RCP 160 Midterm Exam With 100% Correct Answers 2023, Exams of Advanced Education

Download RCP 160 Midterm Exam With 100% Correct Answers 2023 and more Exams Advanced Education in PDF only on Docsity! RCP 160 Midterm Exam With 100% Correct Answers 2023 Identify the indications for chest tube insertion from the list below: I. Pleural effusion II. Acute shortness of breath III. Pneumothorax IV. Empyema - Correct Answer-I, III, IV Identify the proper placement of a chest tube for a pneumothorax. - Correct Answer- Mid-axillary, over the edge of the 4th to 6th intercostal space toward the apex of the lung. Identify the proper placement of a chest tube for fluid removal. - Correct Answer-Mid- axillary over the edge of the 6th to 8th intercostal space toward the posterior base of the lung. Identify two reasons for no bubbling in the Suction Control Chamber: - Correct Answer- Leak in the system between the regulator and the drainage system and The vacuum pressure is turned off. Which of the following troubleshooting interventions is appropriate when no drainage is coming out, when there was drainage before? I. Try to drain loop and prevent tube from looping. II. Try to milk the clot out of the tubing carefully. III. Pull the Chest tube out and replace it. IV. Check CXR for pleural fluid having been cleared. - Correct Answer-I, II, IV Which of the following statements about pleural fluid is false? - Correct Answer-Fluid can move easily between each hemithorax. Pleural fluid with a total protein concentration of less than ____________ of the serum total protein level is one of the indications of transudative pleural effusion. - Correct Answer-50% What is the most common cause of pleural effusion in the clinical setting? - Correct Answer-Congestive heart failure The chest radiograph showed the presence of a meniscus in the right chest together with a blunted right costophrenic angle. Which of the following procedures would you recommend at this point to treat Ms. Paul? - Correct Answer-Posterior chest tube thoracostomy Forty-eight hours after the chest tube insertion Ms. Paul remains on mechanical ventilation. While assessing the chest tube system, you note small bubbles in the water seal chamber generated during peak inspiration. This is an indication of which of the following: - Correct Answer-bronchopleural fistula. What is a common cause of persistent fever in intensive care unit (ICU) patients with pneumonia? - Correct Answer-Parapneumonic effusions Which of the following conditions is most closely associated with exudative pleural effusion? - Correct Answer-Tuberculosis What is the most likely cause of a large unilateral pleural effusion in a 70-year-old patient? - Correct Answer-Malignancy Which of the following is NOT a typical cause of atelectasis? - Correct Answer- hepatomegaly At what anatomic position should an 18-gauge IV catheter be placed to relieve a tension pneumothorax? - Correct Answer-just superior to the second rib Reduction of preload and afterload is important in the management of which of the following? - Correct Answer-Cardiogenic pulmonary edema Which of the following mechanisms ultimately leads to ARDS regardless of the etiology - Correct Answer-Disruption of the endothelial and epithelial barriers Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)? - Correct Answer-Diffuse alveolar and interstitial infiltrates in chest radiograph. Which of the following is the primary system for removing filtered fluid and protein from the lungs? - Correct Answer-Lymphatic Which of the following is another term for hydrostatic pulmonary edema? - Correct Answer-Cardiogenic pulmonary edema Which of the following is the likely cause of nonhydrostatic pulmonary edema? - Correct Answer-Injury to the vascular endothelium and/or alveolar epithelium What is recommended in terms of fluid management of patients with ARDS? - Correct Answer-Conservative Which of the following parameters are important in the management of patients with ARDS? 1. Keep systolic blood pressure below 90 mm Hg. 2. Keep hemoglobin saturation above 90%. 3. Ensure adequate urine output. 4. Keep mean arterial pressure above 60 mm Hg. - Correct Answer-2, 3, and 4 only Which of the following complications has been associated with the use of PEEP in patients with ARDS? - Correct Answer-Reduced cardiac output Why are calcium-channel blockers not used in all patients with idiopathic pulmonary artery hypertension? - Correct Answer-Only a small percentage of IPAH patients respond. What is the initial event in the pathogenesis of idiopathic pulmonary artery hypertension (IPAH)? - Correct Answer-Insult to the pulmonary endothelium What is the critical value for mean pulmonary arterial pressure, above which the right ventricle fails and death may ensue? - Correct Answer-40 mm Hg What are the two most common symptoms associated with primary pulmonary hypertension? - Correct Answer-Dyspnea and angina Pulmonary artery hypertension (PAH) is not typically associated with which of the following conditions? - Correct Answer-Amyotrophic lateral sclerosis Where do most pulmonary emboli originate? - Correct Answer-Deep veins of the legs What ECG findings are typically seen in patients with idiopathic pulmonary artery hypertension? 1. Frequent premature ventricular complexes 2. Right-axis deviation 3. Right ventricular hypertrophy 4. Left bundle-branch block - Correct Answer-2 and 3 only What IV infusion has been found to improve exercise capacity, hemodynamic variables, and survival in patients with severe IPAH? - Correct Answer-Epoprostenol Which of the following pathophysiologic changes in the lung is not typically associated with pulmonary embolism? - Correct Answer-Decreased ciliary mobility A patient receiving mechanical ventilation has an exhaled tidal volume (VT) of 500 mL and a positive-end expiratory pressure setting (PEEP) of 5 cm H2O. Patient-ventilator system checks reveal the following data: Time PIP (cm H2O) Pplateau (cm H2O) 0600 27 15 0800 29 15 1000 36 13 The respiratory therapist should recommend which of the following for this patient? 1. Tracheobronchial suctioning 2. Increase in the set tidal volume 3. Beta adrenergic bronchodilator therapy 4. Increase positive end expiratory pressure - Correct Answer-1 and 3 only. Which of the following are involved in external respiration? - Correct Answer-Alveoli and pulmonary capillaries. The respiratory therapist should expect which of the following findings while ventilating a patient with acute respiratory distress syndrome (ARDS)? - Correct Answer-An elevated plateau pressure (Pplateau) Air accidently trapped in the lungs due to mechanical ventilation is known as which of the following? - Correct Answer-Intrinsic positive end expiratory pressure (intrinsic PEEP) An increase in peak inspiratory pressure (PIP) without an increase in plateau pressure (Pplateau) is associated with which of the following? - Correct Answer-Increase in airway resistance The values below pertain to a patient who is being mechanically ventilated with a measured exhaled tidal volume (VT ) of 700 mL. Time Peak Inspiratory Pressure (cm H2O) Plateau Pressure (cm H2O) 0800 35 30 1000 39 34 1100 45 39 1130 50 44 Analysis of this data points to which of the following conclusions? - Correct Answer- Lung compliance is decreasing. During spontaneous inspiration alveolar pressure (PA) is about. - Correct Answer-- 1 cm H2O Evaluate the combinations of compliance and resistance and select the combination that will cause the lungs to empty slowest. - Correct Answer-CS = 0.05 L/cm H2O Raw = 6 cm H2O/(L/sec) How many time constants are necessary for 95% of the tidal volume (VT) to be delivered from a mechanical ventilator? - Correct Answer-3 The term used to describe the tendency of a structure to return to its original form after being stretched or acted on by an outside force is which of the following? - Correct Answer-Elastance The body's mechanism for conducting air in and out of the lungs is known as which of the following? - Correct Answer-Spontaneous ventilation Based upon the following patient information calculate the patient's static lung compliance: exhaled tidal volume (VT) is 675 mL, peak inspiratory pressure (PIP) is 28 cm H2O, plateau pressure (Pplateau) is 8 cm H2O, and PEEP is set at 5 cm H2O. - Correct Answer-0.22 L/cm H2O Calculate the effective static compliance (Cs) given the following information about a patient receiving mechanical ventilation: peak inspiratory pressure (PIP) is 56 cm H2O, plateau pressure (Pplateau) is 40 cm H2O, exhaled tidal volume (VT) is 650 mL, and positive-end expiratory pressure (PEEP) is 10 cm H2O. - Correct Answer-21.7 mL/cm H2O The pressure required to maintain alveolar inflation is known as which of the following? - Correct Answer-Transpulmonary pressure (PL) Compute the inspiratory time necessary to ensure 100% of the volume is delivered to an intubated patient with a Cs = 60 mL/cm H2O and the Raw = 6 cm H2O/(L/sec). - Correct Answer-1.8 sec What is the name of the external landmark that identifies the point at which the trachea branches into the right and left main stem bronchi? - Correct Answer-Sternal Angle Why is pulmonary surfactant such an important biologic substance? - Correct Answer-It promotes lung stability The classification of the "upper respiratory tract" ends at what point? - Correct Answer- Inferior border of the larynx Which type of lung cells secretes pulmonary surfactant? - Correct Answer-Type II cells pneumocytes What type of flow is seen in and beyond the terminal bronchioles? - Correct Answer- Laminar What intercommunicating channels permit collateral ventilation between adjacent alveoli and primary lobules?1. Bronchial anastomoses 2. Canals of Lambert 3. Pores of Kohn 4. Terminal bronchioles - Correct Answer-2 & 3 only What determines the airway diameter in the normal lung? - Correct Answer-Balance between the sympathetic and parasympathetic tone Which of the following describes an acinus? - Correct Answer-It consists of all structures distal to a terminal bronchiole. What forces establish the sub-atmospheric pressure found in the pleural space? - Correct Answer-Equal opposing tendencies of the chest wall to expand and the lung to collapse. At what point does the trachea branch into two main stem bronchi? - Correct Answer- Carina Which of the following has/have been shown to injure the alveolar-capillary membrane? 1. Excessive pressures 2. Excessive tidal volumes 3. Increased intracranial pressures 4. Pulmonary hypertension - Correct Answer-1, 2, and 4 only What portion of the left lung corresponds anatomically to the middle lobe of the right lung? - Correct Answer-Lingula Which of the following statements about the terminal bronchioles is true? - Correct Answer-They are the smallest of the purely conducting airways. What are the free-wandering phagocytic cells that ingest foreign material in the respiratory zone of the lungs? - Correct Answer-Alveolar macrophages Which of the following statements is true? - Correct Answer-SVR is normally approximately 10 times higher than PVR. Mean arterial blood pressure can be regulated by changing which of the following? 1. Capacity of the circulatory system 2. Effective volume of circulating blood 3. Tone of the capacitance vessels (veins) - Correct Answer-1, 2, and 3 During exercise, cardiac output increases dramatically, but mean arterial blood pressure rises very little. Why is this so? - Correct Answer-Muscle vessels dilate, increasing vascular capacity. During blood loss due to hemorrhage, perfusing pressures can be kept near normal until the volume loss overwhelms the system. Why is this so? - Correct Answer-Venules constrict, decreasing vascular capacity. The underlying goal of the body's cardiovascular control mechanisms is to ensure that all tissues receive which of the following? - Correct Answer-Perfusion according to their metabolic needs The cardiovascular system regulates perfusion mainly by altering which of the following? - Correct Answer-Capacity and resistance of blood vessels What is the primary function of local or intrinsic cardiovascular control mechanisms? - Correct Answer-Alter local blood flow according to tissue needs. Central, or extrinsic, control of the cardiovascular system occurs through the action of which of the following? 1. Autonomic nervous system 2. Circulating humoral agents 3. Local metabolites - Correct Answer-1 and 2 only Central control of vasomotor tone has its greatest impact on which of the following vessels? 1. Arterioles (resistance vessels) 2. Veins (capacitance vessels) 3. Microcirculation (exchange vessels) - Correct Answer-1 and 2 only Which of the following variations control blood flow to the brain? - Correct Answer-Local metabolic control mechanisms Which of the following variation(s) control(s) blood flow to the heart? 1. Local metabolic control mechanisms 2. Local myogenic control mechanisms 3. Central neural innervation - Correct Answer-2 and 3 only Which portion of the nervous system is mainly responsible for the central control of the blood flow? - Correct Answer-Sympathetic nervous system Smooth muscle relaxation and vessel dilation are caused mainly by which of the following?1. Action of local metabolites 2. Cholinergic stimulation 3. Stimulation of beta- adrenergic receptors - Correct Answer-2 and 3 only Which of the following formulas is used to calculate the total amount of blood pumped by the heart per minute, or cardiac output? - Correct Answer-Rate SV What is an approximate normal resting cardiac output for a healthy adult? - Correct Answer-5000 ml/min Which of the following factors determine cardiac stroke volume? 1. Ventricular preload 2. Ventricular afterload 3. Ventricular contractility - Correct Answer-1, 2, and 3 Stroke volume can be calculated using which formula? - Correct Answer-End-diastolic volume end-systolic volume Given a stroke volume of 40 ml and an end-diastolic volume (EDV) of 70 ml, what is the patient's ejection fraction (EF)? - Correct Answer-0.57 What is a normal cardiac ejection fraction? - Correct Answer-64% Which of the following would have a negative impact on cardiac contractility? 1. Acidosis 2. Digitalis 3. Hypoxia 4. Norepinephrine - Correct Answer-1 and 3 only Where are the central centers responsible for regulating the cardiovascular system located? - Correct Answer-Brainstem Which factor stimulates the carotid and aortic chemoreceptors? - Correct Answer-High carbon dioxide levels What are the major effects of peripheral chemoreceptor stimulation? - Correct Answer- Vasoconstriction and increased heart rate Significant loss of blood volume causes an increase in which of the following? 1. Vascular tone 2. Secretion of antidiuretic hormone (ADH) 3. Heart rate - Correct Answer-1, 2, and 3 The dicrotic notch recorded in the aorta immediately follows what mechanical event of the cardiac cycle? - Correct Answer-Closure of the aortic valve What is the cause of a myocardial infarction? - Correct Answer-Partial or complete obstruction of a coronary artery An abnormal amount of fluid can accumulate between the layers of the pericardium resulting in which of the following? - Correct Answer-Pericardial effusion