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Bundle of TMC QUESTION AND ANSWERS 2022/2023
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TMC EXAM 4 question and answer 100% correct
Which of the following equipment is most helpful at measuring FRC in a patient who has significant non-ventilated lung spaces? A. nitrogen analyzer for ... [Show More] a nitrogen washout test B. helium analyzer for a helium dilution test C. plethysmograph D. peak flow meter The correct answer is : C Explanation : You can determine FRC in three different ways - body box, nitrogen washout, or helium dilution. If someone has non-ventilated lung space, nitrogen washout and helium dilution are not helpful and may be inaccurate. FRC determined by body box will be higher because it can access non-ventilated lung space and therefore is more accurate. The respiratory therapist is making a home visit to evaluate an oxygen-dependent patient. The patient has 3+ pitting peripheral edema and has not followed the physician's orders to limit fluid intake. You would expect which of the following hemodynamic values? A. elevated PCWP with a low cardiac output B. low mean arterial pressure C. elevated right sided preload with a normal to low right ventricular after load D. reduced cardiac index The correct answer is : C Explanation : Right-sided preload is another name for CVP (central venous pressure). Peripheral edema is one of the signs associated with right heart failure, which results in an elevated CVP with a normal or low pulmonary artery pressure (PAP), a.k.a. right ventricular afterload. A ventilator-dependent patient is scheduled for an MRI, which will require a transport of 90 minutes. The patient is receiving humidification with a heated- humidification system. A transport ventilator is available. How should a respiratory therapist assure that humidification will be provided to the patient during the MRI procedure? A. Provide a pass-over humidifier B. Provide an HME C. Provide ventilation with a manual resuscitator D. Use the same humidification system in use on the primary ventilator The correct answer is : B Explanation : A heat moisture exchanger (HME) is appropriate for a transport of only 90 min. Furthermore, the scenario does not suggest that the patient has thick, retained secretions, therefore an HME may be applied. Which of the following conditions would benefit most from polysomnography? A. COPD B. congestive heart failure C. suspected increased airway resistance D. obesity with increased day-time sleepiness The correct answer is : D Explanation : Polysomnography is another word for sleep study. An obese patient who has daytime sleepiness would benefit most from polysomnography. Keep in mind that Polysomnography is the study of the problem - not the solution. But it must be done for diagnostic purposes and in order to find the adequate CPAP setting. Which of the following can accurately be stated about a widening alveolar-arterial oxygen gradient? A. decreased venous admixture B. onset of oxygen toxicity C. increased intrapulmonary shunting D. improving V/Q mismatch The correct answer is : C Explanation : A normal alveolar arterial oxygen gradient is below 65 mmHg. When that gradient rises to 200, 300, 400, or more, then you have what is called shunting. If the A-a gradient is less than 300 it's technically called a ventilation perfusion (VQ) mismatch. But generally speaking, as the gradient widens it can properly be said that there is an increase in pulmonary shunting. How many hours will an H cylinder with 1400 psi last for a patient receiving oxygen at 7 lpm? A. 6 hours B. less than 1 hour C. 10 hours D. 4 hours The correct answer is : C Explanation : And H cylinder has a tank factor of 3.14. 3.14x1400 PSI = 4396 L. 4396 L / 7 L per minute = 628 min. 628 min./ 60 min.= 10.4 hours, or about 10 hours. When you get an answer that is not exact, pick the closest number possible. It is common on the exam not see the exact answer from your calculation. This is because the NBRC knows that you're estimating. The respiratory therapist notes a fall in pulse from 80/min to 60/min with a proportional drop in blood pressure during a suction procedure. Which of the following would be the most likely cause of these observations? A. Copious secretions B. Vagal reflex C. Transient hypoxemia D. Suction pressure is too high The correct answer is : B Explanation : During suctioning, a patient's heart rate may fall. This is a normal physiological response associated with the vagal reflex, or the vagal nerve response. This response will also lower blood pressure. A bronchopleural fistula on a patient receiving mechanical ventilation with a chest tube drainage system in place would be most likely be indicated by which of the following observations? A. occasional low-exhaled volume alarm B. high pressure ventilator alarm C. excess bubbling in the water seal chamber D. I:E ratio alarms The correct answer is : C Explanation : A bronchopleural fistula is essentially a leak from the airway in the lungs to the pleural space. This condition can result in two things - one) a low-pressure or low-volume alarm, 2) excess bubbling in the water seal chamber of the chest tube drainage system. When you look at the answers, a leak would not cause a high pressure alarm. The best test determination for a forced vital capacity maneuver is done by which of the following calculations? A. FEV1 + FVC B. SVC + FVC C. TLC - FVC D. FEV1/FVC The correct answer is : A Explanation : To determine the best trial or best patient effort for a forced vital capacity maneuver, the trial with the highest sum of the FEV1 and FVC is considered to be the patient's best effort. Which of the following medications would be helpful at reversing the affect of a benzodiazepine medication? A. Narcan B. Romazicon C. Versed D. Norcuron The correct answer is : B Explanation : Romazicon is the only medication on the list that can reverse the effects of benzodiazepines. A mechanically ventilated patient who with an 8.0 mm trachestomy tube in place has a strong cough, but is unable to expectorate thick, dry secretions. During an attempt to suction the patient, the tube becomes dislodged, but promptly placed back to its proper position. Following the procedure, the respiratory therapist notes dry crackles in the right upper lobe and neck upon auscultation. These breath sounds would most likely be associated with A. retained secretions in the airway B. pneumothorax C. subcutaneous emphysema D. bleb emphysema The correct answer is : C Explanation : In this scenario the respiratory therapist should assume that while the tube was dislodged, breaths delivered by the ventilator caused air to be forced into soft tissue areas under the skin outside of the trachea. This condition is known as subcutaneous emphysema. Auscultation reveals dry crackles and crepitus upon palpation. An emergency room physician orders an arterial blood gas with Carboxyhemoglobin level. This exam will help the physician determine which of the following? A. CO poisoning B. Presence of sickle cell anemia C. Carbon dioxide serum levels D. Presence of fetal hemoglobin The correct answer is : A Explanation : Carboxyhemoglobin (COHb) levels are determined with an instrument called a co-oximeter, which directly measures arterial blood COHb. Both carbon monoxide poisoning and evidence of smoking, or exposure to cigarette smoke can be determined with the COHb level. What is the relative humidity of the inspired gas of a patient who is intubated if the humidity deficit is 33 mg/L? A. 50% B. 75% C. 100% D. 25% The correct answer is : D Explanation : There are 44 mg of water per liter of gas if the gas is at 100% relative humidity. If you have only 11 mg/L of gas (deficit of 33 mg) then you have only 25% relative humidity because 11 mg is 25% of 44. A COPD patient who has bilateral expiratory wheezing would benefit most immediately from which of the following medications? A. Tilade (Nedocromil) B. Budesonide (Pulmicort) C. Albuterol D. Acetylcysteine (Mucomyst) The correct answer is : C 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. A patient with acute epiglottitis is awaiting transport to surgery for a tracheotomy under anesthesia. SpO2 is 88% on room air. While waiting the patient would benefit most from which of the following? A. heliox therapy with 60%/40% mixture B. high flow Venturi mask set at 50% C. simple mask at 6 L/min D. nasal cannula at 2 L/min The correct answer is : A Explanation : The patient has an arterial oxygen saturation of 88% on room air. This is consistent with hypoxemia and indicates a need for supplemental oxygen. Because the patient has acute epiglottitis, Heliox therapy is appropriate to reduce airway resistance. Additionally, the patient would benefit from an adult therapeutic dose of oxygen, which starts at 40%. Therefore, 60-40% Heliox mixture is most appropriate. An MVA victim with severe facial trauma has been trached in the emergency room. The respiratory therapist should now provide A. heated/humidified aerosol at FIO2 1.0 B. cool aerosol at FIO2 0.50 C. heated/humidified aerosol at FIO2 0.50 D. cool aerosol at FIO2 1.0 The correct answer is : A Explanation : In this example, the patient's natural upper airway has been by-passed and the respiratory therapist should be concerned about delivery of cold dry gas. Heat and humidification are the therapist's primary concern. 100% oxygen is also necessary due to the emergent nature of the patient's condition having suffered a motor vehicle accident. A patient is receiving a positive pressure treatment through a fenestrated tracheostomy tube. To prepare the patient to be able to speak, the respiratory therapist should FIRST A. inflate the cuff B. insert the inner cannula C. deflate the cuff D. cap the tube The correct answer is : C Explanation : When a patient has a fenestrated tracheostomy tube and requires transitioning from a positive pressure ventilation configuration to a speaking configuration, the first step is to deflate the cuff. The respiratory therapist should discontinue beta sympathomimetic aerosol therapy in which of the following scenarios? A. A pediatric patient does not cooperate with the therapy B. An asthmatic patient has a peak flow rate that is 75% of predicted or better C. The patient experiences nausea and tingling in their extremities D. A COPD patient is smoking cigarettes between therapy The correct answer is : C Explanation : Beta sympathomimetic medications such as albuterol, Alupent, Xopenex, etc., should be discontinued if the patient does not tolerate them well. Tingling in the extremities, nausea, & increased heart rate greater than 20 bpm, are all examples of poor tolerance. Prior to obtaining an MIP value with a pressure manometer, the respiratory therapist notes the needle is pointing at a positive pressure of 7 cm H2O prior to the maneuver. During the MIP maneuver, the needle reaches -20 cmH2O. The therapist should A. record an MIP of -27 cmH2O B. repeat the maneuver five more times C. record an MIP of -13 cmH2O D. record and MIP of -20 cmH2O The correct answer is : A Explanation : Although -20 cmH2O is observed on the pressure manometer, the real pressure being produced is -27 cmH2O. This is because the manometer is not properly calibrated to zero. Therefore, an adjustment must be accounted for when taking a measurement. You must add the number that the needle is pointing to prior to the maneuver to the number achieved by the patient during the maneuver to get an accurate measurement. A patient who is receiving mechanical ventilation in the assist/control mode with a PEEP of 10 cmH2O is being manually ventilated during a transport to CT scan. During the transport, the respiratory therapist notices desaturation and feels the PEEP should be increased. To do this, the therapist should A. increase oxygen flow rate to the bag B. cover the exhalation port C. squeeze the bag at a higher rate D. increase the tension on the PEEP spring The correct answer is : D Explanation : To increase the PEEP of the patient receiving positive pressure ventilation by manual resuscitation bag, one must tighten or increase the tension of the PEEP spring. To do this, the PEEP valve should be turned clockwise. [Show Less]
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TMC Exam Review question and answers 2022/2023 rated A+
Which of the following tests would be most useful in diagnosing a pulmonary emboli? a. Chest x-ray b. PFT c. Ventilation-perfusion scan (V/Q) d. ABG ... [Show More] c. V/Q scan it would show a lack of blood flow in the affected region of the pulmonary circulation While examining a patient in the ICU, you note that he appears somewhat edematous, and the nurse has indicated that the patient's urine output is "minimal." In which section of the record would you find the patient's fluid balance? a. Physician orders b. Consent form c. Laboratory results d. Nurses notes and flow sheet d. Nurses notes and flow sheet Which of the following physical findings would you expect to see in an alert but anxious patients with asthma early in the course of an attack? a. Respiratory acidosis b. Respiratory alkalosis c. Clubbing d. Cor pulmonale b. Respiratory alkalosis hyperventilation decreases CO2 In the lab results section of a patient's record, the overall WBC count is shown as 22,000 for a febrile patient who appears acutely ill and in moderate respiratory distress. What is the most likely diagnosis? a. Bacterial pneumonia b. Emphysema c. Pulmonary embolus d. Pulmonary fibrosis a. Bacterial pneumonia A PET scan would be most useful in the diagnosis of which of the following conditions? a. Bronchogenic carcinoma b. Chronic bronchitis c. Pulmonary fibrosis d. Smoke inhalation a. Bronchogenic carcinoma PET scan is a nuclear imaging technique used in the diagnosis and staging of tumors Negative inspiratory force (NIF) is most useful in the determination of which of the following? a. Airway resistance b. Functional residual capacity c. Respiratory muscle strength d. Sustained maximal inspiration c. Respiratory muscle strength A 23 year old fire fighter is admitted with suspected smoke inhalation. You place him on a nonrebreathing mask. What is the most appropriate method of monitoring his oxygenation? a. ABG analysis b. CO-oximetry c. Pulse oximetry d. Calculation of P(A-a)O2 b. CO-oximetry Which of the following notes in the maternal medical and/or obstetric history increases the likelihood of a high-risk pregnancy? a. Weight gain b. First pregnancy c. Regular exercise d. Tobacco smoking d. Tobacco smoking Sputum culture and sensitivity would be indicated in the evaluation of which of the following clinical conditions? a. Pulmonary edema b. Bacterial pneumonia c. Bronchiectasis d. Empyema b. Bacterial pneumonia A polysomnography report for a patient with a history of excessive daytime sleepiness indicates an average of 25 apnea/hypopnea events per hour, with most events showing continued efforts to breathe. Which of the following statements is most consistent with this observation? a. Moderate central sleep apnea b. Mild obstructive sleep apnea c. Moderate obstructive sleep apnea d. Severe obstructive sleep apnea c. Moderate obstructive sleep apnea mild AHI 5-14 moderate AHI 15-30 severe AHI >30 Which of these conditions is associated with jugular vein distention? a. Cor pulmonale b. Pneumonia c. Simple pneumothorax d. Septic shock ... You palpate the patient's neck and notice that the trachea is shifted to the patient's left. Which of the following conditions could explain this finding? a. Left ventricular enlargement b. Left upper lobe collapse c. Right lower lobe collapse d. Pleural effusion on the left ... On reviewing the results of the attending physician's physical examination of a patient's chest, you note a "dull percussion note and bronchial breath sounds- LLL." All of the following are potential problems except: a. Infiltrates b. Atelectasis c. Consolidation d. Pneumothorax ... You hear bronchial breath sounds over the patient's right middle lobe. Which condition is probably present? a. Emphysema b. Asthma c. Pneumonia d. Pleural effusion ... Upon exam of an acutely dyspneic and hypotensive patient, you note the following (all limited to the left hemithorax): reduced chest expansion, hyperresonance to percussion, absence of breath sounds and tactile remits, and a tracheal shift to the right. These findings suggest: a. Left-sided pneumothorax b. Left-sided consolidation c. Left lobar obstruction/atelectasis d. Left-sided pleural effusion ... During an interview with your patient, you determine that she is disoriented to time, place, and person. What may explain this finding? a. Respiratory alkalosis b. Severe hypoxemia c. Metabolic acidosis d. Hyperthermia ... [Show Less]
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NBRC Mock TMC Exam Review question and answers 100% correct
A patient is receiving O2 from an E cylinder at 4 L/min through a nasal cannula. The cylinder pressure is 1900 psig. How long will the cylinder run until i... [Show More] t is empty? A. 47 min B. 1.7 h C. 2.2 h D. 3.6 h E cylinder = 0.28 1900x0.28/4 = 133/60 = 2.21 Answer: C. 2 hours, 21 minutes After the Respiratory Therapist sets up a nonrebreathing mask on a patient at a flow rate of 10 L/min, the reservoir bag collapses before the patient finishes inspiring. The RT should do which of the following? A. Change to a simple mask at a flow rate of 10 L/min B. Remove the one-way valve from the exhalation port. C. Place the patient on continuous positive airway pressure (CPAP) D. Increase the flow rate to 15 L/min D. Increase the flow rate to 15 L/min A patient with carbon monoxide (CO) poisoning can best be treated with which of the following therapies? A. Nasal Cannula at 6 L/min B. Simple O2 mask at 10 L/min C. CPAP and 60% O2 D. Nonrebreathing mask D. Nonrebreathing mask The following blood gas levels have been obtained from a patient using a 60% aerosol mask. pH: 7.47 PaCO2: 31 mmHg PaO2: 58 mmHg What should the RT recommend at this time? A. Place the patient on CPAP B. Increase the O2 to 70% C. Intubate and place the patient on mechanical ventilation D. Change to a nonrebreathing mask A. Place the patient on CPAP Given the following data, what is the patient's total arterial O2 content? pH: 7.41 PaCO2: 37 mmHg PaO2: 88 mmHg HCO3: 26 mEq/L SaO2: 95% Hb: 14 g/dL A. 12 mL/dL B. 14 mL/dL C. 16 mL/dL D. 18 mL/dL (Hb x 1.36 x SaO2) + (0.003 x PaO2) (14 x 1.36 x 0.95) + (0.003 x 88) 18.088 + 0.264 = 18.352 Answer: D. 18 mL/dL The respiratory therapist receives an order to set up a moderate level of O2 on a patient who arrives in the ED breathing at a rate of 35 breaths/min. Which of the following O2 delivery devices is most appropriate to use in this situation? A. Simple O2 mask at 10 L/min B. Nasal cannula at 4 L/min C. NRB Mask at 15 L/min D. Air-entrainment mask at 40% O2 D. Air-entrainment mask at 40% O2 A severe COPD patient arrives in the emergency department on a 2 L/min nasal cannula. Arterial blood gas results follow: pH: 7.32 PaCO2: 67 mmHg PaO2: 62 mmHg HCO3: 38 mEq/L Which of the following is the most appropriate recommendation? A. Increase the liter flow to 4 L/min B. Maintain the current O2 level C. Institute noninvasive positive pressure ventilation (NPPV) D. Place on a NRB mask at 12 L/min B. Maintain the current O2 level The physician has ordered O2 to be set up on a patient who has a spontaneous tidal volume of 500 mL and an inspiratory time of 1 second. Which of the following O2 delivery devices will deliver a flow that meets or exceeds this patient's inspiratory flow? A. 35% air-entrainment mask at 6 L/min B. 60% aerosol mask at 12 L/min C. NRB mask at 15 L/min D. Simple O2 mask at 10 L/min 500 mL = 0.5 L 0.5/1 = 0.5 L/s (change L/s to ?/min by multiplying by 60 0.5 L x 60= 30 L/min Select the device that delivers a flow of at least 30L/min A. 35% air-entrainment mask at 6 L/min A patient breathing 50% oxygen has a PaO2 of 248 torr. Which of the following should the RT recommend? A. Discontinue O2 therapy B. Decrease the oxygen to 30% C. Titrate oxygen to maintain an SpO2 > 93% D. Repeat the blood gases because the PaO2 is not possible on this FiO2. C. Titrate oxygen to maintain an SpO2 > 93% Explanation: A PaO2 of 250 torr is normal on 50% O2. Remember, to determine the normal PaO2 on any given O2%, multiply the O2% by 5. This is an approximation. If titrate was not a choice, then you would discontinue the oxygen. A patient is receiving 30% oxygen via an air-entrainment mask at a flow of 5 L/min. The total flow delivered by this device is which of the following? A. 36 L/min B. 45 L/min C. 54 L/min D. 60 L/min (*Use 21 with O2 % less than 40%) (100- 30%)/ (30%-*21) = 70/9 = 8/1 or 8:1 ratio 8+1= 9 9x5 = 45 L/min B. 45 L/min Secretions tend to become thicker if the inspired air has which of the following characteristics? A. A relative humidity of 100% at body temperature B. 32 mg H2O per liter of gas C. A water vapor pressure of 47 mmHg D. 48 mg H2O per liter of gas B. 32 mg H2O per liter of gas A patient receiving 38 mg H2O per liter of gas from a nebulizer has a humidity deficit of which of the following? A. 6 mg/L B. 9 mg/L C. 12 mg/L D. 18 mg/L 44-38= 6 A. 6 mg/L After connecting a nasal cannula to the humidifier outlet, you kink the tubing and hear a whistling noise coming from the humidifier. Which of the following most likely has caused this? A. The humidifier jar is cracked B. The capillary tube in the humidifier is disconnected C. The humidifier has no leaks D. The top of the humidifier is not screwed on tightly C. The humidifier has no leaks You notice that the patient's secretions have become thicker and more difficult to suction since the ventilator humidifier was replaced with an HME. The RT should recommend which of the following? A. Increase inspiratory flow B. Decrease the temperature to the HME C. Replace with a new HME D. Replace the HME with a conventional heated humidifier D. Replace the HME with a conventional heated humidifier Which of the following are indications for cool, bland aerosol therapy? 1. A cough must be induced for sputum collection 2. Mobilization of secretions must be improved 3. Postextubation inflammation of the upper airway must be treated A. 1 only B. 1 and 3 only C. 2 and 3 only D. 1, 2, and 3 D. 1, 2, and 3 You notice that very little mist is being produced by a nebulizer attached to an aerosol mask. Which of the following could be responsible for this? 1. The liter flow is too high 2. The nebulizer jet is clogged with lint 3. The filter on the capillary tube is obstructed A. 1 only B. 2 only C. 1 and 3 only D. 2 and 3 only D. 2 and 3 only An autoimmune compromised patient is to be placed on oxygen with a humidity/aerosol device. Which of the following devices is most likely to deliver contaminated water to the patient? A. Heated cascade humidifier B. Bubble humidifier C. Heated wick humidifier D. Heated jet nebulizer D. Heated jet nebulizer To minimize an increased airway resistance produced by high-density aerosol inhalation, the RT should recommend which of the following? A. Administer a bronchodilator along with the aerosol B. Instruct the patient to breathe through the nose C. Use a heated nebulizer to deliver the aerosol D. Perform chest physiotherapy after the aerosol treatment A. Administer a bronchodilator along with the aerosol The RT is asked to recommend a humidifier that will be able to provide the highest water vapor content to the patient's airway. Which of the following humidifiers should the therapist select? A. Pass-over B. HME C. Heated wick D. Bubble C. Heated wick A heated humidifier is delivering 100% body humidity to a patient's airway. What volume of water is being delivered? A. 24 mg/L B. 37 mg/L C. 44 mg/L D. 47 mg/L C. 44 mg/L A patient is experiencing cardiac arrhythmias and muscle weakness. An arterial blood gas determines that the patient is in metabolic alkalosis. Which of the following is the most appropriate lab value to assess at this time? A. WBC B. BUN C. Plasma protein D. Potassium D. Potassium The term used to describe a condition is which a patient has difficulty breathing while in the supine position is which of the following? A. Orthopnea B. Hypopnea C. Eupnea D. Bradypnea A. Orthopnea A patient enters the emergency department, and on initial examination the RT observes paradoxical chest movement. Which of the following should the therapist suspect? A. Pulmonary edema B. Pneumonia C. Flail chest D. Pleural effusion C. Flail chest Perfusion in the extremities [Show Less]
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TMC exam question and answers with complete solution
Romazicon (flumazenil) -antidote for benzodiazepines such as -GABA receptor antagonist - It can treat drowsiness caused by sedatives following surgery... [Show More] or drug overdose. Which of the following can be used to estimate the level of Hemoglobin? RBC -RBC X 3 = hemoglobin 00:03 01:24 with the use of pressure control the most important alarm is low volume -because the ventilator does not care about volume, the practitioner must. The most important alarm on a volume-cycled ventilator would be high pressure alarm Which of the following would be most effective at resolving a humidity deficit for a patient who is intubated with an 8.0-mm endotracheal tube wick or concha Which of the following would be most helpful for a patient with fixed upper airway obstruction? A. beta II agonist medication B. heliox therapy C. aerosolized epinephrine D. corticosteroids B. heliox therapy Heliox therapy is most appropriate. Helium, when combined with oxygen, is less viscous than pure oxygen or room air, which is made up mostly of nitrogen. This allows patients to breathe in gases with less airway resistance. -fixed obstruction means it cannot be resolved simply with bronchodilators or other immediate methods. which one should be treated first, ventilation or oxygenation ventilation the patient is over oxygenating AND hyperventilating which one should you treat first? over oxygenation -To address over-oxygenation one can either change the PEEP or the FIO2. You will always want to lower the FIO2 below 60% before changing PEEP. ways to decrease CO2 increase the Vt increase the rate remove dead space What would occur on a time-cycled ventilator with a fixed rate if the inspiratory flow rate were increased? A. increase in tidal volume B. decrease in inspiratory time C. decrease in tidal volume D. increase in inspiratory time A. increased in tidal volume On a time-cycled ventilator inspiratory time is predetermined. So, if the flow rate is increased while the mandatory rate is unchanged, the result would be an increase in tidal volume. Which of the following is the most significant complication of bronchoscopy? A. laryngospasms B. hypotension C. vagal nerve stimulation D. coughing A. laryngospasm -This tendency may be reduced by administering aerosolized Lidocaine or any other tissue numbing agent prior to the procedure. What is the respiratory therapist observing if monitoring the total amount of gas exhaled in 60 seconds after excluding dead space? A. minute ventilation B. dead space ventilation C. alveolar minute ventilation D. maximum voluntary ventilation c. alveolar minute ventilation Examining the breathing rate over a period of 60 seconds and multiplying it times the tidal volume gives you minute ventilation. If deadspace is subtracted from that volume then what is being observed is alveolar minute ventilation. 00:02 01:24 education and direction for the performance of positive expiratory pressure (PEP) therapy Proper instructions for the use of a PEP therapy device includes "inhaling deeply and exhaling actively". equations to determine cardiac output fick equation co= SVxHR Which of the following would result in an increase in pulmonary capillary wedge pressure? A. decrease in pulmonary vascular resistance (PVR) B. cor pulmonale C. dehydration D. mitral valve stenosis D. mitral valve stenosis If mitral valve stenosis is present, blood would have difficulty transitioning the left ventricle. This would result in a backup pressure occurring and an elevation of the PCWP. A patient is on 70%/30% 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. 5 L/min B. 8 L/min C. 18 L/min D. 16 L/min D. 16 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 percentage. 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 70/30% mixture factor of 1.6 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 16 L/min. Popping sensations, also referred to as crackling sensations, during palpation of the tissues of the upper chest and neck are related to subcutaneous emphysema, which is a condition of air entering the dermal and subdermal spaces. It is usually caused by a mal-positioned tracheostomy tube. Pulse oximeters are also known as single wavelength spectrophotometers. There are multiple reasons why they may read inaccurately. Those reasons include: high ambient light, the use of fingernail polish, poor peripheral perfusion, and marked hypotension The incidence of ventilator-associated pneumonia, or VAP, is lowered by using a closed system suction catheter, periodically discontinuing sedation, keeping the patient and semi-Fowler's position, and proper handwashing among caregivers Which of the following airway clearance therapies should be administered first in the order of therapy? A. postural drainage and percussion B. nasal tracheal suctioning C. aerosolized Acetylcysteine (Mucomyst) D. verbal coaching for coughing C -aerosolized Acetylcysteine (Mucomyst) the first most logical step would be to thin secretions through use of the medication Mucomyst. The next step, would be postural drainage and percussion followed by verbal coaching for coughing and possibly nasal tracheal suctioning. Digitalis strengthens the contraction of the heart muscle, slows the heart rate, and helps eliminate fluid from body tissues Which of the following is most indicative of a pulmonary embolism? A. increased CVP, decreased PAP B. decreased CVP, decreased cardiac output C. increased PAP, decreased PCWP D. increased PCWP, decreased cardiac output C. increased PAP, decreased PCWP An increased PAP followed by a decreased PCWP indicates that blood is having difficulty flowing through the lung. When we need to raise CO2 there are three choices - decreasing tidal volume, decreasing rate, or adding dead space The use of PEP therapy is contraindicated by epistaxis and a middle ear infection. Paradoxical chest movement is an indication individual ribs are fractured in two or places, which causes the area of the rib cage to move in with inhalation while the rest of the chest moves out. Exosurf CLASS: ARTIFICIAL SURFACTANT IMMATURE NEONATAL LUNGS A left-to-right shunt, due to a leaking septum wall in the heart, is best determined by an increase in mixed venous oxygen saturation. From what location would the respiratory therapist recommend blood extraction for analysis to determine mixed venous oxygen saturation? A. pulmonary artery B. vena cava C. pulmonary vein D. aorta A. pulmonary artery Mixed venous blood, for the assessment of oxygen saturation, is taken from the distal port of the pulmonary artery catheter, or the pulmonary artery Flipped T waves on ECG waveform indicate cardiac ischemia. The best way to treat this is to administer oxygen to the patient One treatment for metabolic alkalosis is to administer potassium chloride The lowest inflection point on a pressure-volume ventilator graphic is an indication of the minimum pressure needed to keep alveoli open. Non-deadly arrhythmias, such as atrial tachycardia, may be addressed through cardioversion Which of the following descriptions most typifies the sound a therapist might here on a patient with a pleural friction rub? A. grating sound B. scattered crackles C. egophany D. sonorous A. grating sound When the patient is placed in an aircraft that does not maintain cabin pressure, any changes in arterial oxygenation result primarily from a change in alveolar oxygen tension or PAO2. Oxygen Index (OI) Paw x FiO2/PaO2 (100) is a value that takes into consideration FIO2, PaO2 levels, and inspiratory pressures. Endrophonium (Tensilon) It can help diagnose myasthenia gravis so that doctors select the proper treatment. It can also reverse the effect of certain muscle relaxants during surgery or after an overdose. the normal systemic vascular resistance SVRI is 1800-2400 mixed venous blood should be taken from the distal end of pulmonary artery catheter to determine PvO2 altitude causes hypoxemia due to barometric pressure which result in decreased alveolar oxygen tension or PAO2 straw colored stain on skin of a newborn indicates presence of meconium A patient that is taking nebulizer treatments needs to be able to demonstrate manual dexterity, and the ability to hold and manipulate the nebulizer Which of the following would be most beneficial in resolving microatelectasis? A. Chest tubes B. Thoracentesis C. Percutaneous ventilation D. Bronchoscopy D. Bronchoscopy A bronchoscopy would be most beneficial because it can ventilate and recruit alveoli in the lung. The other options will not decrease atelectasis A patient with increased airway resistance from a fixed upper airway obstruction would benefit most from which of the following? A. epinephrine B. heliox therapy C. aerosolized atropine D. bronchodilator therapy B. Heliox therapy An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the oxygen coming from the end of the tubing and finds it is 60%. Which of the following most likely explains this finding? A. low flow through the jet orifice B. leak in the tubing C. excess water in the tubing D. poorly calibrated analyzer C. excess water in the tubing When administering oxygen by any device that has a venturi mechanism, back pressure on the venturi will slow the speed of gas, decrease room air entrainment, and result in an increase in FIO2. Of the options offered, only excess water in the tubing would cause this type of back pressure. During the preoperational test of the ventilator, the respiratory therapist notices the galvanic analyzer on the ventilator is reading erroneously low. Which of the following can the respiratory therapist do to correct the problem? A. tag the ventilator as non-functional and avoid placing it in service B. change the fuel cell C. replace the electrolyte solution in the analyzer D. replace the analyzer batteries B. change the fuel cell A galvanic oxygen analyzer will read erroneously under two conditions: the probe or the fuel cell is depleted or the analyzer requires calibration. In this case the probe, which provides the energy for the analyzer, is the most likely culprit and should be changed. While monitoring a patient receiving mechanical ventilation, the respiratory therapist notices the low-pressure and low exhaled volume alarms are sounding. Which of the following could be the cause? A. excess water in the inspiratory limb of the circuit B. kinked endotracheal tube C. disconnected thermistor line D. herniated endotracheal tube cuff C. disconnected thermistor line If you have a low pressure or low exhaled volume ventilator alarm, you must look for the problem that could cause that specific type of alarm. If you look at the answers, a kink in the endotracheal tube would cause a high-pressure alarm so that cannot be the cause. Excess water in the limbs of the circuit would do the same. A high-pressure alarm would also develope if there is a herniated endotracheal tube cuff. This leaves the only possible answer which is a disconnected thermistor line. The high pressure alarm is sounding on a patient receiving volume controlled ventilation. The respiratory therapist should FIRST A. provide manual ventilation B. cancel the alarm C. observe the alarm panel to determine source D. suction the patient The NBRC knows that in real life, when you hear a ventilator alarm, you're tempted to cancel the alarm or attempt to immediately solve the problem. However, the correct answer is always to first provide manual ventilation to the patient. This is true of any ventilator alarm. Your first action should be to stabilize the ventilatory status of the patient, and then troubleshoot the problem. Anectine (succinylcholine) neuromuscular blocker is the medication that manifests muscle twitching about the face and neck when it is working properly. SVC Maneuver A respirometer is the most important piece of equipment when measuring an SVC Inspiratory muscle strength is determined by measuring the maximum inspiratory pressure. This is done with a pressure manometer. PAP normal value the normal systolic PAP ranges from 15 to 25 mm Hg and the diastolic PAP from 6 to 12 mm Hg. When a patient on a ventilator is unable to exhale completely before the inhalation cycle starts, the result will be air-trapping, which will result in auto peep While assisting a physician during a bronchoscopy procedure, the therapist notices bright red blood in the specimen tube. The therapist should prepare which of the following NEXT? A. Heparin B. Atropine C. epinephrine D. cold normal saline C. epinephrine The installation of epinephrine down the bronchoscope to an actively bleeding site will help to immediately stop the bleeding. This should be the first step in treating a bleed in the bronchial tree. The next step should be to compress the site with the bronchoscope followed by the insertion of the Fogarty catheter to tamponade the bleeding site. The device that may be attached to the end of the ET tube that allows PEEP to be maintained during a bronchoscopy is called Bodai adapter [Show Less]
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TMC EXAM 2 question and answer (updated) 2022/2023
A patient with CHF has the following input/output history Yesterday Today IN 1900 mL 2100 mL OUT 1000 mL 1100 mL Which of the following clinical f... [Show More] indings is most likely to be observed? A. bronchial wheezing B. friction rub C. decreased egophony D. moist crepitant rales The correct answer is : D Explanation : This CHF patient is obviously retaining fluid because he is receiving more fluid in that he is putting out. The clinical finding most associated with fluid retention is moist crepitant rales. Fine rales are associated with atelectasis but moist rales is associated with fluid retention, especially congestive heart failure (CHF). An infant born 24 hours prior is experiencing frequent periods of apnea lasting more than 60 seconds. Which of the following medications would be helpful in stimulating the infant's respiratory drive? A. Aminophylline B. Fluticasone C. hormone D. Exosurf The correct answer is : A Explanation : An infant who experiences apnea periods greater than 60 seconds may need respiratory stimulation. This may be accomplished by administering the medication Aminophylline. Aminophlylline is only intended for ventilatory stimulation in infants. The same medication is used for long-term bronchodilation in adults. 00:03 01:24 A respiratory therapist is having difficulty advancing a suction catheter down a fenestrated tracheostomy tube while the inner cannula is removed. The cannula appears to meet resistance within a few inches from insertion. The therapist should A. remove the tracheostomy tube B. twist the catheter while attempting to advance C. inflate the cuff D. obtain a smaller suction catheter The correct answer is : B Explanation : When suctioning somebody with a fenestrated tracheostomy tube, it must be remembered that the suction catheters can sometimes get stuck on the fenestration hole inside the tube. The best remedy for this is to twist the suction catheter until the end is clear of the hole. The following flow volume loop (loop is tall and skinny) is obtained from a 62-year-old factory worker. Which of the following could represent the patient's diagnosis? A. pulmonary fibrosis B. emphysema C. cystic fibrosis D. chronic bronchitis The correct answer is : A Explanation : The flow volume loop is tall and skinny, indicating normal flows but abnormal volumes. This is consistent with a restrictive lung defect. The best answer is the disease that is restrictive in nature. In this case, only pulmonary fibrosis qualifies. Which of the following should be monitored for a ventilator-dependent newborn with IRDS? A. gas distribution (SBN2) in the lungs B. urine specific gravity C. pH D. fluid input and output The correct answer is : D Explanation : All choices are indicated while monitoring a critically ill neonate receiving mechanical ventilation. I & O fluid monitoring is essential. Managing acid-base balance and the artificial airway are also essential. Which of the following is an important element of instruction to a home care patient who will be receiving continuous oxygen therapy at 2 L/min by nasal cannula? A. check oxygen concentrator flow rate once a week B. run a flow calibration check once monthly C. do not change flow rate without a physician order D. increase flow rate during exercise The correct answer is : C Explanation : When instructing a home care patient on the use of their oxygen concentrator, and using oxygen in general, the respiratory therapist must include those things that are appropriate for the patient. In this question no open flames, use of grounded plugs only, and a restriction on changing the flow rate without a physician order are appropriate instructions. It is inappropriate to ask the patient to check or calibrate the concentrator's flow rate once a week. This sort of maintenance should be done by a respiratory therapist. Which of the following parameters is NOT consistent with weaning from mechanical ventilation? A. A-aDO2 of 320 mmHg B. VT to 500 mL C. VD/VT of 0.50 D. RSBI of 86 The correct answer is : A Explanation : In order to wean from a ventilator, the patient's dead space-tidal volume ratio must be below 60% or .60. The rapid shallow breathing index must be below 106. Spontaneous tidal volume must be greater than 5 mL per kilogram. The alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this case, the dead space-tidal volume ratio is too high and the alveoli-arterial oxygen difference is too wide. These are the two criteria that indicate the patient is not ready to wean from the ventilator. A respiratory therapist is alerted by a low-volume ventilator alarm on a patient who has a chest tube drainage system in place. Set tidal volume is 600 mL while return tidal volume is 190 mL. The therapist should FIRST A. increase tidal volume to compensate B. insert an additional chest tube C. clamp the chest tube near the patient D. disconnect the chest tube from wall suction pressure The correct answer is : C Explanation : A patient who is receiving mechanical ventilation, and has a chest tube drainage system in place, must be monitored carefully for lost volume through the lung through the chest tube drainage system. The clinical evidence of this is found in the return tidal volumes. If the volume administered is far greater than the return volume, volume must be being lost in the system somewhere. A loss of volume may be noticed by the excessive bubbling in the water seal compartment. To determine how it is being lost, the first step would be to clamp the chest tube near the patient. If bubbling in the water seal compartment stops, the volume being lost is most likely coming from a perforation in the lung. The patient requires surgery to repair this. While performing routine oxygen rounds, the respiratory therapist notes a COPD patient who is receiving supplemental oxygen at 2 L/min is markedly cyanotic and has a heart rate of 30/min. The therapist should FIRST A. switch to FIO2 1.0 B. increase flow to 4 L/min by nasal cannula C. obtain an arterial blood gas D. go get help The correct answer is : A Explanation : Even though a COPD patient should rarely receive more than 2 L/min oxygen, there are emergency circumstances that would dictate more supplemental oxygen. The use of the word "markedly" is an indication of an emergency. In this case the patient is markedly cyanotic and therefore has an oxygenation emergency. Switching to 100% oxygen is appropriate. A respiratory therapist notices the cuff pressure on an endotracheal tube is 10 cm H2O. After introducing 10.0 mL of air, the cuff pressure is 5 cm H2O. The patient is receiving positive pressure ventilation. The therapist should recommend A. replacing the ET tube B. clamping the pilot tube C. monitoring the patient D. initiating high frequency jet ventilation The correct answer is : A Explanation : The ET tube cuff that fails to increase in pressure after introducing additional air is most likely damaged. When a part of an ET tube is damaged, the only acceptable option is to replace it. Which of the following laboratory examinations would be helpful in further assessing a patient with diabetic ketoacidosis? A. creatinine B. PD50 C. glucose level D. P50 The correct answer is : C Explanation : A patient with diabetic ketoacidosis primarily has a problem with the blood glucose level. Further assessment therefore can be done by examining the glucose level. What would most likely be indicated by an elevated CVP? A. pulmonary embolism B. fluid overload C. left heart failure D. increased pulmonary vascular resistance The correct answer is : B Explanation : Hypervolemia (fluid overload) is shown hemodynamically by an increase in all hemodynamic values including CVP, PAP, PCWP, and cardiac output. Among these values CVP is the first and most significant indicator when fluid levels in the body are high or low. Remember, CVP may be known by other names such as, right atrial pressure, right side preload, right ventricular filling pressure, and right ventricular end-diastolic pressure. 00:03 01:24 For which of the following conditions is PEP therapy most beneficial? A. Postoperative recovery B. ARDS C. pneumonia D. myasthenia gravis The correct answer is : C Explanation : PEP therapy is beneficial at removing secretions. Of the options given, only pneumonia is a disease where secretions are a primary concern. Which of the following would be most helpful in determining if a patient regularly smokes tobacco products? A. COHb B. end-tidal carbon dioxide C. DLCO D. pulse oximetery The correct answer is : A Explanation : The most reliable data that indicates the degree to which the patient has recently been smoking comes from a COHb analysis. A 32-year-old 81-kg (178-lb) adult male is receiving mechanical ventilatory support. Settings are as follows: Mode Assist/control Mandatory rate 10 Total rate 18 Tidal volume 450 mL FIO2 0.6 PEEP 5 cm H2O The patient is cyanotic and anxious. The respiratory therapist will recommend which of the following? A. decrease mandatory rate B. increase tidal volume C. increase inspiratory flow rate D. increase FIO2 The correct answer is : B Explanation : All of the answers offered indicate a change in the ventilator settings. However, the question shows no evidence of arterial blood gas analysis. This is because a close examination of the ventilator settings will show that there is something wrong. The patient weighs 81 kg which would suggest a minimum tidal volume of 500 mL. (6 x 81 kg = 486 mL). The patient's set tidal volume is only 450 mL. This should be corrected. The following graphic (shows fluttering expiratory flow) from an orally intubated patient receiving mechanical ventilation is most likely caused by A. vocal cord paralysis B. condensate in the tubing C. fixed upper airway obstruction D. PEP therapy The correct answer is : B Explanation : Condensate in the tubing will show up as a fluttering expiratory flow. Which of the following patients would benefit most from an inverse I:E ratio ventilation? A. ARDS B. chronic bronchitis C. kyphoscoliosis D. COPD The correct answer is : A Explanation : An inverse I:E ratio is a term that indicates a longer inspiratory time than expiratory time. The patient with adult respiratory distress syndrom is an example of a patient who can benefit from an inverse I:E ratio. Their lungs are noncompliant and therefore require more inspiratory time to allow for better gas distribution. The respiratory therapist is making a plan of care for a patient with mycoplasma pneumonia who needs assistance with airway clearance of secretions. In which order should therapy be performed? A. coach coughing, bronchodilator, percussion, postural drainage B. postural drainage, percussion, bronchodilator, coach coughing C. percussion, postural drainage, bronchodilator, coach coughing D. bronchodilator, percussion, postural drainage, coach coughing The correct answer is : D Explanation : There is an oder at which procedures should be done to mobilize and remove secretions. The first steps are to open the airway, dislodge the sputum, move dispute into the upper airway, and then remove the sputum through coughing or suctioning. A pulmonary rehabilitation patient is having difficulty complying with a smoking cessation program. A physical and psychological screen reveals a heavy physiological dependence and a low psychological dependence on smoking. Which of the following is appropriate? A. Valium B. psychological counseling C. Versed D. nicotine replacement therapy The correct answer is : D Explanation : A physiological dependence on nicotine can be overcome slowly by having the patient use nicotine replacement therapy. This may include chewing gum with nicotine or transdermal preparations. A 31-week-gestional age infant has a respiratory rate of 30/min and a heart rate of 70/min while breathing room air. Five minutes after birth, the infant is acrocyanotic and has a weak cry. Following suctioning of the oropharynx the respiratory therapist should A. administer Atropine sulfate B. provide manual ventilation with the bag-valve C. begin chest compressions D. place the infant in an oxyhood at FIO2 0.40 The correct answer is : B Explanation : Five minutes after birth this infant is still showing signs of significant respiratory distress. Supporting ventilation with a bag-valve is appropriate. Which of the following equations would determine cardiac index? A. C.O. / ejection fraction B. C.O. / BSA C. C.O. x BSA D. stroke volume x heart rate The correct answer is : B Explanation : Cardiac index can be calculated by dividing the cardiac output by the body surface area. The body surface area is given in units of millimeters squared. Body surface area rarely deviates from about 2 m², regardless of the size of the patient. So essentially, we could take cardiac output and divide it by two to get cardiac index. This can be done even if the body surface area of the patient is unknown. For example, if the cardiac output is 4 L/min, the cardiac index is about 2. Conversely, if cardiac index is 1.8, cardiac output could be estimated to be 3.6 L/min. What is the primary purpose for a nitrogen washout test? A. determine closing volume B. determine FRC C. evaluate evenness of pulmonary gas distribution D. directly measure TLC The correct answer is : B Explanation : A nitrogen washout test is used to determine three different lung volumes: TLC, RV, and FRC. For the NBCR exam the most important of those volumes is the FRC. Thus, when asked what a nitrogen washout test is for (or helium dilution test), the correct answer is FRC. While transporting a patient from a helicopter landing pad to the emergency department (ED), the respiratory therapist notices the ET tube has become unsecured. To best confirm to location of the ET tube, the therapist should recommend A. observe chest rise B. palpate the trachea C. chest radiograph D. auscultate breath sounds The correct answer is : C Explanation : One may quickly determine the location of an endotracheal tube by observing chest rise and auscultating breath sounds. However, neither of these methods are conclusive. The only way to confirm proper placement is through a chest x-ray. A patient receives postural drainage and percussion. During the treatment, the patient develops rhonchi. The respiratory therapist should NEXT A. administer an IPPB treatment B. perform nasal tracheal suctioning C. discontinue treatment D. switch to PEP therapy The correct answer is : B Explanation : The development of rhonchi during postural drainage and percussion is an indication that the therapy is working - is mobilizing secretions effectively and moving them upward where they can be expectorated or suctioned. A respiratory therapist is preparing for defibrillation on a patient with pulseless ventricular tachycardia. Which of the following should NOT be part of that preparation? A. set the defibrillator to deliver 360 joules B. prepare to administer supplemental oxygen C. set up for manual ventilation with a bag/valve D. set the defibrillator's synchronization to ON The correct answer is : D Explanation : Pulseless ventricular tachycardia should be treated with defibrillation. When defibrillating a deadly cardiac rhythm, the synchronization setting on the defibrillator should be set to "off". A 62-year-old male has ventricular tachycardia. The patient is not alert and will not respond to verbal stimuli. A pulse is palpable. The respiratory therapist will respond by A. administering methyl prednisone, IV B. administering Isuprel (Isoproterenol) C. defibrillating the patient D. performing cardioversion The correct answer is : D Explanation : The treatment for ventricular tachycardia without a pulse is defibrillation at 300-360 W. Cardioversion, however, is used with atrial arrhythmias and ventricular tachycardia where there is a pulse present. A patient shows signs of hypoxemia while on a heated aerosol set at 40% with the flow rate set to 8 L/min. The patient's minute ventilation is 38.0 L. Which of the following changes should be made? A. decrease FIO2 to 28%, maintain flow rate B. increase FIO2 to 0.5, maintain flow rate C. increase to FIO2 to 1.0 with a flow rate to 15 L/min D. increase flow rate to 10 L/min The correct answer is : D Explanation : This question requires one to recognize that the flow rate is not meeting the patient's ventilatory demand. It requires a little math to determine how much total flow the patient is receiving. In this case the ratio for 40% is 3:1. If you add 3+1, you get 4. Then, if you multiply 4 times 8 L/min. you get a total flow of 32 L per minute. The patient's reported minute ventilation is 38 L per minute. This would cause the patient to entrain extra air and would ultimately lower FIO2, resulting in an increase in hypoxemia. [Show Less]
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TMC Exam C question and answer 100% correct
a. manual dexterity The respiratory therapist should evaluate which of the following to develop a teaching plan for a patient who will be using a small vo... [Show More] lume nebulizer at home? a. manual dexterity b. highest grade level achieved in school c. spousal support d. English speaking proficiency d. bronchoscopy Which of the following would be most beneficial in resolving microatelectasis? a. chest tubes b. percutaneous ventilation c. thoracentesis d. bronchoscopy 00:03 01:24 b. oropharyngeal airway A 45 year-old patient is recovering in the intensive care unit after undergoing a surgical procedure to repair a hernia. The patient remains unconscious. To prevent soft tissue obstruction, the respiratory therapist should recommend a(n) a. double-lumen endobronchial tube b. oropharyngeal airway c. bite block d. nasopharyngeal airway d. Run 2 only Quality control material has published values for pH of 7.20, PO2 of 65 mmHg. Documentation indicates the range of pH is 0.5% and is 3% for PO2. Machine results are as follows: Run 1: pH 7.19, PO2 64 Run 2: pH 7.10, PO2 69 Run 3: pH 7.21, PO2 65 Which quality control run(s) indicate the machine is out of control? a. Run 1 and 2 b. Run 2 and 3 c. Run 3 only d. Run 2 only a. ABG and alveolar oxygen tension A respiratory therapist is considering a patient's readiness to wean from mechanical ventilation. To determine the A-aDO2, the therapist will need which of the following? a. ABG and alveolar oxygen tension b. VD/VT and PAO2 c. CaO2 and PAO2 d. VD/VT and ABG c. heliox therapy A patient with increased airway resistance from a fixed upper airway obstruction would benefit most from which of the following? a. bronchodilator therapy b. epinephrine c. heliox therapy d. aerosolized atropine d. inspiratory muscle strength Evaluating MIP (maximum inspiratory pressure) is most useful in evaluating which of the following? a. presence of a restrictive pulmonary defect b. effectiveness of cough c. presence of obstructive pulmonary defect d. inspiratory muscle strength b. excess water in the tubing An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the oxygen coming from the end of the tubing and finds it is 60%. Which of the following most likely explains this finding? a. poorly calibrate analyzer b. excess water in the tubing c. low flow through the jet orifice d. leak in the tubing a. examine the ventilator circuit for proper connections During a preoperational test of the ventilator with a test lung, the respiratory therapist notes a return tidal volume of 600 cc. Ventilator settings are: Mode: Assist/control FiO2: 0.50 Mandatory rate: 10 VT: 750 mL What action should the therapist take? a. examine the ventilator circuit for proper connections b. obtain a larger test lung c. increase the set tidal volume to 900 mL d. obtain a smaller test lung d. change the fuel cell During the preoperational test of the ventilator, the respiratory therapist notices the galvanic analyzer on the ventilator is reading erroneously low. Which of the following can the respiratory therapist do to correct the problem? a. replace the analyzer batteries b. replace the electrolyte solution in the analyzer c. tag the ventilator as non-functional and avoid placing it in service d. change the fuel cell b. poor hand washing among staff Which of the following is most likely to increase nosocomial infection in a hospital? a. use of an HME for 48 hours b. poor hand washing among staff c. frequent disconnection in the ventilator circuit d. use of alcohol-based hand cleaners b. disconnected thermistor line While monitoring a patient receiving mechanical ventilation, the respiratory therapist notices the low-pressure and low exhaled volume alarms are sounding. Which of the following could be the cause? a. kinked endotracheal tube b. disconnected thermistor line c. excess water in the inspiratory limb of the circuit d. herniated endotracheal tube cuff 00:03 01:24 a. a fracture in the plastic wye A patient receiving positive pressure ventilation has a low-pressure alarm sounding. Which of the following could be the cause? a. a fracture in the plastic wye b. herniated cuff c. excess secretions in the airway d. kinked ET tube a. provide manual ventilation The high pressure alarm is sounding on a patient receiving volume controlled ventilation. The respiratory therapist should FIRST a. provide manual ventilation b. suction the patient c. observe the alarm panel to determine source d. cancel the alarm d. Anectine (succinylcholine chloride) Which of the following medications is shown to have sufficient affect when facial muscle twitching is observed? a. Halcion b. Curare (d-turbo curare) c. Romazicon d. Anectine (succinylcholine chloride) d. respirometer A respiratory therapist is preparing to measure SVC on a patient in the emergency department. Which of the following equipment is required? a. Collins water-seal spirometer b. Geissler tube c. Wheatstone bridge d. respirometer b. pressure manometer A respiratory therapist is asked to determine a patient's inspiratory muscle strength. Which of the following equipment is required for this evaluation? a. Fleisch pneumotrachometer b. pressure manometer c. respirometer d. peak flow meter b. peak flow meter A respiratory therapist is ordered to do a bedside assessment of the effectiveness of a bronchodilator on a patient with an acute asthmatic episode. Which of the following equipment will be needed to perform this evaluation? a. maximum inspiratory pressure manometer b. peak flow meter c. Collins water-seal spirometer d. respirometer a. 25/8 mmHg Which of the following pressures is most consistent with a normal pulmonary artery pressure (PAP)? a. 25/8 mmHg b. 12/8 mmHg c. 120/80 mmHg d. 25/4 mmHg d. change to an 80%/20% heliox mixture A patient receiving heliox therapy at 70%/30% mixture by non-rebreathing mask has the following arterial blood gas results: pH 7.35 / PaCO2 45 / PaO2 110 / HCO3 24 / BE 0 Which of the following actions is appropriate? a. change to a heliox mixture of 60%/40% b. discontinue heliox therapy c. switch to a partial rebreathing mask d. change to an 80%/20% heliox mixture c. use an air-entrainment mask set at 28% A COPD patient complains of shortness of breath while exercising with a 2 L/min nasal cannula. During exercise, SPO2 is noted to fall to 84%. Which of the following would be most helpful to the patient during exercise? a. decrease flow to 1 L/min nasal cannula b. avoid exercising c. use an air-entrainment mask set at 28% d. use a non-rebreathing mask a. place the patient on a non-rebreathing mask A patient in the emergency room is receiving oxygen by nasal cannula at 3 L/min. Blood gases reveal the following: pH 7.53 / PaCO2 30 / PaO2 51 / HCO3 23 / BE -1 The respiratory therapist should immediately a. place the patient on a non-rebreathing mask b. decrease flow to 1 L/min c. increase flow to 5 L/min d. place the patient on a Venturi mask at 40% d. increase PEEP to 22 cmH2O An 80-kg (176-lb) female patient is receiving mechanical ventilation on the following settings: Mode: assist/control Mandatory rate: 14/min Total rate: 14/min VT: 550 mL FiO2: 0.60 PEEP: 20 cmH2O ABG: pH 7.38 / PaCO2 42 / PaO2 62 / HCO3 26 / BE +2 The respiratory therapist should a. increase the FIO2 to 0.7 b. order a chest radiograph c. increase FiO2 to 1.0 d. increase PEEP to 22 cmH2O b. increase flow to 15 L/min A patient is showing signs of respiratory distress with a respiratory rate to 30/min and a spontaneous tidal volume of 800 mL. The patient is receiving oxygen at 60% by large volume nebulizer with the flow set at 10 L/min. The respiratory therapist should suggest to a. increase FiO2 to 1.0 and the flow to 15 L/min b. increase flow to 15 L/min c. sedate the patient d. decrease the FiO2 to 0.50 d. decrease inspiratory time The physician orders a change in I:E ratio from 1:2 to 1:4 for a COPD patient receiving volume-cycled mechanical ventilation. Which of the following accommodates the physician's request if the mandatory rate is not changed? a. increase the inspiratory time b. decrease the inspiratory flow rate c. decrease expiratory time d. decrease inspiratory time a. autoPEEP For a patient receiving volume-controlled ventilation in the assist/control mode, the starting of the inhalation cycle before the expiratory flow rate returns to zero would result in which of the following? a. autoPEEP b. atelectasis c. alveolar collapse d. decreased FRC c. epinephrine While assisting a physician during a bronchoscopy procedure, the therapist notices bright red blood in the specimen tube. The therapist should prepare which of the following NEXT? a. Heparin b. atropine c. epinephrine d. cold normal saline d. Bodai adapter A respiratory therapist is asked to assist a physician with a bronchoscopy procedure on a patient who is ventilator dependent and requires high levels of PEEP. Which of the following equipment should be used? a. closed in-line suction catheter b. manual PEEP valve c. Magill forceps d. Bodai adapter b. reduce future treatment dosage to 0.25 mL A patient receiving 0.5 mL Albuterol by small volume nebulizer complains of tingling fingers, nervousness, and heart palpitations. The therapist should a. decrease dosage to 0.15 mL b. reduce future treatment dosage to 0.25 mL c. have the patient pause at the top of each breath d. instruct the patient in performing shallow inspirations a. cancerous mass in the lung For which of the following is the respiratory therapist observing if obtaining a series of oblique chest radiographs? a. cancerous mass in the lung b. pneumonia c. pneumothorax d. pleural effusion d. mass in the left lobe A spiral CT scan would be most helpful in evaluating which of the following? a. atelectasis b. asbestosis c. pneumonia d. mass in the left lobe b. decrease tidal volume A 65-kg (143-lb) patient with pneumonia is receiving mechanical ventilator support by a Servo adult ventilator on the following settings with corresponding arterial blood gas values: Mode: assist/control Mandatory rate: 10/min VT: 700 mL FiO2: 0.50 pH 7.48 / PaCO2 33 / PaO2 98 / HCO3 24 / BE 0 Which of the following actions is most appropriate? a. increase tidal volume b. decrease tidal volume c. decrease FiO2 d. decrease mandatory rate b. increase alveolar ventilation A patient is undergoing a full cardiopulmonary arrest. The patient is intubated and is being monitored with an infrared capnographic device. PetCO2 data is showing 3%. Which of the following is most appropriate? a. obtain PaCO2 by a Douglas bag b. increase alveolar ventilation c. recalibrate the capnometer d. clean the infrared device c. ET tube markings at the lips Which of the following can be examined to initially determine the approximate position of the oral endotracheal tube? a. chest radiograph b. lateral neck radiograph c. ET tube markings at the lips d. diaphragmatic excursion a. radiologist reports the ET tube is 1 inch above the carina Which of the follow data, if observed, would indicate proper positioning of an oral endotracheal tube? a. radiologist reports the ET tube is 1 inch above the carina b. end of ET tube 2 cm below the aortic knob c. end of ET tube is 6 cm above the carina d. poor left chest symmetry d. racemic epinephrine A child has been extubated and is demonstrating mild stridor. Which of the following agents would be most helpful to administer by aerosol? a. albuterol b. Atropine c. Aminophylline d. racemic epinephrine b. ventilator circuit bronchoscopy adapter A respiratory therapist is asked to assist a physician for a diagnostic bronchoscopy on a mechanically ventilated patient. What special equipment should be brought to the room? a. laryngoscope and blade b. ventilator circuit bronchoscopy adapter c. ventilator circuit endotracheal tube wedge d. Wrights respirometer d. stroke volume Which of the following data is needed to calculate cardiac output? a. VO2 b. QS/QT c. A-aDO2 d. stroke volume c. IC Which of the following volumes is being observed when a patient is using a volume-type incentive spirometer? a. ERV b. TLC c. IC d. IRV b. cystic fibrosis For which of the following conditions is chest wall oscillation therapy most beneficial? a. ARDS b. cystic fibrosis c. drug overdose d. Guillain-Barre syndrome a. hemoglobin Which of the following is needed to determine C(a-v)O2? a. hemoglobin b. VD/VT c. PvO2 d. PaO2 c. combined metabolic and respiratory acidosis Arterial blood gases on a patient in the cardiac intensive care unit are as follows: pH 7.10 / PaCO2 52 / PaO2 65 / HCO3 15 / BE -9 Which of the following represents an accurate interpretation of these results? a. metabolic compensated respiratory acidosis b. metabolic acidosis c. combined metabolic and respiratory acidosis d. respiratory acidosis a. report the problem to the supervisor In spite of repeated attempts, a respiratory therapist is unable to obtain successful quality control values on a blood gas analyzer. The therapist should a. report the problem to the supervisor b. continue running quality control samples c. inform the medical director d. place the machine in service but monitor closely b. change the electrode A therapist is unable to obtain a reading with a galvanic-type oxygen analyzer when attempting to measure oxygen percentage inside an isolette while the red warning flag is active. The therapist should? a. replace the batteries b. change the electrode c. discontinue the red-flag warning system d. replace the electrolyte solution b. administer 2 units of blood Four hours after a quadruple coronary artery bypass graft, a patient's blood pressure is 90/50 mmHg and the patient is ashen in color. The following data is also available: PAP: 10 mmHg PCWP: 5 mmHg CVP: 1 mmHg The patient could benefit most from which of the following? a. adminster normal saline, IV b. administer 2 units of blood c. an echocardiogram d. Lasix (furosemide) a. decrease EPAP only A patient is receiving non-invasive positive pressure ventilation by mask with an IPAP of 16 cmH2O and an EPAP of 8 cmH2O. Corresponding blood gas data is as follows: pH 7.29 / PaCO2 51 / PaO2 108 / HCO3 24 / BE 0 Which adjustment is most appropriate? a. decrease EPAP only b. increase IPAP and EPAP c. increase IPAP only d. decrease EPAP and IPAP [Show Less]
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TMC Practice Exam B Kettering question with complete solution
After a patient undergoes a thoracentesis, the respiratory therapist notes that the obtained pleural fluid is clear with a slight straw color. This fluid i... [Show More] s most likely the result of A. empyema. B. congestive heart failure. C. lung carcinoma. D. hemothorax. B. congestive heart failure. Which of the following would be most important to evaluate for a patient who is entering a smoking cessation program? A. Height B. Smoking history C. Weight D. Diet B. Smoking history 00:03 01:24 The respiratory therapist is calibrating a spirometer and checking the volume with a 3.0 liter super syringe. The volumes recorded are: 2.85 L, 2.8 L, and 2.8 L. Based upon the information obtained which of the following is a correct statement? A. Another syringe needs to be used B. Spirometer is accurate C. The plunger was advanced too slowly D. Spirometer may have a leak D. Spirometer may have a leak Which of the following is an indication for high frequency jet ventilation? A. Bronchopleural fistula B. Wilson Mikity syndrome C. Necrotizing lesion of right lung D. Centrilobular emphysema A. Bronchopleural fistula A 43-year-old female patient has just undergone a total abdominal hysterectomy. The patient arrives in the post anesthesia care unit obtunded with minimal response to painful stimulus. What treatment should the respiratory therapist recommend for this patient? A. Initiate assisted ventilation B. Insert oropharyngeal airway C. Obtain positron emission tomography D. Initiate noninvasive capnography B. Insert oropharyngeal airway A 44 week gestational age infant has just been delivered via C-section and is gasping, grunting, and has tachycardia and tachypnea. At one minute his Apgar score is 4 and at 5 minutes the score is 5. The infant is most likely suffering from A. transient tachypnea of the newborn. B. meconium aspiration. C. bronchopulmonary dysplasia. D. apnea of prematurity. B. meconium aspiration. What is the normal VD/VT ratio for a patient breathing room air? A. 5 - 15% B. 20 - 40% C. 45 - 55% D. 65 - 75% B. 20 - 40% A heat moisture exchanger is indicated for humidification in which of the following situations? A. Mechanical ventilation in a long-term care facility. B. Transport to a tertiary care center. C. Patient with tenacious secretions. D. Delivery of aerosolized bronchodilators. B. Transport to a tertiary care center. All of the following could cause a patient's right-hemidiaphragm to be elevated, EXCEPT A. right lower lobe atelectasis. B. right side hyperlucency, absent vascular markings. C. hepatomegaly. D. right lower lobe consolidation with air bronchograms. B. right side hyperlucency, absent vascular markings A 64-year-old, 70 kg (154 lb) man with severe COPD is receiving independent (differential) lung ventilation following thoracotomy and right lower lobectomy. Which of the following setting combinations would be most appropriate for this patient? A. Right lung 50 mL; left lung 650 mL B. Right lung 150 mL; left lung 550 mL C. Right lung 350 mL; left lung 350 mL D. Right lung 550 mL; left lung 150 mL B. Right lung 150 mL; left lung 550 mL A patient in the intensive care unit has the following hemodynamic measurements: CVP (mm Hg) 5 PAP (mm Hg) 29/8 PCWP (mm Hg) 8 BP (mm Hg) 130/70 Cardiac output (L/min) 5.1 Cardiac index (L/min/m2) 2.7 What is the pulse pressure? A. 15 mm Hg B. 21 mm Hg C. 60 mm Hg D. 90 mm Hg C. 60 mm Hg A 2-year-old child with croup has been intubated for 4 days with a 4 mm ID uncuffed endotracheal tube. Heated aerosol at an FIO2 of 0.30 has been delivered to the patient. The physician asks the respiratory therapist to evaluate the patient for possible extubation. Which of the following would most likely indicate that the patient is ready for extubation? A. The patient is making normal quiet ventilatory efforts. B. A negative sputum culture and sensitivity has been reported. C. The patient's ABG are within normal range. D. Breath sounds are heard around the tube on auscultation. D. Breath sounds are heard around the tube on auscultation. 00:03 01:24 A patient is seen in the Emergency Department for complaints of nausea and vomiting. A nasogastric tube has been inserted and the patient is started on lasix. Which of the following should the respiratory therapist monitor? A. Cardiac enzymes B. Serum electrolytes C. Arterial blood gases D. Cell hydration level B. Serum electrolytes While instructing a patient prior to a vital capacity maneuver, the respiratory therapist should direct the patient to A. exhale to residual volume and inhale to inspiratory capacity. B. inhale to total lung capacity then exhale to residual volume. C. exhale normally then inhale to total lung capacity. D. inhale normally then exhale to functional residual capacity. B. inhale to total lung capacity then exhale to residual volume. A patient involved in an automobile accident is brought to the ED with tachypnea, tracheal deviation to the right, splinting, asymmetrical chest movement, and decreased breath sounds on the left side. The respiratory therapist should initially A. insert a chest tube. B. administer 100% oxygen via mask. C. perform endotracheal intubation. D. initiate non-invasive positive pressure ventilation. B. administer 100% oxygen via mask. A 77-year-old male patient is admitted to the emergency room with shortness of breath, fine basilar crackles, +2 pitting edema and a chest radiogram with a butterfly pattern. These results are most consistent with which of the following? A. Pulmonary edema B. Pulmonary interstitial emphysema C. Pneumothorax D. Emphysema A. Pulmonary edema Which of the following formulas will determine the total flow being delivered to a patient with a 28% venturi mask running at 6 L/min? A. total flow = 6 x 2 B. total flow = 6 x 4 C. total flow = 6 x 5 D. total flow = 6 x 11 D. total flow = 6 x 11 Fine crepitant crackles are most commonly associated with which of the following conditions? A. Bronchitis B. Pulmonary edema C. Pneumonia D. Foreign body aspiration B. Pulmonary edema A patient with end-stage pulmonary fibrosis is receiving oxygen at 2 L/min via a transtracheal oxygen catheter. The patient experiences an increased work of breathing and shortness of breath. The respiratory therapist should A. manually ventilate the patient with a resuscitation bag. B. increase the flow to the transtracheal catheter to 6 L/min. C. evaluate the SpO2 with a pulse oximeter. D. flush the transtracheal device with isotonic saline. D. flush the transtracheal device with isotonic saline. During bedside monitoring the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first A. verify the position of the transducer. B. check the transducer dome for air bubbles. C. flush the catheter with heparin solution. D. attempt to draw blood from the arterial line. B. check the transducer dome for air bubbles. An optimal PEEP study is initiated on a patient receiving mechanical ventilation. The respiratory therapist first places the patient on a PEEP of 10 cm H2O for 20 minutes with no adverse effects. The PEEP is increased to 15 cm H2O and the patient's heart rate rises significantly with a severe fall in the blood pressure. Based upon the above information, the therapist should conclude that the patient is suffering from A. peripheral vasoconstriction. B. hypovolemia. C. increased venous return. D. increased SVR B. hypovolemia. A post-operative thoracotomy patient is receiving incentive spirometry therapy Q2H. Breath sounds are diminished in the bases of the lungs with scattered crackles. The patient's inspiratory capacity has decreased over the past 2 days. A chest radiograph indicates thin-layered basilar densities. Which of the following has most likely occurred? A. Atelectasis B. Pneumonia C. Pulmonary edema D. Consolidation A. Atelectasis A patient is in full cardiopulmonary arrest and after several attempts, the patient is orally intubated with a size 7 mm ID endotracheal tube. The nurse is unable to establish IV access. The ECG monitor shows sinus bradycardia. Which of the following drugs should be administered through the endotracheal tube? A. Lidocaine B. Epinephrine C. Atropine D. Dobutamine C. Atropine [Show Less]
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TMC Practice Exam question and answers 2022/2023
A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent w... [Show More] ith A. liver failure. B. pulmonary embolism. C. heart failure. D. electrolyte imbalances Heart failure A patient is admitted to the ED following a motor vehicle accident. On physical exam, the respiratory therapist discovers that breath sounds are absent in the left chest with a hyperresonant percussion note. The trachea is shifted to the right. The patient's heart rate is 45/min, respiratory rate is 30/min, and blood pressure is 60/40 mm Hg. What action should the therapist recommend first? A. Call for a STAT chest x-ray. B. Insert a chest tube into the left chest. C. Needle aspirate the 2nd left intercostal space. D. Activate the medical emergency team to intubate the patient. Needle aspirate the 2nd left intercostal space. 00:03 01:24 All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT A. maintaining cuff pressures between 20 and 25 mm Hg. B. using the minimal leak technique for inflation. C. using a low-residual-volume, low-compliance cuff. D. monitoring intracuff pressures. monitoring intracuff pressures. A 52 year-old post-operative cholecystectomy patient's breath sounds become more coarse upon completion of postural drainage with percussion. The respiratory therapist should recommend A. continuing the therapy until breath sounds improve. B. administering dornase alpha. C. administering albuterol therapy. D. deep breathing and coughing to clear secretions. deep breathing and coughing to clear secretions. A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? A. IS / SMI B. IPPB with normal saline C. postural drainage and percussion D. PEP therapy IPPB with normal saline A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? 1. Tidal volume 2. Respiratory Rate 3. Inspiratory flow 4. Sensitivity 1, 2, and 3 only Which of the following would be the most appropriate therapy for a dyspneic patient who has crepitus with tracheal deviation to the left and absent breath sounds on the right? A. Perform chest physiotherapy B. Administer an IPPB treatment C. Insert an endotracheal tube D. Insert a chest tube Insert a chest tube A 55 year-old post cardiac surgery patient has the following ABG results: pH 7.50, PaCO2 30 torr, PaO2 62 torr, HCO3 25 mEq/L, SaO2 92%, HB 14 g/dL, BE +2. Venous blood gas results are pH 7.39, PvCO2 43 torr, PvO2 37 torr, and SvO2 66%. Calculate the patient's C(a-v)O2. A. 2.5 vol% B. 4.0 vol% C. 5.0 vol% D. 5.5 vol% 5.0 vol% A patient on VC, SIMV with a VT of 500 mL has a PIP of 25 cm H2O, Pplat of 15 cm H2O and PEEP of 5 cm H2O. What is the patient's static lung compliance A. 25 mL/cm H2O B. 35 mL/cm H2O C. 45 mL/cm H2O D. 50 mL/cm H2O 50 mL/cm H2O Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 86%. Which of the following would be most appropriate at this time? A. cool mist aerosol treatment B. aerosolized racemic epinephrine C. manual ventilation with resuscitation bag and mask D. reintubation reintubation Which of the following patients would most likely benefit from pressure support ventilation? A. An intubated patient with an absent respiratory drive. B. A patient on SIMV with a set rate of 12/min and total rate of 24/min. C. A patient with acute lung injury. D. A patient who requires short-term post-operative ventilatory support. A patient on SIMV with a set rate of 12/min and total rate of 24/min. A patient receiving mechanical ventilation has developed a temperature of 99.9° F with purulent secretions over the last 12 hours. The respiratory therapist has also noted a steady increase in peak inspiratory pressure. What initial recommendation should be made to address these changes? A. Initiate bronchial hygiene therapy. B. Obtain a sputum gram stain. C. Administer IPV. D. Insert a CASS tube. Obtain a sputum gram stain. 00:02 01:24 Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? 1. FEV1 2. PEFR 3. FRC 4. RV 1 and 2 only The respiratory therapist is providing patient education for a patient who is being discharged home on aerosol therapy. The most important reason for the patient to follow the recommended cleaning procedures using a vinegar/water solution is that this solution will A. sterilize the equipment. B. retard bacterial growth. C. kill all micro-organisms and spores. D. extend the equipment life. Retard bacterial growth A patient who complains of dyspnea is noted to have a dry, non-productive cough. On physical examination, breath sounds are diminished on the right, tactile fremitus is decreased and there is dullness to percussion over the right lower lobe. The respiratory therapist should suspect that the patient is suffering from A. pneumonia. B. pulmonary embolism. C. pleural effusion. D. bronchiolitis. pleural effusion Which of the following suction catheters would be appropriate to use for a patient with a size 8.0 mm ID endotracheal tube? A. 8 Fr B. 10 Fr C. 12 Fr D. 14 Fr 12 Fr A patient who is receiving continuous mechanical ventilation is fighting the ventilator. His breath sounds are markedly diminished on the left, there is dullness to percussion on the left, and the trachea is shifted to the left. The most likely explanation for the problem is that A. the patient is disconnected from the ventilator. B. the patient is experiencing diffuse bronchospasm. C. the endotracheal tube has slipped into the right main stem bronchus. D. the patient has developed a left tension pneumothorax. the endotracheal tube has slipped into the right main stem bronchus The respiratory therapist notes a developing hematoma after an arterial blood gas was drawn from the right radial artery. The immediate response is to A. notify the charge nurse. B. apply a pressure dressing. C. apply pressure to the site. D. perform a modified Allen's test. apply pressure to the site. A patient's breathing pattern irregularly increases and decreases and is interspersed with periods of apnea up to 1 minute. Which of the following conditions is the most likely cause of this problem? A. Diabetes insipidus B. Renal failure C. Metabolic acidosis D. Elevated intracranial pressure Elevated intracranial pressure What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? A. Less than 5 B. 5 to 15 C. 16 to 30 D. Greater than 30 5 to 15 While monitoring a newborn utilizing a transcutaneous monitor, you notice a change in PtcO2 from 60 to 142 torr and simultaneously the (PtcCO2) changes from 37 to 2 torr. What is the most likely explanation for these changes? A. Upper airway obstruction B. Poor peripheral perfusion C. Air leak around the sensor D. Device is out of range Air leak around the sensor A patient on the general medical ward is on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? A. 5 L/min B. 55 L/min C. 88 L/min D. 140 L/min 55/Lmin Which of the following measurements is most indicative of pulmonary edema? A. Heart rate of 120/min B. Blood pressure of 92/72 mm Hg C. Pulmonary artery pressure of 25/10 mm Hg D. Pulmonary capillary wedge pressure of 30 mm Hg Pulmonary capillary wedge pressure of 30 mm Hg Sleep apnea can be defined as repeated episodes of complete cessation of airflow for A. 5 seconds or longer. B. 10 seconds or longer. C. 15 seconds or longer. D. 20 seconds or longer. 10 seconds or longer A patient in the ICU receiving mechanical ventilation has just undergone a fiberoptic bronchoscopy procedure in which a tissue biopsy was collected. Immediately following the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT A. hypoxemia. B. pneumothorax. C. pulmonary hemorrhage. D. bronchospasm/laryngospasm. hypoxemia What size endotracheal tube would be appropriate for an adult female patient? A. 6.0 to 6.5 mm B. 6.5 to 7.0 mm C. 7.0 to 7.5 mm D. 7.5 to 8.0 mm 7.0 to 7.5 mm The respiratory therapist has been asked to measure Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should A. initiate an inspiratory hold just after the next ventilator-delivered breath. B. initiate an expiratory hold just prior to the next ventilator-delivered breath. C. subtract Pplat from Pdyn. D. subtract set PEEP from the measured Pplat. initiate an expiratory hold just prior to the next ventilator-delivered breath. A patient who suffered trauma in an ATV accident is being monitored in the ICU. A pulmonary artery catheter has been placed and the following data is available: PvO2 46 torr PCWP 19 mm Hg PAP (mean) 10 mm Hg CVP 12 cm H2O Cardiac Output 3L/min The respiratory therapist should recommend 1. IV fluid challenge 2. positive inotropic agent 3. inhaled nitric oxide 4. diuretic therapy 2 and 4 [Show Less]
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