RRT Clin sims Exam 437 Questions with Verified Answers
Emphysema - CORRECT ANSWER Weakening and enpermanent enlargement of the air spaces distal to the
... [Show More] terminal bronchioles
Etiology of Emphysema - CORRECT ANSWER Cigarette smoking >80% of all cases
Genetic predisposition
Occupational exposure
Atmospheric pollutants
Primary Assessment of Emphysema - CORRECT ANSWER Past medical history
Shortness of breath
Cough
Appearance of the chest
Respiratory Pattern
Color
Appearance of the nail beds
Diagnostic chest percussion
Breath sounds
Secondary Assessment of Emphysema - CORRECT ANSWER CXR
Arterial Blood Gas
Pulmonary Function
CBC
Sputum
Appearance of CXR in patient with Emphysema - CORRECT ANSWER Hyper lucent lung fields
Depressed or flattened diaphragm
Narrow heart
Increased retro sternal air space (lateral film)
Arterial Blood Gas findings in patient with Emphysema - CORRECT ANSWER Mild to moderate Emphysema
Acute alveolar hyperventilation with hypoxemia
Severe Emphysema
Chronic ventilatory failure with hypoxemia
Pulmonary Function Findings in patient with Emphysema - CORRECT ANSWER Decreased flow rates and Decreased DLco
CBC findings in a patient with Emphysema - CORRECT ANSWER Increased RBC, Hb, HCT
Sputum findings in a patient with Emphysema - CORRECT ANSWER May indicate bacterial infection
Treatment/Management of Emphysema - CORRECT ANSWER Low Flow (FiO2) oxygen therapy 1-2 L/min (.24-.28)
Antibiotics as indicated by sputum culture
Pulmonary Rehab and Home Care
Aerosolized medications
Consider NPPV for acute exacerbation of ventilatory failure
Annual Flu injection
Smoking cessation
Pulmonary Hygiene
Chronic Bronchitis - CORRECT ANSWER Daily productive cough for at least 3 consecutive month each year for 2 years in a row
Etiology of Chronic Bronchitis - CORRECT ANSWER Cigarette smoking
Pollution
Infection
GERD
Primary Assessment of Chronic Bronchitis - CORRECT ANSWER Past medical history
Shortness of Breath
Cough
Appearance of the Chest
Respiratory Pattern
Color
Appearance of Nail beds
Diagnostic Chest Percussion
Breath Sounds
Secondary Assessment of Chronic Bronchitis - CORRECT ANSWER CXR
Arterial Blood Gas
Pulmonary Function
CBC
Sputum Electrolytes
CXR findings in a patient with Chronic Bronchitis - CORRECT ANSWER Hyper lucent lung fields
Depressed or flattened diaphragm
Enlarged or elongated heart
Arterial Blood gas in a patient with mild to moderate Chronic Bronchitis - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia
ABG in a patient with severe Chronic Bronchitis - CORRECT ANSWER Chronic ventilatory failure with hypoxemia
Pulmonary Function test in a patient with Chronic Bronchitis - CORRECT ANSWER Decreased flow rates
CBC in a patient with Chronic Bronchitis - CORRECT ANSWER Increased Hb and HCT
Sputum findings in a patient with Chronic Bronchitis - CORRECT ANSWER May indicate infection
Electrolyte findings in a patient with Chronic Bronchitis - CORRECT ANSWER Increased HCO3 (chronic ventilatory failure)
Treatment and Management of a patient with Chronic Bronchitis - CORRECT ANSWER Pulmonary Hygiene therapy
Antibiotics for infection
Oxygen for hypoxemia
Aerosolized mediations
Consider NPPV for acute exacerbations
Smoking cessation
Reduce risk factors
What aerosolized medications should be considered for Chronic Bronchitis - CORRECT ANSWER Short acting Beta 2 agonists
Anticholinergics
Long acting Beta 2 agonists
Inhaled corticosteroids
Bronchiectasis - CORRECT ANSWER Chronic dilation and distortion of one or more bronchi as a result of excessive inflammation and destruction of bronchial walls, blood vessels, elastic tissue and smooth muscle. Can create an obstructive or restrictive pattern
Etiology of Bronchiectasis - CORRECT ANSWER Not always clear
Can be either acquired or congenital
Primary assessment of Bronchiectasis - CORRECT ANSWER Past medical history
Shortness of breath
Cough- productive with purulent foul smelling sputum, hemoptysis and 3 layer sputum
Appearance of chest
Respiratory pattern
Color
Appearance of nail beds
Diagnostic chest percussion
Breath sounds
Secondary Assessment of Bronchiectasis - CORRECT ANSWER CXR
ABG
Pulmonary Function
CBC
Sputum
Special Diagnostic tests
CXR findings in Bronchiectasis - CORRECT ANSWER Hyperlucent lung fields
Depressed or flattened diaphragm
Enlarged or elongated heart
ABG of mild to moderate Bronchiectasis - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia
ABG of severe Bronchiectasis - CORRECT ANSWER Chronic ventilatory failure with hypoxemia
Pulmonary findings in Bronchiectasis - CORRECT ANSWER Decreased flow rate
CBC findings in Bronchiectasis - CORRECT ANSWER Increase RBC, Hb, HCT
Sputum findings in Bronchiectasis - CORRECT ANSWER May indicate infection
Special Diagnostic findings in Bronchiectasis - CORRECT ANSWER CT scan or bronchogram indicates a tree in winter pattern
Treatment and management of Bronchiectasis - CORRECT ANSWER Pulmonary hygiene
Antibiotics for infection
Aerosolized medications
Surgical resection of involved segments if necessary
Oxygen for hypoxemia
What aerosolized medications can be used for Bronchiectasis - CORRECT ANSWER Short acting Beta 2 agonists
Anticholinergics
Inhaled corticosteroids
Sleep Apnea - CORRECT ANSWER Cessation of breathing for a period of 10 seconds or longer. Sleep apnea is diagnosed in patins who have more that 5 episodes of apnea per hour during sleep over a 6 hour peroid
Central Sleep Apnea - CORRECT ANSWER Caused by failure of the respiratory center of the brain to send signals to the respiratory muscles
Obstructive Sleep Apnea - CORRECT ANSWER Caused by anatomic obstruction of the upper airway in the presence of continued ventilatory effort
Mixed Sleep Apnea - CORRECT ANSWER Combination of both central and obstructive. Usually begins as central apnea followed by onset of ventilatory effort without airflow
Primary Assessment of Sleep Apnea - CORRECT ANSWER Past medical history- daytime sleepiness, insomnia at night, loud snoring with periods of apnea, morning headaches, hypothyroidism
Physical Appearance- Obese, short stocky neck, large tongue
Secondary Assessment of Sleep Apnea - CORRECT ANSWER CXR
ABG
Pulmonary Function
Special Tests
CXR of Sleep Apnea - CORRECT ANSWER May be normal or demonstrate right and/or left sided heart failure
ABG of Sleep Apnea - CORRECT ANSWER Chronic ventilatory failure with hypoxemia (severe sleep apnea)
Pulmonary Function of Sleep Apnea - CORRECT ANSWER Decreased volumes
With obstructive sleep apnea a saw tooth pattern is seen on maximal inspiratory and expiratory flow volume loops
Special tests for Sleep Apnea - CORRECT ANSWER Sleep study (polysomnography)
If both flow and respiratory effort decrease then desaturation is caused by Central Apnea
If nasal flow decrease with an increase in respiratory effort then desaturation is caused by obstructive sleep apnea
Treatment and management of Central Sleep Apnea - CORRECT ANSWER Drug therapy
Phrenic nerve pacer
Nocturnal ventilation
What drugs are used to manage Central Sleep Apnea - CORRECT ANSWER REM inhibitors (Vivactil)
Carbonic anhydrase inhibitors (Diamox)
Respiratory Stimulants (Aminophylline, caffeine)
Treatment and management of Obstructive Sleep Apnea - CORRECT ANSWER Weight loss
Sleep posture (lateral or upright)
Oxygen therapy for hypoxemia
NIPPV
Nasal CPAP
BiPAP
Oral surgery
Tracheostomy
Oral appliances
Neck Collar
Asthma - CORRECT ANSWER A chronic, inflammatory, obstructive, non contagious airway disease with varying levels of severity and characterized by exacerbation's. A reversible condition characterized by increased responsiveness of the small airways to stimuli
Etiology of Asthma - CORRECT ANSWER External or environmental agents
Infections
Exercise
Cold air exposure
Chemical exposure
GERD
Sleep
Emotional stress
PMS
Primary assessment of Asthma - CORRECT ANSWER Past medical history
--allergies, episodes of cough & wheezing
Shortness of breath
--pursed-lip breathing, chest tightness
Cough
--increased & productive with presence of eosenophils
--Charcot-Leyden ceystals
--Kirschman spirals
--increased IgE levels
Appearance of the chest
--increased A-P diameter during episode
Respiratory Pattern
--accessory muscle usage, tachypnea
Color
--cynotic
Diagnostic Chest percussion
--hyperresonant/tmpanic note
Breath sounds
--diffuse wheezing, diminished b/s
Physical appearance
--Diaphoresis, Anxous, speak short phrases
Vital Signs
--Tachycardia, Pulsus paradoxing during severe episode
Secondary assessment of Asthma - CORRECT ANSWER CXR
ABG
Pulmonary Function
Sputum
CXR findings in Asthma - CORRECT ANSWER During acute episode: flattened diaphragms, hyperinflation and some infiltrates (may develop pneumothroax)
ABG findings in Asthma - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia, hypercarbia may occur in status asthmaticus
Pulmonary Function findings in Asthma - CORRECT ANSWER Decreased flow rates, normal DLco, pre and post bronchodilator improvement- at least 12% and 200 mL increase in FEV1
Sputum findings in Asthma - CORRECT ANSWER May indicate infection
Treatment and management of Asthma - CORRECT ANSWER Environmental control
Oxygen therapy
Bronchopulmonary hygiene
Aerosolized medications
Asthma action plan based on peak flow monitoring
Rescue medications used for Asthma - CORRECT ANSWER Short Acting Beta2 agonists
Anticholinergics
Controller medication used for Asthma - CORRECT ANSWER Long acting Beta2 agonists
Inhaled corticosteroids
Mast cell stabilizers (for prevention)
Systemic medications used for Asthma - CORRECT ANSWER Corticosteroids
Leukotriene modifiers
Xanthines
Immunomodulators
Emergency room treatment for acute episodes of Asthma - CORRECT ANSWER Oxygen therapy
Aerosol therapy with SABA and anticholinergic (consider continuous aerosol therapy)
Steroids (IV or oral)
Close monitoring
Intubation and mechanical ventilation if respiratory arrest occurs
Consider adjunct therapies: Heliox, magnesium sulfate, subcutaneous epinephrine
Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Involves any type of trauma to the chest wall
Etiology of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Industrial accidents
Vehicle accidents
Falls
Violence
Surgery
Primary assessment of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Past medical history
--history of injury
Shortness of breath
Cough
--possibly hemoptysis
Appearance of chest
--brusing over area involved
Respiratory Pattern
--paradoxical chest movement - fail chest. shallow rapid respirations, severe chest pain
Color
--cynotic
Diagnostic Chest Percussion
Breath sounds
--diminished breath sounds over affected area
Vitals
--elevated heart rate & BP
Secondary assessment of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER CXR
ABG
Pulmonary Function
CXR findings in Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Increased opacity from lung compression, rib fractures
ABG findings in Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia
Pulmonary Function findings in Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Decreased volumes and capacities
Treatment and management of Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Oxygen therapy for hypoxemia
Analgesics
Routine bronchial hygiene
Hyperinflation therapy (IS, IPPB, deep breathing and coughing)
Prevention of pneumonia
Closely monitor for acute ventilatory failure
Treatment and management of severe Rib fractures, Flail Chest, Chest Trauma - CORRECT ANSWER Stabilization of chest wall
Volume control ventilation for 5 to 10 days
PEEP
Pneumothorax - CORRECT ANSWER Gas or free air accumulated in the pleural space
Etiology of Pneumothorax - CORRECT ANSWER Traumatic- obvious injury
Spontaneous- no obvious injury
Primary Assessment of Pneumothorax - CORRECT ANSWER Past medical history
Shortness of breath
Appearance of the chest
Respiratory pattern
color
Diagnostic chest percussion
Breath sounds
Physical appearance
Vital signs
Secondary Assessment of Pneumothorax - CORRECT ANSWER CXR
ABG
CXR findings of Pneumothorax - CORRECT ANSWER Hyperlucency with absence of vascular markings on the affected side, tracheal shift to the unaffected side, depressed diaphragm, lung collapse
ABG findings of Pneumothorax - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia
Treatment and management of Pneumothorax - CORRECT ANSWER Oxygen for hypoxemia
Hyperinflation therapy (IS, IPPB) after chest tube insertion
Mechanical ventilation with PEEP for acute ventilatory failure
Treatment and management of small Pneumothorax - CORRECT ANSWER Less than 20% of lung collapse may only require bed rest and limited physical activity. Absorption usually occurs within 30 days
Treatment of management of large Pneumothorax - CORRECT ANSWER Greater than 20% of lung collapse should be evacuated by chest tube
Needle aspiration of the chest if necessary if patient is unstable: bradycardia, hypotension, cyanosis
Hemothorax - CORRECT ANSWER Blood accumulated in the pleural space
Etiology of Hemothorax - CORRECT ANSWER Traumatic- obvious injury
Primary assessment of Hemothorax - CORRECT ANSWER Past medical history
Shortness of breath
Cough
Appearance of the chest
Respiratory pattern
Color
Diagnostic chest percussion
Breath sounds
Secondary assessment of Hemothorax - CORRECT ANSWER CXR
ABG
CBC
CXR findings in Hemothorax - CORRECT ANSWER Increased radio density, tracheal shift away from the affected side
ABG findings in Hemothorax - CORRECT ANSWER Acute alveolar hyperventilation with hypoxemia
CBC findings in Hemothorax - CORRECT ANSWER Reduced RBC, Hb, HCT
Treatment and management of Hemothorax - CORRECT ANSWER Thoracentesis or chest tube to drain fluid
Oxygen for hypoxemia
Hyperinflation therapy (IS,IPPB) after chest tube insertion
Mechanical ventilation with PEEP for acute ventilatory failure
Thoracic Surgery - CORRECT ANSWER Any surgical procedure performed on structures within the thoracic cavity
Etiology of Thoracic Surgery - CORRECT ANSWER Lung repairs or resections
Tracheal / mediastinal repairs or resections
Pneumonectomy or lobectomy
Cardiac surgery: valve replacements, bypass grafts
Primary Assessment of Thoracic Surgery - CORRECT ANSWER Past medical history
Shortness of breath
Cough
Appearance of the nail beds
Diagnostic chest percussion
Breath sounds
Secondary assessment of Thoracic Surgery - CORRECT ANSWER Routinely performed pre operative basic laboratory testing
CXR
Pulmonary function
Treatment and management of Thoracic Surgery Pre operative - CORRECT ANSWER Hyperinflation therapy, IS, IPPB
Treatment and management of Thoracic Surgery Post op - CORRECT ANSWER Hyperinflation therapy
Prevention of infection
Monitor chest drainage systems
Observe for post op complications
Post op complications associated with Thoracic Surgery - CORRECT ANSWER Subcutaneous emphysema
Increased pressures on mechanical ventilation
Decreased static lung compliance
Hypovolemic shock- decreased hemodynamic values
Head trauma or surgery - CORRECT ANSWER Any injury or surgical procedure performed on the skull and or brain
Etiology of Head trauma or surgery - CORRECT ANSWER Traumatic brain injury
Tumors
Aneurysms
Cerebrovascular accidents
Seizures
Primary assessment of Head trauma or surgery - CORRECT ANSWER Past medical history
--tumors, headaches, cranial bleeds, trauma, seizures, hemiparalysis, slurred speach
Respiratory pattern
--irregular rhythm, cheyne-stokes breathing
Level of consciousness
--altered level of conciousness
Pupillary response
--abnormal
Secondary assessment of Head trauma or surgery - CORRECT ANSWER Special tests: CT, MRI,PET scans
Intracranial Pressure Monitoring: Normal values are 5 to 10 mmHg
Treatment and management of Head trauma or surgery - CORRECT ANSWER Oxygen therapy- maintain PaO2 level near 100 torr
Mechanical ventilation
Mechanical ventilation for Head trauma or surgery - CORRECT ANSWER Maintain PaCO2 level between 25 to 30 torr to reduce ICP
Minimiza airway resistance by utilizing low PEEP and peak inspiratory pressures
Set low pressure and exhaled volume alarms appropriately
Medications used to treat Head trauma or surgery - CORRECT ANSWER Barbiturates for sedation
Mannitol to decrease ICP
Dilantin for seizures
Neck and Spinal Injury/Surgery - CORRECT ANSWER Any injury or surgical procedure performed on the neck and or around the spine
Etiology of Neck and Spinal Injury/Surgery - CORRECT ANSWER Traumatic injury
Tumors
Spine deformities
Primary assessment of Neck and Spinal Injury/Surgery - CORRECT ANSWER Past medical history
--fall, accidents, tumors
Appearance of the neck/spine
--bruses over affected area
Respiratory Pattern
--maybe be apneic with severe damageto spine
Level of consciousness
--altered
Secondary assessment of Neck and Spinal Injury/Surgery - CORRECT ANSWER CT
MRI
Treatment and management of Neck and Spinal Injury/Surgery - CORRECT ANSWER Oxygen therapy to treat or prevent hypoxemia
Maintain patent airway
Support ventilation, oxygenation, circulation and perfusion as indicated by bedside assessment and laboratory testing
Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Any surgical procedure performed on structures within the abdominal cavity
Etiology of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Gall bladder
Colon
Uterine
Appendix
Primary assessment of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Past medical history
Respiratory pattern
Secondary assessment of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Routinely perform pre op basic laboratory testing
Pre op pulmonary function testing (basic spirometry testing)
Treatment and management of Abdominal Surgery/Pre & Post Op patients - CORRECT ANSWER Pre op: Hyperinflation therapy (IS,IPPB)
Post op: Hyperinflation therapy (IS,IPPB)
Prevention of infection
Analgesics as needed
Mechanical ventilation if needed
What are possible post op complications associated with Abdominal Surgery - CORRECT ANSWER Increased pressure on the vent
Decreased static lung compliance
Hypovolemic shock(decreased hemodynamic values)
Laryngectomy - CORRECT ANSWER Surgical removal of the larynx
With only vocal cord involvement, the temporary stoma is closed within days after removal of the cords. With more radical involvement, the entire larynx may be removed along with the epiglottis and thyroid cartilage. IN the case the stoma becomes permanent
Following Laryngectomy - CORRECT ANSWER There is nor longer a connection between the upper and lower airways, and the patient has a permanent atoms. The patient can not be orally or nasally intubated. If mechanical ventilation is required. insert an endotracheal tube into the laryngectomy opening
Etiology of Laryngectomy - CORRECT ANSWER Carcinoma of the upper airway
Trauma
Primary assessment of Laryngectomy - CORRECT ANSWER Past medical history: upper airway carcinoma
Secondary assessment of Laryngectomy - CORRECT ANSWER Routinely perform basic laboratory testing
Treatment and management of Laryngectomy - CORRECT ANSWER Use meticulous suctioning technique
Cool aerosol will help keep secretions thin in the early post op period
Laryngectomy tube is removed after 3 to 6 weeks, at that time the stoma is considered stable and permanent
Monitor basic laboratory tests
ARDS - CORRECT ANSWER An illness or injury that affects the lung compliance that includes a multitude of etiologic factors
Etiology of ARDS - CORRECT ANSWER Aspiration
Trauma
Drug overdose
Fluid overload
Inhalation of toxins and irritants
Shock
Primary assessment of ARDS - CORRECT ANSWER Past medical history
Shortness of breath
Cough
Respiratory pattern
Color
Diagnostic chest percussion
Breath sounds
Secondary assessment of ARDS - CORRECT ANSWER CXR
ABG
Pulmonary function
Sputum
Special tests
CXR findings of ARDS - CORRECT ANSWER Diffuse alveolar infiltrates with a honeycomb or ground glass appearance, radiopacity
ABG findings in ARDS - CORRECT ANSWER Refractory hypoxemia
Acute alveolar hyperventilation with hypoxemia
Pulmonary function findings in ARDS - CORRECT ANSWER Decreased volumes and capacities
Sputum findings in ARDS - CORRECT ANSWER May indicate infection
Special tests performed in ARDS - CORRECT ANSWER Hemodynamic monitoring reveals elevated PAP
Treatment and management of ARDS - CORRECT ANSWER Treat underlying cause
Oxygen therapy up the 60%, then add CPAP/PEEP
Titrates oxygen to below 60%, then reduce CPAP/PEEP with patient improves
Hyperinflation therapy (IS,IPPB) for atelectasis
Consider mechanical ventilation
Alternative modes of mechanical ventilation - CORRECT ANSWER PCV
IRV
APRV
PRVC
HFV
ARDSnet protocol - CORRECT ANSWER Reduce tidal volume to 6 ML/kg
Maintain plateau pressure <30 cmH2O
Recruitment maneuvers
For patients with any neurologic/neuromuscular disease watch for ventilatory failure by monitoring - CORRECT ANSWER Tidal volume 5 mL/kg IBW if less than consider vent
Vital capacity less than 1000mL
MIP -20 or more negative
Myasthenia Gravis - CORRECT ANSWER Chronic disorder of the neuromuscular junction that interferes with chemical transmission of acetylcholine
Descending paralysis: remember mind to ground
Etiology of Myasthenia Gravis - CORRECT ANSWER Related to circulating antibodies of the autoimmune system
Clinical manifestation are provoked by - CORRECT ANSWER Emotional upset
Physical stress
Exposure to extreme temperature changes
Pregnancy
Febrile illness
Primary assessment of Myasthenia Gravis - CORRECT ANSWER Past medical history
Physical appearance (don't pick pupillary response)
Respiratory pattern
Breath sounds
Physical appearance of Myasthenia Gravis - CORRECT ANSWER General weakness that improves with rest
Drooping eyelids (ptosis)
Double vision (diplopia)
Difficulty swallowing (dysphagia)
Past medical history of Myasthenia Gravis - CORRECT ANSWER Gradual onset of weakness, may have previous admissions for Myasthenia Gravis
Secondary assessment of Myasthenia Gravis - CORRECT ANSWER Special tests
Spontaneous ventilatory parameters
ABG
Pulmonary function
Special tests for Myasthenia Gravis - CORRECT ANSWER Edrophonium: Tensilon challenge
Electomyography
Spontaneous ventilatory parameters - CORRECT ANSWER Decreasing tidal volume, vital capacity, MIP [Show Less]