TMC EXAM 160 Questions with Verified Answers FORM A
A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+
... [Show More] pitting edema in the ankles. These findings are consistent with - CORRECT ANSWER 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? - CORRECT ANSWER Needle aspirate the 2nd left intercostal space
All of the following strategies are likely to decrease the likelihood of damage to the tracheal mucosa EXCEPT - CORRECT ANSWER using a low residual volume, low compliance cuff
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 - CORRECT ANSWER deep breathing & coughing to clear secretions
A 65 kg spinal cord injured patient develops atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? - CORRECT ANSWER IPPB
A healthy adult female can exhale what portion of her forced vital capacity in the first second? - CORRECT ANSWER 70%
A patient on VC ventilation demonstrates 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 - CORRECT ANSWER 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? - CORRECT ANSWER insert a chest tube
Following cardiac surgery, a 55 year-old 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. - CORRECT ANSWER 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? - CORRECT ANSWER 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 76%. Which of the following would be most appropriate at this time? - CORRECT ANSWER Reintubation
Which of the following patients would most likely benefit from pressure support ventilation? - CORRECT ANSWER A patient on SIMV with a mandatory 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? - CORRECT ANSWER obtain a sputum gram stain
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 - CORRECT ANSWER 1 & 2 only
The respiratory therapist provides 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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? - CORRECT ANSWER 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 - CORRECT ANSWER 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 - CORRECT ANSWER 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? - CORRECT ANSWER elevated intracranial pressure
What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? - CORRECT ANSWER 5 to 15
While monitoring a newborn utilizing a transcutaneous monitor, the respiratory therapist notices 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? - CORRECT ANSWER air leak around the sensor
A patient on the general medical ward receives oxygen via 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? - CORRECT ANSWER 55 L/min
Which of the following measurements is most indicative of congestive heart failure? - CORRECT ANSWER pulmonary capillary wedge pressure of 30 mmHg
Sleep apnea can be defined as repeated episodes of complete cessation of airflow for - CORRECT ANSWER 10 seconds or longer
A patient in the ICU receiving mechanical ventilation underwent fiberoptic bronchoscopy during 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 - CORRECT ANSWER hypoxemia
What size endotracheal tube would be appropriate for an adult female patient? - CORRECT ANSWER 7.0 to 7.5 mm
The respiratory therapist is asked to evaluate the presence of Auto-PEEP on a patient receiving mechanical ventilation. In order to do this, the therapist should - CORRECT ANSWER 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:
PCWP 4 mm Hg
PAP (mean) 8 mm Hg
CVP 2 cm H2O
Cardiac Output 3L/min
The respiratory therapist should recommend - CORRECT ANSWER IV fluid challenge
What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? - CORRECT ANSWER VC provides a constant minute ventilation
Bronchial breath sounds heard over the lung periphery indicate - CORRECT ANSWER lung consolidation
During a pre-operative evaluation, bedside spirometry results are as follows: FVC 88% of predicted, FEV1 85% of predicted, FEV1/FVC 82% of predicted and FEF25-75 81% of predicted. How should the respiratory therapist interpret these results? - CORRECT ANSWER Normal lung function
A 55 year-old male patient is evaluated for pulmonary rehabilitation. During a cycle ergometer cardiopulmonary stress procedure, the patient has a heart rate of 100/min and a respiratory rate of 20/min. He suddenly begins to complain of chest pain and severe shortness of breath. The respiratory therapist should - CORRECT ANSWER terminate the procedure immediately
At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. At 5 minutes post-delivery, the infant is completely pink, heart rate is 140/min, respiratory rate is 40/min, cough reflex is present, and the baby is active with a strong cry. What APGAR scores should be assigned? - CORRECT ANSWER 6 & 10
The respiratory therapist is asked to administer 2.5 mg of albuterol to a patient via small volume nebulizer. The medication is available in a 0.5% solution. What volume of albuterol should be administered? - CORRECT ANSWER 0.50 mL
After consulting on management of a patient with pneumonia and atelectasis, the pulmonologist documents a need to change the patient's treatment regimen in the Progress Notes. The respiratory therapist should - CORRECT ANSWER check the medical record for new physician orders
A 60 kg (132 lb) patient is mechanically ventilated at the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? - CORRECT ANSWER change to airway pressure release ventilation
In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a - CORRECT ANSWER 3.0 L syringe
While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding?
1. Pneumothorax
2. Pleural effusion
3. Pneumonia
4. Atelectasis - CORRECT ANSWER 2, 3, and 4 only
Following thoracotomy, a patient on volume-control ventilation has a chest tube in the left pleural space. While inspecting the chest drainage system, the respiratory therapist notes bubbling in the water seal chamber during the inspiratory phase. The therapist should report this to the physician as - CORRECT ANSWER a persistent bronchopleural fistula
A 19-year-old patient is brought to the Emergency Department after taking a handful of pills. The patient is obtunded but is making regular, sonorous respiratory efforts. Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? - CORRECT ANSWER obtain an ABG
A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from - CORRECT ANSWER myocardial infarction
A young healthy adult with complaints of intermittent wheezing is seen in the pulmonary clinic. A pre/post bronchodilator spirometry reveals a normal study with no reversibility. Which of the following should the respiratory therapist recommend? - CORRECT ANSWER bronchial provocation
Twenty-four hours after a patient was intubated, she develops a fever of 99.9°F, a right lower lobe infiltrate, and her white blood cell count is 12,000 per mm3. The respiratory therapist should recommend - CORRECT ANSWER antibiotic therapy
A tracheostomy tube has just been inserted percutaneously into a patient with a C3 fracture. How much air should the respiratory therapist initially inject into the cuff? - CORRECT ANSWER enough to achieve a pressure of 25-35 cm H2O
All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT - CORRECT ANSWER pulmonary hypertension
Which of the following factors are determinants of cardiac output? - CORRECT ANSWER stroke volume and heart rate
The following ABG results are reported for a patient in the ED on room air: pH 7.20; PaCO2 24 torr; PaO2 95 torr; HCO3 10 mEq/L; SaO2 95%; BE -15 mEq/L. The respiratory therapist should recommend - CORRECT ANSWER administering sodium bicarbonate.
The physician asks the respiratory therapist to select ventilator parameters that will deliver the lowest peak inspiratory pressure possible. Which of the following inspiratory flow patterns will enable the therapist to fulfill the physician's request? - CORRECT ANSWER decelerating
An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia in this patient is - CORRECT ANSWER ventilation/perfusion mismatch
A 16 year-old patient with cystic fibrosis attends high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient? - CORRECT ANSWER Vibratory/oscillatory PEP
A patient reports that he has difficulty breathing while lying in a supine position and prefers to sleep sitting in a chair. The respiratory therapist should record this complaint in the medical record as - CORRECT ANSWER orthopnea
A patient receiving oxygen therapy at home calls in the middle of the night and reports that the oxygen supply tubing will not stay attached to her transtracheal catheter. The flow rate to the transtracheal catheter is set at 0.5 L/min. The patient has attempted to flush the catheter with saline and push a cleaning rod through it without success. The respiratory therapist should instruct the patient to - CORRECT ANSWER switch to a nasal cannula
A patient with copious amounts of secretions has required nasotracheal suctioning for the past 36 hours and has now developed mild epistaxis. Which of the following should the respiratory therapist recommend? - CORRECT ANSWER Insert a nasopharyngeal airway after bleeding has been controlled.
The most probable cause of air bronchograms and increased density on a chest x-ray is - CORRECT ANSWER pneumonia
Following abdominal surgery, a 70 year-old patient receives mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 torr and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? - CORRECT ANSWER increase the FiO2
The primary source of infection in the health care setting is - CORRECT ANSWER poor handwashing techniques of personnel
A 36 year-old patient is admitted to the ED with a temperature of 38.5° C and suspected pneumonia. The patient has no history of pulmonary disease. Auscultation reveal medium crackles throughout both lungs. Which of the following should be recommended for management of this patient? - CORRECT ANSWER regular coughing and deep breathing
The respiratory therapist obtains a blood gas sample from the patient's radial artery and applies pressure to the site for 10 minutes. After removing any excess air from the syringe, the next step for proper handling of the blood sample is - CORRECT ANSWER placing the syringe in an ice bath
Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? - CORRECT ANSWER increased fremitus
A spontaneous breathing trial is initiated on an intubated, awake, and alert 70 kg (154 lb) patient. After 40 minutes on an FIO2 of 0.30, ABG results are as follows: pH 7.39, PaCO2 44 torr, PaO2 85 torr, and HCO3- 24 mEq/L. The patient's vital signs remained stable throughout the trial. Which of the following is the most appropriate recommendation? - CORRECT ANSWER extubate the patient
After assisting with bronchoalveolar lavage and lung biopsy on a mechanically ventilated patient, the respiratory therapist notes the activation of a high pressure alarm. Peak inspiratory pressure has increased from 32 cm H2O before the procedure to 45 cm H2O after the procedure. Possible causes for the increased pressure include
1. bronchospasm.
2. pneumothorax.
3. pulmonary hemorrhage. - CORRECT ANSWER 1, 2 and 3
A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position? - CORRECT ANSWER Head down, patient prone with a pillow under hips
A 72 year-old female post stem cell transplant patient in the ICU complains of difficulty breathing and is noted to have diffuse fluffy infiltrates on chest X-ray. The B-type Natriuretic Peptide (BNP) test result demonstrates 700 pg/mL. What is the patient's possible condition? - CORRECT ANSWER moderate heart failure
Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following? - CORRECT ANSWER Endobronchial intubation
The respiratory therapist performs the quality control procedures for the blood gas analyzer in the NICU and notices a single data point that is 3 standard deviations from the mean value for the pH electrode. The therapist should - CORRECT ANSWER perform another control run
A patient receiving pressure-controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: heart rate 90/min, respiratory rate 18/min, SpO2 94%. Which of the following change(s) will address the situation?
1. Increase the pressure limit
2. Increase the sensitivity
3. Increase the mandatory rate
4. Decrease the inspiratory time - CORRECT ANSWER 1 and 3 only
A 60 year-old male has just been extubated following coronary artery bypass grafting. His chest X-ray demonstrates platelike infiltrates with scattered densities and he is noted to have decreased chest expansion with an increased respiratory rate. Which of the following treatments should be recommended for this patient? - CORRECT ANSWER lung expansion therapy
A 42 year-old trauma patient in the ED has been intubated with a 6.5 mm oral endotracheal tube equipped with a high-residual-volume, low-pressure cuff. The respiratory therapist notes that a cuff pressure of 42 cm H2O is necessary to achieve a minimal occluding volume. This would indicate that the - CORRECT ANSWER tube is not of the appropriate size
A patient receives oxygen via nasal cannula at 2 L/min and has the following ABG results: pH 7.37, PaCO2 42 torr, PaO2 80 torr, HCO3 38 mEq/L. The most likely explanation for these results is that - CORRECT ANSWER the numbers were not reported correctly
The respiratory therapist completes oxygen rounds and checking oxygen saturations on a number of patients. What solution would be most appropriate for disinfecting the surface of the pulse oximeter between patients? - CORRECT ANSWER Ethyl alchohol
Evaluation of a spontaneously breathing patient reveals tachypnea, tracheal deviation to the right and an absence of breath sounds on the left. The most likely etiology would be - CORRECT ANSWER left tension pneumothorax
The most serious complication associated with airway suctioning is - CORRECT ANSWER hypoxemia
What is the most appropriate position for a female patient who is 5'3" tall, weighs 200 kg and complains of difficulty breathing? - CORRECT ANSWER lateral fowlers
Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? - CORRECT ANSWER 50 torr
The ability to distinguish central apnea from obstructive apnea during a sleep study requires the respiratory therapist to monitor
1. electrocardiogram.
2. electroencephalogram.
3. nasal air flow.
4. chest wall impedance. - CORRECT ANSWER 3 and 4 only
All of the following statements are TRUE with regard to cuff inflation techniques EXCEPT
A. minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring.
B. minimal leak technique allows a small leak at the end of inspiration.
C. at minimal occlusion volume, air leakage around the tube cuff should cease.
D. cuff pressure should not exceed 35 cm H2O in order to allow circulation to tracheal mucosa. - CORRECT ANSWER A
A capnograph used for continuous monitoring of a patient on mechanical ventilation should be recalibrated every - CORRECT ANSWER 8 hours
A sudden decrease in end-tidal CO2 occurs in a mechanically ventilated patient. A repeat analysis yields the same results. Which of the following situations might account for these readings? - CORRECT ANSWER The ventilator circuit has become disconnected.
A patient has mild stridor immediately after extubation. This finding is most often associated with - CORRECT ANSWER upper airway obstruction
A patient who suffered multiple trauma in a car accident receives oxygen via nasal cannula at 2 L/min. Vital signs are: heart rate 110/min, respiratory rate 32/min, blood pressure 90/60 mm Hg. The pulse oximeter reads 78%. Which of the following should the respiratory therapist recommend to maximize the patient's FIO2? - CORRECT ANSWER Non-rebreathing mask at 15 L/min
The primary reason for the use of respiratory care protocols is to - CORRECT ANSWER standardize provision of care
What is normal urine output in an adult patient? - CORRECT ANSWER 40 mL/hr
A patient with a closed head injury has had a cuffed tracheostomy tube in place for several weeks. The physician wishes to decannulate the patient but maintain the patency of the stoma for secretion removal. Which of the following devices would facilitate this request? - CORRECT ANSWER Tracheostomy button
A patient with chronic bronchitis is seen in the pulmonary clinic with complaints of frequent cough and secretion production. Despite completing a round of antibiotics as prescribed, the patient continues to have scattered infiltrates on his chest X-ray. Which of the following tests should the respiratory therapist recommend? - CORRECT ANSWER flexible bronchoscopy
A 60 kg (132 lb) female patient with congestive heart failure receives NPPV with an IPAP of 16 cm H2O, EPAP of 10 cm H2O, and FIO2 of 0.70. Available laboratory data includes: pH 7.40, PaCO2 42 torr; PaO2 145 torr; HCO3 26 mEq/L, SaO2 99%, CVP 10 cm H2O. Breath sounds reveal a few fine bibasilar crackles. This situation should be described as - CORRECT ANSWER hyperoxygenation
Which of the following physiologic values would be present in a patient who has proper fluid balance? - CORRECT ANSWER CVP between 3 and 6 mmHg
The respiratory therapist prepares to assist with bronchoscopy for a patient in the ICU currently receiving mechanical ventilation in the VC,AC mode. The therapist should anticipate addressing all of the following considerations EXCEPT - CORRECT ANSWER the patient's extrinsic PEEP levels will increase.
Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions? - CORRECT ANSWER chronic bronchitis
A post-operative thoracic surgery patient is having difficulty developing an effective cough. The respiratory therapist could recommend all of the following techniques to aid this patient in generating a more effective cough EXCEPT: - CORRECT ANSWER applying pressure to patient's abdomen during exhalation.
Which of the following should the respiratory therapist consider when preparing for helicopter transport of a patient receiving mechanical ventilation?
1. Select a ventilator that uses demand valves rather than a reservoir IMV system.
2. Calculate oxygen cylinder duration of flow.
3. Selecting a ventilator that incorporates an internal air compressor. - CORRECT ANSWER 1 and 2 only
A 65 year-old female patient with advanced emphysema comes to the ED and is placed on a nasal cannula at 6 L/min. On inspection, the respiratory therapist finds that the patient has become drowsy and less responsive since the oxygen therapy was initiated an hour ago. ABG on 6 L/min are: pH 7.33, PaCO2 64 torr, PaO2 85 torr, HCO3 35 mEq/L. Which of the following should the therapist recommend? - CORRECT ANSWER Change to a 24% Venti-mask and repeat ABG.
A patient receiving warfarin (Coumadin®) has a prothrombin time (PT) of 20 seconds. These findings indicate a - CORRECT ANSWER high likelihood of excessive bleeding.
A mechanically ventilated patient with a tracheostomy tube is on the following settings: PC, SIMV, PIP 30 cm H2O, f 20/min, FIO2 0.60, PEEP 5 cm H2O. The ventilator alarm suddenly begins to sound and on quick examination, the respiratory therapist notices a generalized decrease in breath sounds and a reduction in delivered tidal volume from 650 mL to 500 mL. Which of the following conditions is most likely? - CORRECT ANSWER Partial obstruction of the tracheostomy tube.
The respiratory therapist instructs a postoperative abdominal surgery patient in how to perform incentive spirometry. The therapist should explain that the purpose of the treatment is to - CORRECT ANSWER prevent areas of lung collapse
A pulse oximeter provides an accurate indication of a patient's oxygenation status in which of the following situations?
1. Polycythemia
2. Pulmonary hypertension
3. Congestive heart failure
4. Carbon monoxide poisoning - CORRECT ANSWER 1,2 & 3 only
What increase in FEV1 during post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern? - CORRECT ANSWER 12% and 200 mL
A patient with a history of asthma presents to the ED in severe respiratory distress with increased accessory muscle use. Vital signs are: heart rate 110/min, respiratory rate 32/min and SpO2 of 88% on room air. Bilateral expiratory wheezes are heard on auscultation. The respiratory therapist should recommend initiating - CORRECT ANSWER albuterol
A patient in the ICU is ventilated with PC, SIMV with a set inspiratory pressure of 62 cm H2O. The respiratory therapist notes that the patient's SpO2 is 92% and PETCO2 is 25 torr. The pressure-volume waveform reveals over-distension. The therapist should - CORRECT ANSWER decrease the inspiratory pressure
An adult patient with asthma is receiving a mixture of 70% helium and 30% oxygen through a nonrebreathing mask with an oxygen flowmeter set at 10 L/min. What is the actual flow being delivered to the mask? - CORRECT ANSWER 16 L/min
Which of the following should the respiratory therapist utilize in order to determine the severity of respiratory distress in a newborn? - CORRECT ANSWER Silverman score
While administering 3.5 mg of albuterol to a patient with asthma in the ICU, the respiratory therapist notes that the patient's heart rate increases from 120 to 150 beats/minute. What is the appropriate modification for the next treatment for this patient? - CORRECT ANSWER reduce the dose of albuterol
The respiratory therapist prepares to assist with the intubation of an adult male patient. The anesthesia resident wishes to administer a neuromuscular blocker that has a fast onset and short duration. Which of the following should the therapist recommend? - CORRECT ANSWER Succinylcholine
A patient receiving mechanical ventilation has a capnometer in-line at the Y-connector of the vent circuit for continuous monitoring of exhaled CO2. The capnogram suddenly indicates an abrupt decrease in the PETCO2 from 5.3% to 0.0%. The respiratory therapist should - CORRECT ANSWER reattach the patient to the circuit
A 28 year-old female has been admitted through the ED with suspected CO poisoning. She receives oxygen by non-rebreather mask at 10 L/min. Upon entering the patient's room, the respiratory therapist notes that the reservoir bag of the mask collapses during inspiration. This is most likely the result of - CORRECT ANSWER insufficient flow to the reservoir bag.
Pre- and post-bronchodilator spirometry is performed on a patient and yields the following results:
Pre-Bronchodilator (% predicted)
FVC *82*
FEV1 *46*
FEF200-1200 *51*
FEF 25-75 *49*
MVV *65*
Post-Bronchodilator (% predicted)
FVC *83*
FEV1 *66*
FEF200-1200 *68*
FEF 25-75 *70*
MVV *75*
The respiratory therapist should recommend the initiation of - CORRECT ANSWER bronchodilator therapy
The physician asks the respiratory therapist to set an optimal PEEP level for a mechanically ventilated patient . The PEEP level is optimal when - CORRECT ANSWER Oxygen delivery to the tissues is maximal.
Thirty minutes after extubation, a patient exhibits moderate stridor. Which of the following should the respiratory therapist recommend? - CORRECT ANSWER Administer racemic epinephrine by small volume nebulizer.
A 75 year-old patient with end-stage COPD is admitted to the ED with an acute exacerbation. He has a DNI order in his chart. Physical exam reveals that the patient is febrile and has a weak, non-productive cough. Breath sounds reveal bilateral coarse crackles with scattered wheezes. The patient is started on bronchodilator therapy and antibiotics. Serial ABG results are:
7 PM
FIO2 *0.21*
pH *7.30*
PaCO2 *70 torr*
PaO2 *48 torr*
HCO3 *34 mEq/L*
SpO2 *78%*
8 PM
FIO2 *0.40*
pH *7.21*
PaCO2 *83 torr*
PaO2 *58 torr*
HCO3 *34 mEq/L*
SpO2 *89%*
What should the respiratory therapist recommend? - CORRECT ANSWER initiate NPPV
While providing education to patients who will be discharged home on oxygen therapy, the respiratory therapist explains the hazards associated with oxygen delivery equipment in the home. This instruction should include all of the following EXCEPT
A. liquid oxygen burns when refilling portable tanks.
B. how to properly secure oxygen cylinders for transport.
C. use of grounded 3-prong outlets for electrical equipment.
D. emergency procedure to deal with gas explosions. - CORRECT ANSWER D
A mixed venous blood sample is needed to determine the oxygen consumption of the tissues. The mixed venous blood sample should be obtained from the - CORRECT ANSWER pulmonary artery
During review of the medical record prior to obtaining an ABG sample, the respiratory therapist notes that the patient has a platelet count of 115,000/mm3. Based on this finding, what should the therapist do?
1. Perform ABG as normal.
2. Refuse to perform the ABG.
3. Hold pressure on the puncture site for a longer time after sample is collected.
4. Recommend that an ABG should be performed on the patient only if absolutely necessary. - CORRECT ANSWER 2 and 4 only
The respiratory therapist assists with elective intubation of a patient with myasthenia gravis in the ICU. While providing manual ventilation, the self-inflating resuscitation device becomes difficult to compress. Which of the following would the therapist do FIRST? - CORRECT ANSWER replace the manual resuscitation bag
decrease inspiratory time - CORRECT ANSWER During ventilator rounds in ICU, the respiratory therapist notes that the patient in Room 3 has the following waveform graphic displayed on her ventilator: What action should the therapist take?
A patient receives CPAP at 10 cm H2O and 0.30 FIO2 with the heated humidifier set at 40° C. As the gas is delivered to the patient through large bore tubing, which of the following will occur?
1. Excess water will rain out
2. Humidity deficit will occur
3. Relative humidity will decrease
4. Relative humidity will remain 100% - CORRECT ANSWER 1 and 4 only
While measuring peak flow on a patient with well-controlled asthma, the respiratory therapist notes that the peak flow meter consistently reads 200 L/min despite excellent patient effort. The most likely explanation for these results is that the - CORRECT ANSWER peak flow meter is clogged
The respiratory therapist notices the low pressure alarm sounding from the ventilator for the patient in ICU Bed 1. As the therapist enters the room, she notes that during inspiration, the pressure manometer reads 6 cm H2O. The therapist's first action should be to - CORRECT ANSWER check the exhalation valve
The respiratory therapist should recommend home apnea monitoring for infants with all of the following situations EXCEPT
A. preterm infant with significant apnea periods.
B. sibling of a SIDS baby.
C. APGAR scores of 4 and 6 at delivery. D. a history of snoring. - CORRECT ANSWER C
A patient being evaluated in the Pulmonary Clinic reports that he smoked a pack and a half of cigarettes (30 cigarettes) per day for 20 years. How should the respiratory therapist describe the patient's smoking history? - CORRECT ANSWER 30 pack-years
Which of the following airway clearance techniques uses a pneumatic device to deliver compressed gas mini-bursts at sub-tidal volumes to the airway at frequencies of 100 to 250/min? - CORRECT ANSWER Intrapulmonary percussive ventilation
An ICU patient's blood pressure is continuously monitored via an arterial catheter in the left radial artery. The respiratory therapist places the patient in Trendelenburg position for bronchial hygiene therapy and the blood pressure monitor begins to alarm. When the patient is returned to the original position, the blood pressure normalizes. What is the most likely reason for the variation in blood pressure? - CORRECT ANSWER The tip of the catheter was below the transducer.
The respiratory therapist receives an order to administer a mixture of 80% helium/20% oxygen to a 40 year-old patient in an acute asthmatic episode. Which of the following devices would most effectively deliver the gas mixture to the patient? - CORRECT ANSWER Nonrebreathing mask
A 75 kg (165 lb) patient with acute lung injury is mechanically ventilated at the following settings: VC, A/C; VT 300 mL, respiratory rate 16/min, FIO2 0.50 and PEEP +5 cm H2O. The following arterial blood gas results are obtained: pH 7.30, PaCO2 58 torr, PaO2 79 torr, HCO3- 28 mEq/L. The patient's condition should be described as - CORRECT ANSWER hypoventilation
A respiratory therapist calibrates a thermal conductivity helium analyzer. What should the analyzer read when exposed to room air? - CORRECT ANSWER 0%
A patient who has significant decreases in airflow during sleep but does not have a complete cessation of breathing is having what type of episodes? - CORRECT ANSWER Hypopnea
A patient admitted to the ED is noted to have pulse and blood pressure variations with respirations. This is most indicative of - CORRECT ANSWER cardiac tamponade.
Which of the following medications CANNOT be administered by metered dose inhaler? - CORRECT ANSWER Acetylcysteine
The respiratory therapist instructs a patient to take a maximal inspiration followed by a maximal exhalation without force. Which of the following values are being measured? - CORRECT ANSWER Slow vital capacity
The respiratory therapist prepares to administer inhaled nitric oxide to a neonate with respiratory distress syndrome. The most appropriate initial dose of iNO for this patient is - CORRECT ANSWER 20 ppm
The respiratory therapist works with a patient with COPD in a smoking cessation program. The patient complains of recent weight gain. The therapist should explain that this is not unusual and is a result of - CORRECT ANSWER a decrease in the patient's metabolism.
A 50 kg (110 lb) patient is mechanically ventilated with the following settings: VC, A/C, VT 400 mL, respiratory rate 14/min, FIO2 0.60 and 10 cm H2O PEEP. The chest radiograph demonstrates diffuse bilateral radiopacity. ABG results are: pH 7.36, PaCO2 47 torr, PaO2 50 torr, and HCO3- 26 mEq/L. The respiratory therapist should increase the - CORRECT ANSWER PEEP
Adverse effects of inhaled NO include all of the following EXCEPT
A. methemoglobinemia.
B. aplastic anemia.
C. rebound pulmonary hypertension.
D. nitrogen dioxide toxicity. - CORRECT ANSWER B
All of the following are goals of bronchial hygiene therapy EXCEPT
A. reverse the underlying disease process.
B. improve mobilization
pulmonary gas exchange.
D. reduce the work of breathing. - CORRECT ANSWER a
Which of the following values should the respiratory therapist report as indicative of pulmonary embolism in a patient with acute dyspnea?
A. QS/QT of 10%
B. VD/VT of 60%
C. CL of 60 mL/cm H2O
D. RAW of 2.4 cm H2O/L/sec - CORRECT ANSWER b
A 70-kg (154 lb) patient with emphysema receives mechanical ventilation. Current ventilator settings are as follows: VC, SIMV; VT 550 mL, respiratory rate 12/min, FIO2 0.30. The patient is awake and alert and does not appear to be in any distress. The total respiratory rate is 14/min. ABG results are as follows: pH 7.35, PaCO2 58 torr; PaO2 65 torr; HCO3 30 mEq/L. His SpO2 is 94% and MIP is -30 cm H2O. This patient is most likely - CORRECT ANSWER ready for a spontaneous breathing trial.
A 36 year-old fireman was trapped and subsequently rescued from the collapse of a burning building. Which of the following devices would be appropriate to accurately assess his oxygenation status? - CORRECT ANSWER Hemoximeter
Upon review of the chest radiograph after an elective intubation, the respiratory therapist notes that the distal tip of the endotracheal tube is 3 cm above the carina. How should the therapist interpret this finding? - CORRECT ANSWER The tube is in the proper position.
A 68 year-old patient with advanced emphysema is receiving oxygen by nasal cannula at 1 L/min. The physician has ordered that the patient's SpO2 be maintained at 90%. ABG on 1 L/min are pH 7.34, PaCO2 65 torr, PaO2 55 torr, HCO3 35 mEq/L. What should the respiratory therapist recommend FIRST? - CORRECT ANSWER Titrate oxygen flow to the nasal cannula
The respiratory therapist assisted the pulmonologist with a bedside fiberoptic bronchoscopy procedure in the ICU. In order to clean and disinfect the bronchoscope, the therapist should - CORRECT ANSWER soak in alkaline glutaraldehyde for 10 hours.
The respiratory therapist is called to ICU to evaluate a patient on continuous flow CPAP (8 cm H2O, FIO2 0.30) who is showing signs of respiratory distress. The patient's SpO2 has changed from 94% to 90%. The therapist observes that the CPAP pressure manometer displays negative pressure during inspiration. The therapist should - CORRECT ANSWER increase inspiratory flow to the CPAP system
The physician asks the respiratory therapist to monitor the effectiveness of bronchodilator therapy in a patient with asthma. What is the most appropriate parameter to monitor? - CORRECT ANSWER Serial peak flow measurement
A patient receiving high frequency oscillatory ventilation (HFOV) demonstrates excess CO2 retention on a recent arterial blood gas. Which of the following could be adjusted to correct this situation? - CORRECT ANSWER Amplitude (∆P)
The high pressure alarm sounds frequently on the ventilator of a 58 year-old patient who is being mechanically ventilated following major orthopedic surgery. The mandatory rate on the ventilator is 12/min and auscultation reveals bilateral vesicular breath sounds. Current vital signs include: heart rate 130/min, respiratory rate 36/min, blood pressure 125/88 mm Hg, temperature 37.1°C (98.8°F), and SpO2 96%. The patient appears quite agitated. The patient's respiratory pattern is most likely the result of - CORRECT ANSWER post-operative pain.
While evaluating a patient who is in semi-Fowler position, the respiratory therapist finds that the patient's jugular vein extends approximately 7 cm above his sternal angle. The therapist should recommend initiation of which therapy? - CORRECT ANSWER Positive inotrope
The patient in ICU Bed 6 is noted to have a meniscus in the left chest with a blunted left costophrenic angle on the morning chest radiograph. On physical exam, the respiratory therapist finds that the breath sounds are decreased on the left with a dull percussion note. What treatment should the therapist recommend? - CORRECT ANSWER Perform a left posterior thoracentesis.
Following CABG surgery, a 59 year-old patient's C(a-v)O2 increases from 5 mL/dL to 8 mL/dL. The respiratory therapist should report to the physician that the patient's - CORRECT ANSWER cardiac output is decreasing.
The respiratory therapist obtains a SpO2 reading of 90% on a patient receiving oxygen therapy via 50% venti-mask. This would indicate a PO2 value of approximately - CORRECT ANSWER 60 torr
While making oxygen rounds, the respiratory therapist hears a high-pitched sound coming from a bubble humidifier. The patient is receiving oxygen by air-entrainment mask at 28% and the oxygen flowmeter is set at 12 L/min. The therapist should - CORRECT ANSWER remove the bubble humidifier.
A 33 year-old patient with trauma has been ventilated at the current settings for 24 hours. While reviewing ventilator data from the patient, the respiratory therapist notes the following:
0800
Peak Inspiratory Pressure (cm H2O) *28*
Plateau Pressure (cm H2O) *23*
1000
Peak Inspiratory Pressure (cm H2O) *35* Plateau Pressure (cm H2O) *25*
1200
Peak Inspiratory Pressure (cm H2O) *50*
Plateau Pressure (cm H2O) *25*
This information would indicate that - CORRECT ANSWER the patient needs suctioning
Noninvasive Positive Pressure Ventilation (NPPV) is contraindicated for the management of which of the following conditions? - CORRECT ANSWER Adult respiratory distress syndrome (ARDS)
A sputum sample from an intubated patient with pneumonia has an offensive odor and is described as green and mucopurulent. The respiratory therapist should suspect that this condition is caused by - CORRECT ANSWER Pseudomonas aeruginosa.
A pediatric patient on high-flow oxygen therapy is monitored with a finger pulse oximetry probe. There are frequent and repeated false low SpO2 alarms (less than 90%). Which of the following should the respiratory therapist recommend in this situation? - CORRECT ANSWER Relocate the sensor to the forehead or ear lobe.
A 44 year-old patient who suffered a cerebral vascular accident has been moved from Neuro-ICU to the step-down unit. He becomes diaphoretic and his SpO2 suddenly drops from 95% to 88% on a 32% tracheostomy collar. His heart rate is 115/min, respiratory rate is 42/min and his breath sounds are very diminished. The respiratory therapist is unsuccessful in attempting to pass a 12 Fr suction catheter. The therapist should - CORRECT ANSWER replace the tracheostomy tube.
A well-penetrated chest X-ray has which of the following qualities? - CORRECT ANSWER Vertebrae are just visible behind the heart.
A 13 year-old patient in the ED complains of dyspnea, chest tightness, and a loose productive cough. The patient has a respiratory rate of 33 breaths/minute and bilateral wheezing in the lungs. What treatment should the respiratory therapist initiate? - CORRECT ANSWER oxygen
A spontaneously breathing post-CVA patient has developed right lower lobe infiltrates on chest x-ray and has coarse breath sounds. When the respiratory therapist attempts to suction the patient by the nasotracheal route, a gag reflex is present but the patient does not cough. Watery secretions are aspirated through the suction catheter. The therapist should - CORRECT ANSWER reposition the patient to a sniffing position.
After performing spirometry on a patient in the pulmonary clinic, the respiratory therapist notes that both the inspiratory and expiratory flow portion of the flow-volume loop is flattened. The therapist should interpret the condition demonstrated on the flow-volume loop as a/an - CORRECT ANSWER large airway obstruction.
A 30 year-old male with bronchitis has coarse bilateral rales with a SpO2 of 90%. Despite a good cough effort, he has great difficulty in removing his thick secretions. The respiratory therapist should initiate - CORRECT ANSWER a heated humidifier and oxygen therapy.
A 58 year-old male patient receives mechanical ventilation in the ICU on the following settings: VC,SIMV, VT 650 mL, f 12/min, FIO2 0.65, PEEP 10 cm H2O. He has a large amount of thick, yellow secretions. How should the respiratory therapist suction this patient? - CORRECT ANSWER Use a closed-system suction catheter.
An oxygen-dependent patient uses a nasal cannula at 3 L/min continuously at home. He complains that his liquid oxygen portable device runs out too quickly when he attends church services and prevents him from dining out in restaurants afterwards. Which of the following devices should the respiratory therapist recommend to resolve the issue? - CORRECT ANSWER Use a pulse-dose oxygen delivery system. [Show Less]