CSE 1 Exam 120 Questions with Verified Answers
1. various oxygen administration devices
2. intubation equipment
3. suction equipment
4. chest
... [Show More] tube placement equipment
5. Bag-valve device with various sizes of mask
6. medications for pain and agitation
7. fluids for vascular support
8. Venous and arterial line equipment
9. cardiac monitor and defibrillator - CORRECT ANSWER clinical simulation 1
A respiratory therapist assigned to the ED is asked to assist in the evaluation of a 24 year old male victim of a motorcycle accident who will be arriving in 5 minutes. Which of the following should be available for the arrival of this patient?
1. Vital signs (TPR) and blood pressure
2. general appearance
3. breath sounds
4. chest inspection
5. SpO2
6. skin color
7. ECG via cardiac monitor
8. pupillary response - CORRECT ANSWER When the patient arrives at the ED, he is awake, but agitated. He has a cervical collar on and is moving all extremities while breathing room air. During the initial evaluation of this patient, which of the following should be assessed?
oxygen via nonrebreathing mask at 12L/min - CORRECT ANSWER Which of the following should be recommended?
Arterial blood gas analysis
12-lead ECG
Chest x-ray
CBC
Chemistry and toxicology
Electrolytes - CORRECT ANSWER The ED physician requests recommendations of diagnostic studies and laboratory data that would help to further assess the patients condition. Which of the following should be evaluated?
Endotracheal intubation and manual ventilation - CORRECT ANSWER Which of the following should be recommended to the ED physician?
Continue manual ventilation and begin chest compressions - CORRECT ANSWER clinical simulation 2
An evening shift respiratory therapist on call for labor and delivery (L&D) receives a page to report immediately to the L&D to assist in the management of an infant female who was delivered limp and cyanotic. The infant is manually ventilated via mask and resuscitator bag. There are no efforts at spontaneous respirations and the heart rate is approximately 50 breaths/min. The infant is 36 weeks gestation and weighs 2622 grams. Which of the following should be recommended?
3.0-mm internal diameter; uncuffed endotracheal tube - CORRECT ANSWER One minute later, the infant remains unresponsive and with minimal improvement in color. The physician now requests assistance in performing endotracheal intubation. Which of the following endotracheal tubes should be selected for this infant?
Heart rate
Spontaneous respirations
Chest excursion
Breath sounds - CORRECT ANSWER The infant is intubated and manual ventilation is resumed. Which of the following should now be assessed?
Reposition the endotracheal tube - CORRECT ANSWER Which of the following should be recommended?
Stop chest compression; continue to manually ventilate; transfer the infant to the NICU - CORRECT ANSWER Five minutes later, the infants color has significantly improved. The heart rate is now 136/minute. No detectable spontaneous respirations are observed. Which of the following should be recommended?
VC- SIMV; FIO2 0.40, PS 10 cmH2O; mandatory rate 14; Tidal volume 575mL; PEEP 5 cmH20
OR
VC-AC; FIO2 0.40; mandatory rate 14; tidal volume 575 mL; PEEP 5 cmH2O - CORRECT ANSWER clinical simulation 3
A respiratory therapist assigned to the cardiac intensive care unit (CICU) will be managing the ventilator care of a coronary artery bypass (CABG) patient who will be admitted to the unit after surgery.
When the patient arrives in the unit, the anesthesiologist states that the patients PaO2 normalizes with an FIO2 of 0.40. The patient is 178 cm (5ft, 10 in) tall and weighs 83 kg (183lbs). Which of the following initial ventilator settings should be recommended?
ECG via cardiac monitor
General appearance
Ventilator settings
Ventilator alarms
Breath Sounds
SpO2
Vital signs (TPR) and blood pressure - CORRECT ANSWER Which of the following should be assessed immediately after connecting the patient to the ventilator?
Maintain the present ventilator settings - CORRECT ANSWER Thirty minutes later, arterial blood gases are obtained and the results are pH 7.39, PaCO2 43 mmHg, HCO3 26 mEq/L, PaO2 96 mmHg, and SaO2 97%. Which of the following should be recommended?
stop suctioning and continue to closely observe - CORRECT ANSWER One hour later, the patient requires suctioning. While suctioning the patient with an FIO2 of 1.0 and via a closed suction system, the following ECG rhythm is noted on the patients cardiac monitor. Which of the following should be recommended?
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Check the manual resuscitator bag for proper function - CORRECT ANSWER The ECG rhythm deteriorates to ventricular bigeminy and manual ventilation is initiated. While manually ventilating the patient, there is minimal resistance to bag compression and the patients chest is barely rising during bag compression. Which of the following should be done?
Disconnect the patient from the ventilator and manually ventilate - CORRECT ANSWER The patient is now stable and has been reconnected to the ventilator. At this time, the high pressure alarm sounds. Which of the following should be done?
Emphysema - CORRECT ANSWER clinical simulation 4
A respiratory therapist assigned to the surgical floor is asked to evaluate a 72 year old, 64 kg (141 lbs), 173 cm (5 ft, 8 in) tall male who recently had colectomy surgery. The patients nurse states that the patient has been reluctant to get out of bed since surgery. The patient is currently receiving oxygen therapy via nasal cannula at 1 L/min. Theo-Dur 200 mg bid, aerosol albuterol (Ventolin) and ipratropium (Atrovent) every 4 hours while awake.
The chest x-ray shown below is an x-ray taken of the patient on the day of admission. On the basis of this x-ray, which of the following is the most likely diagnosis of this patient?
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Current physician orders
Past medical history
Past and current respiratory modalities
Laboratory data
Code status
Electrocardiographic studies
pulmonary function studies
Nurses notes
Progress notes
Radiologic reports
Past and present surgical procedures - CORRECT ANSWER Which of the following would be pertinent to review in the patients medical chart?
Temperature
Heart rate
Respiratory rate and pattern
Blood pressure
Sensorium
Appearance of extremities
Breath sounds
Character of sputum
General appearance
Chest inspection
SpO2 - CORRECT ANSWER Which of the following should be assessed?
Aerosol albuterol (Ventolin) treatment - CORRECT ANSWER Which of the following should be recommended?
Allow him to rest for a few minutes and instruct him to slow his respirations; then continue the treatment - CORRECT ANSWER Five minutes after therapy is started, the patient complains of shakiness and lightheadedness. The pulse has essentially remained the same, but the patients respirations have increased to 32/minute. Which of the following should be done?
Heart rate
Blood pressure
Respirations
Breath sounds
Hemodynamic status
ECG via cardiac monitor
Position of ET tube
Ventilator settings
Ventilator alarm settings
End-tidal CO2
SpO2 - CORRECT ANSWER clinical simulation 5
A 27 year old, 52 kg (115 lbs) 160 cm (5ft, 3 in) tall female is undergoing surgery for removal of a large mediastinal tumor. Following surgery, the patient is stabilized and transferred to the recovery room. The respiratory therapist is asked to assist in the ventilator management of this patient while in the recovery room. Which of the following should be assessed?
Set the FIO2 at 0.50 - CORRECT ANSWER Arterial blood gases are obtained and the results are pH 7.35, PaCO2 43 mmHg, HCO3 23 mEq/L, PaO2 139 mmHg, and SaO2 99%. Which of the following should be recommended?
continue with the current course of therapy - CORRECT ANSWER One hour later, the patient is transferred to the ICU. After transferring the patient to the bed and connecting to the ventilator, the following ECG rhythm is noted on the cardiac monitor. Which of the following should be recommended?
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Ask the nurse to manually ventilate the patient and tell the nurse she will be right there - CORRECT ANSWER While the therapist is on lunch break, the patients nurse calls and informs the therapist that the ventilator is alarming. Which of the following should the therapist do?
Check the oxygen dial on the ventilator
Check the oxygen and air hoses for occlusions
Check the oxygen and air connections - CORRECT ANSWER After arriving in the patients room, the therapist finds that the ventilators oxygen alarm had been activated. Which of the following should be done?
Reconnect the patient to the ventilator and perform a system check - CORRECT ANSWER During the system check, the therapist finds that the oxygen connection at the wall outlet had become loose. After tightening the connection, the therapist resets the alarm. Which of the following should the therapist do next?
Pulse and blood pressure
Respiratory rate and pattern
ECG via cardiac monitor
CBC
General appearance
Breath sounds
Chest x-ray
Arterial blood gas analysis
Position of trachea - CORRECT ANSWER clinical simulation 6
A respiratory therapist assigned to the pediatric intensive care unit (PICU) is asked to evaluate a restless and agitated 9 year old female who was admitted two days prior for community acquired pneumonia (CAP). The patient is currently receiving IV antibiotics and oxygen via 28% air entrainment mask. The patient weighs 29 kg (64 lbs) and is 119 cm (3ft 11in) tall. Which of the following should be assessed and evaluated?
Endotracheal intubation and mechanical ventilation - CORRECT ANSWER Which of the following should be recommended?
5.0-mm internal diameter; cuffed endotracheal tube
OR
6.0-mm internal diameter; uncuffed endotracheal tube - CORRECT ANSWER Which of the following endotracheal tubes should be selected for this patient?
VC-SIMV; FIO2 1.0; PS 5 cm H2O; mandatory rate 25; tidal volume 225 mL; PEEP 3 cmH2O - CORRECT ANSWER The patient has been successfully intubated. Which of the following initial ventilator settings should recommended?
Chest x-ray
Medication for sedation
Elevation of the head of the bed
Arterial blood gas analysis - CORRECT ANSWER Which of the following should be recommended for post intubation care and support?
Vital signs (TPR) and blood pressure
Chest inspection
Respiratory pattern
Breath sounds
General appearance
SpO2 - CORRECT ANSWER clinical simulation 7
A respiratory therapist is asked to come to the medical floor to evaluate a 77 year old male patient with a long standing history of COPD who is exhibiting signs of increasing respiratory distress. Which of the following should be assessed?
Arterial blood gas analysis - CORRECT ANSWER Which of the following should be recommended?
Manual ventilation - CORRECT ANSWER Which of the following should be recommended now?
Endotracheal intubation and mechanical ventilation - CORRECT ANSWER While manually ventilating, it is noted that the patient now has sporadic and gasping spontaneous efforts. Which of the following should be recommended next?
VC-SIMV; FIO2 0.40; PS 10 cm H2O; mandatory rate 12; tidal volume 550 mL; PEEP 5 cm H20
OR
VC-A/C; FIO2 0.40; mandatory rate 10; tidal volume 550 mL; PEEP 5 cmH2O - CORRECT ANSWER The patient is 175 cm (5ft 9in) tall and weighs 62 kg (136 lbs). Which of the following initial ventilator settings should be recommended?
Assess the patients condition - CORRECT ANSWER clinical simulation 8
A respiratory therapist assigned to the ED is asked to evaluate an adult female who has just been brought to the ED by the local paramedics. The paramedics state that the patient has been trapped in a burning car before the fire was extinguished. The patient is currently receiving supplemental oxygen via nonrebreathing mask. Which of the following should be the first action in the treatment of this patient?
Vital signs (TPR) and blood pressure
Level of consciousness
Pupillary reaction
Condition of oral and nasal mucous
Breath sounds
Response to painful stimuli
Extent of burns
Skin color - CORRECT ANSWER Which of the following should be assessed?
Endotracheal intubation - CORRECT ANSWER Which of the following should be recommended?
Power supply
light source
Bronchoscope tip maneuverability
Ensure the availability of lidocaine
Ensure the availability of epinephrine
Ensure an adequate supply of sterile gauze
Ensure the availability of gowns; gloves; and mask - CORRECT ANSWER The physician has elected to nasally intubate with the aid of a bronchoscope and to explore the upper lung fields for mucosal damage. Which of the following would be pertinent to check prior to this procedure?
Epinephrine - CORRECT ANSWER During bronchoscopy, the onset of endotracheal bleeding is noted. Which of the following should be recommended to stop the bleeding?
Humidified 100% oxygen via T-piece - CORRECT ANSWER The patient has been successfully nasally intubated with a 7.0 mm nasal endotracheal tube. The physician now ask for a recommendation of continued support and treatment for this patient. Which of the following should be recommended?
Temperature
Pulse
Blood pressure
Respirations
Skin color
Pupillary size and reaction
Breath sounds
ECG via cardiac monitor
Inspection of chest
Appearance of extremities - CORRECT ANSWER clinical simulation 9
A respiratory care supervisor is called to come to the ED to assist in the management of a 31 year old male who sustained a stab wound to the heart during an assault. The patient is manually ventilated with an FIO2 of 1.0 via bag valve mask device. Which of the following should be assessed?
Orotracheal intubation and cardiac compressions - CORRECT ANSWER Which of the following should be recommended?
IV epinephrine - CORRECT ANSWER Two minutes after orotracheal intubation and the start of cardiac compressions, the following ECG rhythm is displayed on the cardiac monitor. The patient has no palpable pulse or blood pressure. Which of the following should be recommended?
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Performing an emergency thoracotomy and initiating open cardiac massage - CORRECT ANSWER Three minutes later, a second dose of IV epinephrine is administered. The ECG rhythm remains unchanged. Which of the following should be recommended?
Pericardial decompression via pericardiocentesis - CORRECT ANSWER An anterolateral left thoracotomy has been done and it is now noted that the pericardial sac is dilated and filled with blood. Which of the following should be recommended?
Open defibrillation using 30 joules - CORRECT ANSWER The following ECG pattern is now displayed on the patients monitor. Which of the following should be recommended?
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Set the PEEP at 6 cmH2O - CORRECT ANSWER clinical simulation 10
A respiratory therapist assigned to the pediatric intensive care unit (PICU) is evaluating a 16 month old male toddler who fell into the familys swimming pool and was found face down in the water. He was resuscitated at the scene by paramedics, but remained unconscious. After stabilization in the ED, he was transferred to the unit, intubated, and mechanical ventilation initiated. Ventilator settings are: VC-A/C, FIO2 1.0; mandatory rate22, tidal volume 90 mL, PEEP 4 cmH2O. Arterial blood gas results on these settings are: pH 7.32, PaCO2 41 mmHg, HCO3 20 mEq/L, PaO2 53 mmHg. The patient is 81 cm (32in) tall and weighs 12 kg (26.4lbs). Which of the following should be recommended?
Endotracheal suctioning and an aerosolized bronchodilator treatment - CORRECT ANSWER During the next half hour, IV diuretics and antibiotics are started. A chest x-ray taken shortly after transfer to the unit reveals a properly placed endotracheal tube and increased bilateral haziness.
One hour later, the patients heart rate has increased to 168/min and his respirations are 32/min. Auscultation of the chest reveals bilateral inspiratory crackles with diffuse expiratory wheezes. Which of the following should be recommended?
Set the PEEP at 8 cmH2O - CORRECT ANSWER Thirty minutes later, arterial blood gases are obtained and the results are: pH 7.39, PaCO2 41 mmHg, HCO3 24 mEq/L, and PaO2 62 mmHg. Which of the following should be recommended?
Temperature
Heart rate
Spontaneous respirations
Spontaneous tidal volume
Blood pressure
Rapid shallow breathing index (RSBI)
Maximum inspiratory pressure (MIP)
Chest x-ray
Breath sounds
Arterial blood gas analysis - CORRECT ANSWER Forty-eight hours later, the ventilator settings are VC-SIMV, FIO2 0.30, PS 5 cmH2O, mandatory rate 8, tidal volume 90 mL, PEEP 3 cmH2O. The physician request recommendations regarding continued care of this patient. Which of the following should be assessed?
Discontinue mechanical breaths; initiate pressure support
Initiate CPAP 3 cmH2O with an FIO2 of 0.30 - CORRECT ANSWER The patients current chest x-ray is shown below. Which of the following should be recommended?
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Extubate and administer 40% oxygen via aerosol mask - CORRECT ANSWER One hour later, vital signs remain stable and the patient is resting comfortably. Arterial blood gases are obtained and the results are: pH 7.39, PaCO2 41 mmHg, HCO3 24 mEq/L, PaO2 82 mmHg. Which of the following should be recommended?
Vital signs (TPR) and blood pressure
General appearance
Breath sounds
Arterial blood gas analysis
Chest x-ray
Response to painful stimuli
Drug screen and blood alcohol level
Pupillary response
ECG via cardiac monitor - CORRECT ANSWER clinical simulation 11
A respiratory therapist on call to the ED has just received a page to come to the ED to assist in the evaluation of an adult female who has been brought to the ED by the paramedics after being found unconscious in the back alley outside a local tavern.
The paramedics state that they found an empty bottle of Demerol (meperidine) and two empty bottles of bourbon alongside the patient. The patient is manually ventilated via mask and resuscitator bag. Which of the following should be assessed?
Aspiration pneumonia - CORRECT ANSWER The patients x-ray, taken upon admission, is shown below. Based on this x-ray and the patients current history, which of the following is the most likely diagnosis?
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Endotracheal intubation - CORRECT ANSWER Which of the following should be recommended?
VC-SIMV; FIO2 0.60; PS 8 cmH2O; mandatory rate 15; tidal volume 400 mL; PEEP 5 cmH20
OR
VC-A/C; FIO2 0.60; mandatory rate 15; tidal volume 400 mL; PEEP 5 cmH2O - CORRECT ANSWER During the next half hour, the patient is stabilized and transferred to the ICU. The physician now ask for a recommendation of initial ventilator settings. The patient is 157 cm (5ft, 2in) tall and weighs 75 kg (165 lbs). Which of the following should be recommended?
Maintain present ventilator settings - CORRECT ANSWER It is now six hours post admission. Ventilator settings remain unchanged. Current arterial blood gas results are pH 7.33, PaCO2 42 mmHg, HCO3 20 mEq/L, PaO2 98 mmHg and SaO2 97%. The physician ask for the next recommendation. Which of the following should be recommended?
Heart rate
Temperature
Respiratory rate and pattern
Blood pressure
Breath sounds
Chest configuration
Chief medical complaint
Past and present medical history
Pedal edema
SpO2
Smoking history - CORRECT ANSWER Clinical simulation 12
A respiratory therapist is called to come to the respiratory ward to evaluate a 55 year old morbidly obese male with a history of chronic bronchitis who has just been admitted with acute onset of respiratory distress. Which of the following should be included in the initial assessment of this patient?
Oxygen via nasal cannula at 2 L/min and aerosol albuterol treatments qid and prn - CORRECT ANSWER When the assessment findings are reported to the patients physician, he asks for a recommendation. Which of the following should be recommended?
CBC
Electrolytes
Arterial blood gas analysis
Sputum culture and sensitivity
Chest x-ray
12- lead ECG - CORRECT ANSWER The physician now asks for recommendations of diagnostic and laboratory data that would help to further evaluate the patients cardiopulmonary status. Which of the following should be evaluated?
Maintain current therapy - CORRECT ANSWER Antibiotic therapy has been started. The physician now asks for the next recommendation. Which of the following should be recommended?
Discontinue oxygen therapy and administer albuterol MDI as needed - CORRECT ANSWER Over the next 36 hours, the patients condition stabilizes and his vital signs are normal except for moderate hypertension. He has tolerated therapy well and his breath sounds are essentially clear to auscultation with an occasional expiratory wheeze. Arterial blood gas results while on an FIO2 of 0.28 are: pH 7.39, PaCO2 55mmHg, HCO3 33 mEq/L, PaO2 78 mmHg and SaO2 96%. The physician asks for the next recommendation. Which of the following should be recommended?
Diagnostic testing to determine the presence of sleep apnea syndrome - CORRECT ANSWER The physician now asks for a recommendation regarding the next course of action in the management of this patient. Which of the following should be recommended?
Character of respiratory secretions
Heart rate and blood pressure
ECG via cardiac monitor
Breath sounds
Chest x-ray
Arterial blood gases
Position of endotracheal tube
Ventilator alarms
Ventilator settings - CORRECT ANSWER clinical simulation 13
A respiratory therapist reporting for duty is assigned to the ICU. The patient in bed 4 is a 60 year old, 67 kg (148lbs), 180 cm (5ft, 11in) tall male who has COPD and was admitted to the ICU three days prior for respiratory failure. At that time, he was intubated and mechanical ventilation initiated. A spontaneous breathing trial had been attempted earlier in the day, but the patient did not tolerate the change in therapy. Mechanical ventilation had been re-instituted with the following settings: VC-A/C, FIO2 0.30, mandatory rate 8, tidal volume 550 mL, PEEP 5 cmH2O. Which of the following should be assessed to determine the patients current clinical condition?
Switch to SIMV+ PSV mode of ventilation - CORRECT ANSWER Which of the following should be recommended?
Respiratory rate
Temperature
SpO2
Heart rate
CBC
Blood pressure
Color
Chest inspection
Breath sounds
Chest X-ray
Arterial blood gas analysis
ECG via cardiac monitor
General appearance - CORRECT ANSWER During the next 3 days, the patients course of therapy is uneventful and the patient is weaned from mechanical ventilation and then extubated. During this time the patient remains immobile and bedfast.
On day 6 of admission the patient has a sudden onset of coughing with blood streaked sputum and a complaint of sharp right-sided chest pain and becomes agitated with respiratory distress. The physician now request assistance in evaluating the patient. Which of the following should be assessed?
CT pulmonary angiography - CORRECT ANSWER Which of the following should be recommended to the physician?
Pulmonary embolism - CORRECT ANSWER The physician now asks what most likely caused the patients onset of respiratory distress. Which of the following should be suggested?
Vital signs (TPR) and blood pressure
ETT position and cuff pressure
Chest x-ray
Breath sounds
Ventilator settings
Ventilator alarms
Sensorium
Intracranial pressure (ICP)
ECG via cardiac monitor
Arterial blood gases - CORRECT ANSWER clinical simulation 14
A respiratory therapist assigned to the neurotrauma intensive care unit (NTICU) is evaluating a 23 year old, 80kg (176 lbs), 185cm (6ft 1in) tall male who was admitted to the unit one day prior with traumatic brain injury(TBI) following a sky diving accident. The patient is intubated and receiving mechanical ventilation. Which of the following should be assessed?
Set the FIO2 at 0.40 - CORRECT ANSWER Which of the following should be recommended?
Set the FIO2 at 0.35 - CORRECT ANSWER Thirty minutes later, arterial blood gases are obtained and the results are: pH 7.45, PaCO2 36 mmHg, HCO3 24 mEq/L, and PaO2 123 mmHg. The patients ICP remains unchanged. Which of the following should be recommended?
Manually ventilate the patient and evaluate the patient-ventilator status - CORRECT ANSWER Two hours later, the ventilators high pressure alarm activates. Which of the following should be done?
Attempt to pass a suction catheter through the endotracheal tube - CORRECT ANSWER While manually ventilating the patient, it is extremely difficult to compress the resuscitator bag while it is connected to the endotracheal tube, although the bag compresses easily when not connected to the patients endotracheal tube. Which of the following should be done or recommended?
Assess the infants condition - CORRECT ANSWER clinical simulation 15
A respiratory therapist working in a Level III neonatal intensive care unit (NICU) is informed that an infant female has just been delivered via cesarean section and is en route to the NICU. The therapist is also informed that the infant was intubated in the delivery room due to poor air exchange. On arrival in the NICU, the infant is placed in an open bed with radiant warmers and given supplemental oxygen 40% via T-adapter. Which of the following should be the first action in the treatment of this infant?
Vital signs (TPR) and blood pressure
Gestational age
Weight
General appearance
Breath sounds
Moro reflex
Grasp reflex
APGAR scores at 1- and 5- minutes
Treatment in delivery room
History of delivery - CORRECT ANSWER Which of the following should be assessed?
Set the FIO2 at 0.50 and obtain diagnostic and laboratory data - CORRECT ANSWER Which of the following should be recommended?
Chest x-ray
Arterial blood gas analysis
CBC
Electrolytes
Sputum culture
Blood culture
Urinalysis
Glucose screening - CORRECT ANSWER Which of the following should be evaluated?
PC-A/C: FIO2 0.60; PIP 20 cmH2O; mandatory rate 40; PEEP 4 cmH2O; I-time 0.4 sec - CORRECT ANSWER The infants current chest x-ray is shown below. Which of the following should be recommended next?
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Temperature
Respiratory rate and pattern
Heart rate
Blood pressure
Sensorium
Breath sounds
SpO2
General appearance - CORRECT ANSWER clinical simulation 16
The charge nurse on the medical ward asks the respiratory therapist to assist in the evaluation of a 74 year old retired school teacher who was admitted with post influenza bacterial pneumonia. The charge nurse informs the therapist that since admission the patient has become increasingly restless and tachypneic. Initial assessment of this patient should include which of the following?
Obtain an arterial blood gas sample and administer 50% oxygen via air-entrainment mask
OR
Obtain an arterial blood gas sample and administer oxygen via nonrebreathing mask at 12 L/min - CORRECT ANSWER The patients physician has just arrived on the ward and ask for a recommendation for appropriate therapy. Which of the following should be recommended?
CBC
Electrolytes
Sputum culture and sensitivity
Blood culture and sensitivity
Urine culture and sensitivity
Repeat arterial blood gas analysis
Sputum smear and Gram stain
Chest x-ray - CORRECT ANSWER The physician now request recommendations of diagnostic and laboratory data that would be helpful to further assess the patients current clinical condition. Which of the following should be evaluated?
Mask CPAP 10 cmH2O with an FIO2 of 0.50 - CORRECT ANSWER An IV line has now been placed and a broad-spectrum IV antibiotic started. The patients current chest x-ray is shown below. Which of the following should be recommended?
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Initiate manual ventilation - CORRECT ANSWER Following the initiation of CPAP therapy, the patients clinical condition appears to improve. However, forty-eight hours later, the patient becomes acutely dyspneic and intensely cyanotic with accessory muscle use and intercostal retractions noted. Vital signs are: pulse 134/min, respirations 38/min and labored, blood pressure 144/78 mmHg. Which of the following should be recommended now?
Transfer the patient to the intensive care unit; intubate and initiate mechanical ventilation - CORRECT ANSWER While manually ventilating, it is now noted that the patient has no spontaneous respirations. Which of the following should be recommended?
Cardiopulmonary exercise test - CORRECT ANSWER clinical simulation 17
A respiratory therapist assigned to the respiratory clinic is asked to evaluate a 48 year old male with a history of COPD and smoking cigarettes who presented to the clinic with complaints of increasing shortness of breath on exertion of 6 months duration. To evaluate the patients shortness of breath on exertion, which of the following should be recommended?
Heart rate
Blood pressure
Respirations
Tidal volume
ECG
O2 consumption
CO2 production
Arterial blood gases
Work load
Pulse oximetry - CORRECT ANSWER Which of the following would be appropriate to assess during the patients exercise test?
Moderately severe exercise impairment - CORRECT ANSWER A treadmill exercise test was administered in two phases: While breathing room air and while breathing oxygen with an FIO2 of 0.28. The first phase of the test was terminated at a work load of 2 mph, 0% grade, due to a PaO2 of 49 mmHg with an SaO2 of 78%. The second phase of the exercise test was terminated at a work load of 3 mph, 4% grade, because of rapidly increasing dyspnea. The patient achieved a maximal minute VO2 while on oxygen of only 54% of his age-related prediction. The patients heart rate and blood pressure responses were appropriate for the workloads achieved while breathing both air and oxygen. The ECG throughout the test was unremarkable. On the basis of this information, which of the following would be the most likely interpretation?
Implement a rehabilitation program to include smoking cessation; bronchial hygiene; oxygen at 2L/min for exertion - CORRECT ANSWER Which of the following should be recommended?
Set the mandatory rate at 15 and set the PEEP at 10 cmH2O - CORRECT ANSWER clinical simulation 18
A respiratory therapist assigned to the ICU is asked to manage the ventilator care of a 69-year-old, 75.5 kg (166 lbs), 178 cm (5ft, 10in) male who was transferred to the ICU following a cardiac arrest. The patient is intubated and receiving VC-A/C, FIO2 1.0, mandatory rate 12, tidal volume 575 mL, PEEP 5 cmH2O. Arterial blood gas results on these settings are: pH 7.24, PaCO2 50 mmHg, HCO3 20 mEq/L, PaO2 51 mmHg, SaO2 82%.
A right radial arterial line and a pulmonary artery (PA) catheter are in place. Capnography and respiratory mechanics monitoring are also initiated. Which of the following should be recommended?
Set the PEEP at 15 cmH2O - CORRECT ANSWER Thirty minutes later, arterial blood gases are obtained and the results are: pH 7.38, PaCO2 44 mmHg, HCO3 25 mEq/L, PaO2 67 mmHg, SaO2 88%. Which of the following should be recommended?
Administer IV fluids to increase intravascular volume - CORRECT ANSWER Thirty minutes later, the arterial blood gas results are: pH 7.36, PaCO2 41 mmHg, HCO3 23 mEq/L, PaO2 78 mmHg, SaO2 94%. Other pertinent data include:
Pulse: 96/min, BP: 84/56 mmHg, Cardiac output: 4.1 L/min
PAWP: 4 mmHg, CVP: 2 mmHg, Mean PAP: 9 mmHg
Which of the following should be recommended?
Continue present therapy - CORRECT ANSWER Fifteen minutes later, the following pulmonary artery waveform and ECG tracing are observed on the cardiac monitor. Which of the following should be recommended?
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Vital signs (TPR) and blood pressure
Breath sounds
SpO2
End-tidal CO2
Ventilator settings
Respiratory mechanics and waveforms
ECG via cardiac monitor - CORRECT ANSWER Three hours later, the patient becomes agitated and diaphoretic. Which of the following should initially be assessed?
Increase the ventilator sensitivity - CORRECT ANSWER Which of the following should be recommended?
Vital signs (TPR) and blood pressure
Facial muscle tone
Ability to swallow
Muscle strength
Sensorium
Character of cough
Breath sounds
Skin color
Diagnostic chest percussion
Chest symmetry
History of present illness
History of past illnesses - CORRECT ANSWER clinical simulation 19
A respiratory therapist assigned to the surgical floor is asked to evaluate a 47 year old female with a 37-year history of myasthenia gravis. The patients chief medical complaints are increasing dyspnea, fatigue and cough. Which of the following should be assessed?
Administer an aerosol bronchodilator and obtain diagnostic and laboratory data - CORRECT ANSWER Which of the following should be recommended?
CBC
Electrolytes
Arterial blood gas analysis
Chest x-ray
Sputum culture
Sputum smear and Gram stain - CORRECT ANSWER Which of the following diagnostic and laboratory data should be recommended in order to further assess the patients cardiopulmonary status?
Oxygen via 40% aerosol mask - CORRECT ANSWER The patients current chest x-ray is shown below. The physician asks for a recommendation of appropriate therapeutic care. Which of the following should be recommended?
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Aerosol bronchodilator concurrently with PEP therapy 4 times daily - CORRECT ANSWER Which of the following additional therapies or supportive care should be recommended?
Temperature
CBC
Heart rate and blood pressure
Arterial blood gas analysis
Breath sounds
Respiratory rate and pattern
Chest x-ray
Appearance of extremities
Vital capacity
Character and nature of cough
History of present illness - CORRECT ANSWER clinical simulation 20
A respiratory therapist is asked to evaluate a 35 year old male patient who underwent thoracic surgery the previous day who is now complaining of increasing shortness of breath and cough. Which of the following should be assessed?
Incentive spirometry treatments q1hr while awake - CORRECT ANSWER Which of the following should be recommended?
Vital signs (TPR) and blood pressure
CBC
ECG via cardiac monitor
Arterial blood gas analysis
Sputum culture and Gram stain
Breath sounds
Blood culture
Chest x-ray
General appearance
Skin color - CORRECT ANSWER Forty-eight hours later, the patient experiences acute respiratory distress. Supplemental oxygen is initiated via nonrebreathing mask at 13 L/min. Which of the following should now be assessed?
Endotracheal intubation and mechanical ventilation - CORRECT ANSWER Which of the following should be recommended?
VC-AC; FiO2 1.0, mandatory rate 14; tidal volume 600 mL; PEEP 5 cmH2O
OR
VC-SIMV; FIO2 1.0; PS 8 cmH2O; mandatory rate 15; tidal volume 600 mL; PEEP 5 cmH2O - CORRECT ANSWER The patient is 185 cm (6 ft 1 in) tall and weighs 86 kg (190lbs). Which of the following initial ventilator settings should be recommended?
Check the endotracheal tubes cuff for proper inflation - CORRECT ANSWER After connecting patient to the ventilator, returned tidal volumes range between 400 to 500 mL. Which of the following should be done?
CBC
Blood culture
Culture of the epiglottis
Chest x-ray
Breath sounds
Arterial blood gas analysis
Vital signs (TPR) and blood pressure
SpO2
General appearance - CORRECT ANSWER clinical simulation 21
A respiratory therapist assigned to an 8-bed pediatric intensive care unit (PICU) is evaluating a 28-month old male toddler who was just admitted to the unit following intubation in the ED for respiratory distress secondary to acute epiglottitis. The patient is receiving humidified 40% oxygen via T-adapter. The physician asks for recommendations of further treatment and supportive care. Which of the following should be assessed?
Set the FIO2 at 0.35 - CORRECT ANSWER Which of the following should be recommended to the physician?
Administering IV antibiotics
Continuous monitoring of SpO2
Daily direct visualization of the epiglottis
Continuous cardiac monitoring - CORRECT ANSWER Which of the following additional therapies and supportive care should be recommended?
Directly visualizing the epiglottis for abnormalities - CORRECT ANSWER Twenty-four hours later, the patients condition has significantly improved. Vital signs are normal and the patient is alert and oriented. SpO2 is 98% with and FIO2 of 0.24. Which of the following should be recommended?
Transfer the patient to the operating room and extubate - CORRECT ANSWER Direct visualization of the epiglottis shows that it is normal in size and shape. Which of the following should now be recommended?
Hemophilus influenzae - CORRECT ANSWER The patient is transferred to the operating room and extubated without complications. He is then returned to the PICU for observation and monitoring. Twenty-four hours later, he is discharged on oral amoxicillin. Based on the information obtained about the patient and his course of therapy, which of the following etiological agents was most likely responsible for the onset of his problems?
Pulse and blood pressure
ECG via cardiac monitor
Respiratory rate and pattern
Response to noxious stimuli
General appearance
Pupillary response
Breath sounds
Response to painful stimuli
Response to verbal commands
Muscle tone and reflexes - CORRECT ANSWER clinical simulation 22
A respiratory care supervisor on call to the ED receives a page from the ED requesting assistance in the evaluation of a 23 year old female victim of a car vs pedestrian collision. The patient is unconscious and receiving oxygen via nonrebreathing mask at 12 L/min. Which of the following should be assessed?
Nasotracheal intubation and mechanical ventilation - CORRECT ANSWER Which of the following should be recommended?
7.0 mm ID endotracheal tube
Water based lubricant
Gloves
Local anesthetic
Suctioning equipment - CORRECT ANSWER The ED resident states that he has decided to contact the pulmonary physician on call to nasally intubate the patient vis bronchoscopy. Which of the following may be needed for this procedure?
VC-A/C; FIO2 1.0; mandatory rate 14; tidal volume 470 mL; PEEP 5 cmH2O - CORRECT ANSWER The patient has been successfully nasally intubated. The ED physician now requests a recommendation of initial ventilator settings. The patient is 168 cm (5ft, 6 in) tall and weighs 75 kg (165lbs). Which of the following initial ventilator settings should be recommended?
Maintain current settings and continue to monitor - CORRECT ANSWER Twenty minutes later, an arterial blood gas sample is obtained with the following results: pH 7.39, PaCO2 36 mmHg, HCO3 21 mEq/L, and SaO2 96%. The ED resident asks for the next recommendation. Which of the following should be recommended?
Check the endotracheal tube for a cuff leak - CORRECT ANSWER Five minutes later, during a patient-ventilator system check, the ventilator waveform shown below is noted on the ventilators monitor. Which of the following should be recommended?
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