: Echo with bubble study confirms a patent foremen ovale.
Mechanical vent: PEEP 18
FiO2 60%
What should you do next?
A. Administration of Nipride
B. Perform a V/Q scan
C. Start iNO
D. Take patient to surgery for PFO closure.
THE CORRECT ANSWER IS C. START iNO. NITRIC OXIDE WOULD KEEP PULMONARY PRESSURE DOWN AND DECREASING THE NEGATIVE EFFECTS OF THE PFO.
56 year female with a PaO2/FiO2 ratio of 154 without any previous history of cardiac disease in admitted to the CVICU and has a PAC in place
Her hemodynamics are:
CVP 14 mmHg PCWP 12 cmH20 PAP 30 mmHg BP 98/58 HR 120
What would you recommend?
A. Protonix
B. Romazicon
C. Sildenafil
D. Flolan
THE CORRECT ANSWER IS D. EXCESSIVE PAP IS CAUSING INTRACARDIAC SHUNTING. THIS CAN BE RESOLVED BY GIVING FLOLAN WHICH WILL SELECTIVELY DILATE THE PULMONARY VESSELS AND LOWER PAP.
This test may help detect the presence of antibodies to HIV:
A. ELISA
B. Protein electrophoresis
C. T Cell count
D. ESR
A!!
In the treatment of asystole, this medication can be repeated every 3-5 mins
A. Adenosine
B. Epinephrine
C. Vasopressin
D. Lidocaine
B!!
In the treatment of symptomatic bradycardia, the dose of this medication is 0.5 mg. It can be repeated in 3-5 mins
A. Atenolol
B. Epinephrine
C. Magnesium
D. Atropine
D!!
The typical dose of this medication is 0.4 to 2 mg for narcotic reversal
A. Naloxone (Narcan)
B. Vasopressin
C. Metoprolol
D. Amiodarone
A!!
This medication is indicated in the treatment for the following arrhythmias: Pulseless VT/VF, VT with a pulse, and wide complex tachycardia
A. Lidocaine
B. Adenosine
C. Magnesium
D. Epinephrine
A! Lidocaine. Usually given at 1 - 4 mg/min. Observe for neurologic symptoms. Decrease rate in the elderly and those with impaired liver function.
You are called to do an ABG stat in the ER
Results pH 7.35 PaC02 25 Pa02 40 HC03 14 BE -10 Sa02 74% Co-OX OxyHb 97%, CarboxyHb 1%,MetHb 1%, Hb 13.8
What should you do after obtaining these results?
A. Report the Sa02 value at 73%
B. Report the Sa02 value at 97%
C. Recommend Bicarb Stat
D. Recalibrate the instrument and repeat
THE CORRECT ANSWER IS D IN THIS QUESTION YOU MUST LOOK CAREFULLY THERES A LARGE DISCREPANCY BETWEEN THE ABG ANALYZERS Pa02 AND Sa02 40 and 73% AND THE OXYHB IS AT 97% ONE OF THESE READINGS ARE WRONG SINCE THERES NO MORE ADDIONAL INFO ABOUT THIS PATIENT THE ONLY OPTION HERE IS TO RECALIBRATE AND REPEAT ANALYSIS.
Which symptom of clinical evidence patients have normally with MetHgb?
A. Abdominal pain
B. Diarrhea
C. Central Cyanosis
D. Fever
THE CORRECT ANSWER IS C CENTRAL CYANOSIS, ANOTHER SYMPTOMS FOR METHB ARE FATIGUE, DYSPNEA, AND HEADACHE
What is the normal glucose level for a term infant? mg/dL
A. less than 30
B. less than 15
C. over 30
D. less than 5
THE CORRECT ANSWER IS C >30: BE ON GUARD THIS QUESTION WILL COME UP IN YOUR SIMS,IN A DIFFERENT MANNER , ALWAYS CHECK THE GLUCOSE LEVEL ON YOUR BABY!!!! **purpose of knowing this? It’s for their brain function, hypoglycemia can cause seizures and such in the neonate/infant. Respiratory wise, they can’t regulate their body temp and then require more oxygen
