Respiratory Care Practices and Therapies, Exams of Advanced Education

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Egan's Final Exam with correct Answers

You are planning a patient transport that will take approximately 1 hr. The patient requires manual ventilation with 10 L/min of O2. What is the minimum number of full E cylinders you would take with you? - Answer- 2 *duration of flow (min) = Pressure (psig) × Cylinder factor/Flow (L/min) Which of the following is an expected role of a respiratory therapist?

1. Promoting lung health & wellness
2. Providing patient education
3. Assessing the patient's cardiopulmonary health status
4. Selling oxygen (O2) therapy devices to patients - Answer- 1, 2, & 3 only When was synchronized intermittent mandatory ventilation (SIMV) first introduced? - Answer- 1975 What was the name for the first professional organization for the field of respiratory care? - Answer- Inhalation Therapy Association (ITA) The majority of respiratory care education programs in the United States offer what degree? - Answer- Associate's degree Due to the aging of the majority of the population, which of the following will be the focus of the Respiratory Therapist of the future?
5. verifying insurance information
6. disease management & rehabilitation
7. patient & family education
8. tobacco education & smoking cessation - Answer- 2, 3, & 4 Respiratory care education programs are reviewed by which committee to ensure quality? - Answer- Committee on Accreditation for Respiratory Care (CoARC) A therapist who says "You seem to be anxious about your surgery" to a patient just admitted for bypass surgery is using what interpersonal communication technique? - Answer- reflecting feelings Which of the following organisms are destroyed by a disinfection agent?
9. gram-negative cocci
10. bacterial spores

3. gram-positive rods
4. viruses - Answer- 1, 3, & 4 only What is the minimum recommended time for handwashing in the healthcare environment? - Answer- 15 sec Which of the following diseases travel through droplet mode? - Answer- influenza What ethical issue has recently become a significant concern for respiratory therapists and all health care providers due to a congressional act? - Answer- Patient's right to privacy When a respiratory patient defers a patient's questions about a condition to the attending physician, what ethical principle is being practiced? - Answer- role fidelity What branch of law is concerned with the recognition and enforcement of the rights and duties of private individuals and organizations? - Answer- Civil If a respiratory therapist refers a Medicare patient to a particular home care company ad receives a finder's fee in return, this is an example of - Answer- Medicare fraud Which of the following would be the worst heat conductor? - Answer- Air Which of the following are true of liquids?
5. they are easy to compress
6. they exert pressure
7. they exert buoyant force
8. they conform to their containers - Answer- 2, 3, & 4 only What is the temperature at which the vapor pressure of a liquid equals the pressure exerted on the liquid by the surrounding atmosphere? - Answer- boiling point Which of the following are true about molecular water vapor?
9. water vapor exhibits kinetic energy
10. molecular water can be seen
11. water vapor exerts pressure - Answer- 1 & 3 only Which of the following represents a direct measure of the kinetic activity of water vapor molecules? - Answer- water vapor pressure A gas at 50°C with a relative humidity of 100% is cooled to 37°C. Which of the following will occur?
12. condensation on surfaces
13. visible droplet formation
14. warming of the adjacent air - Answer- 1, 2, & 3

A combination of neutral atoms, free electrons, and atomic nuclei describes - Answer- plasma. For every liquid there is a temperature above which the kinetic activity of its molecules is so great that the attractive forces cannot keep them in a liquid state. This temperature is called the - Answer- critical temperature What physical principle underlies most fluid circuitry? - Answer- Coanda effect Which of the following compares the clinical outcomes of two groups? - Answer- Cohort studies What is the primary indication for tracheal suctioning? - Answer- retention of secretions While suctioning a patient, you observe an abrupt change in the electrocardiogram waveform being displayed on the cardiac monitor. Which of the following actions would be most appropriate? - Answer- stop suctioning and immediately administer oxygen Before the suctioning of a patient, auscultation reveals coarse breath sounds during both inspiration and expiration. After suctioning, coarseness disappears, but expiratory wheezing is heard over both lung fields. What is most likely the problem? - Answer- The patient has hyperactive airways and has developed bronchospasm Before beginning an extubation procedure, the practitioner should check and confirm the operation of which of the following?

1. laryngoscope light source
2. Endotracheal tube cuff
3. Suction equipment
4. Cardiac Defibrillator - Answer- 1, 2, & 3 only To make oral intubation easier, how should the patient's head and neck be positioned? - Answer- Flexed neck with towel placed What should be the maximum time devoted to any intubation attempt? - Answer- 30 sec Which of the following bedside methods is the best indicator to confirm proper endotracheal tube position in the trachea? - Answer- CO2 monitor What is the primary indication for tracheostomy? - Answer- when a patient has a long- term need for an artificial airway What is the most common sign associated with the transient glottic edema or vocal cord inflammation that follows extubation? - Answer- stridor

Which of the following is likely to increase the likelihood of damage to the tracheal mucosa? - Answer- Maintaining cuff pressures between 20 to 30 mmHg What is the leading cause of death among adults over 40 in the United States? - Answer- Sudden cardiac arrest You enter an adult's room and find her collapsed on the floor near the bed. When you shake her and shout, "Are you OK?" there is no response. What should be your next, immediate step be? - Answer- Call for help (call a code). For chest compressions to be effective, in what position must the patient be placed? - Answer- Horizontal supine, on a flat surface Which of the following is a proper rate of external chest compressions for adults? - Answer- 100/min The automatic external defibrillator will indicate that a shock is needed if it detects which of the following rhythms?

1. Bradycardia
2. Atrial fibrillation
3. Ventricular fibrillation
4. Pulseless ventricular tachycardia - Answer- 3 & 4 only During CPR, a properly positioned endotracheal tube can do which of the following?
5. Isolate and protect the lower airway from aspiration.
6. Permit suctioning of the trachea and main stem bronchi.
7. Facilitate positive-pressure ventilation and oxygenation.
8. Provide a route for administration of selected drug agents. - Answer- 1, 2, 3, & 4 Which of the following is the drug of choice for a patient with stable ventricular tachycardia? - Answer- Adenosine What is the ideal route for the administration of most drugs used in emergency life- support situations? - Answer- Peripheral intravenous line What is the most common cause of airway obstruction in unconscious patients? - Answer- Tongue falling back into the pharynx What is the best way to increase CPR survival rates in the field? - Answer- Provide early defibrillation. What is the leading risk factor for the development of COPD? - Answer- Cigarette smoking

It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma? - Answer- Reversal of the FEV1 after the use of a bronchodilator Which of the following medications is indicated for regular use in patients with stable COPD? - Answer- Corticosteroids Which of the following symptoms are typical symptoms of asthma?

1. Cough
2. Shortness of breath
3. Chest tightness
4. Chest pain - Answer- 1, 2, & 3 only An asthma patient's best effort produces a PEFR of 55% of personal best. What is indicated at this time? - Answer- Patient should probably seek medical attention right now. What is the primary goal of humidity therapy? - Answer- Maintain normal physiologic conditions. Administration of dry gases at flows exceeding 4 L/min can cause which of the following?
5. Structural
6. Heat loss
7. Water loss - Answer- 1, 2, & 3 Inhalation of dry gases can do which of the following?
8. Increase viscosity of secretions
9. Impair mucociliary motility
10. Increase airway iritability - Answer- 1, 2, & 3 Clinical indications for delivering cool humidified gas include which of the following?
11. Postextubation edema
12. Upper airway inflammation
13. Croup (laryngotracheal bronchitis)
14. Epiglottitis - Answer- 1, 2, 3, & 4 What device adds molecular water to gas? - Answer- Humidifier The greater the temperature of gas, the - Answer- more water vapor it can hold Which of the following types of humidifiers are used in clinical practice?

1. heat and moisture exchanger
2. Passover humidifier
3. Bubble humidifier - Answer- 1, 2, & 3 Heat and moisture exchangers (HMEs) are mainly used to do what? - Answer- Warm and humid gases delivered to the trachea via ventilator circuits. What is the most common device used to generate bland aerosols? - Answer- Large- volume jet nebulizers Indications for warming inspired gases including which of the following?
4. Treating a patient whose airways are reactive to cold
5. Providing humidification when the upper airway is bypassed
6. Treating a patient with a low body temperature (hypothermia)
7. Reducing upper airway inflammation or swelling - Answer- 1, 2, & 3 only What is the retention of aerosol particles resulting from contact with the respiratory mucosa called? - Answer- Deposition Which of the following factors affect pulmonary deposition of an aerosol?
8. Size of the particles
9. Shape and motion of the particles
10. Physical characteristics of the airways
11. Class of medication being delivered - Answer- 1, 2, & 3 only Where do most particles in the 5- to 10-μm range deposit? - Answer- upper airways Which of the following techniques will increase aerosol deposition by sedimentation in the lungs? - Answer- 10-sec breath hold What is the primary hazard of aerosol therapy? - Answer- Adverse drug reactions To monitor a patient for the possibility of reactive bronchospasm during aerosol drug therapy, what should you do?
12. Measure pre- and post-peak flow and/or percentage forced expiratory volume in 1 second (%FEV1)
13. Auscultate for adventitious breath sounds
14. Don't observe the patient's response
15. Communicate with the patient during therapy - Answer- 1, 2, & 4

When fired inside the mouth, what percentage of the drug dose delivered by a simple metered-dose inhaler (MDI) without a holding chamber deposits in the oropharynx? - Answer- Approximately 80% When using a metered dose inhaler without a holding chamber or a spacer, the patient should be instructed to fire the device at what point? - Answer- Immediately after beginning a slow inspiration Which of the following is false about the optimal technique for using a small-volume jet nebulizer (SVN) for aerosol drug delivery? - Answer- Deep breathing or breath-holding improves SVN deposition. Advantages of small-volume ultrasonic nebulizers for drug delivery include which of the following?

1. Greater respirable drug mass
2. Less dead space and waste
3. Increased mobility
4. Decreased cost - Answer- 1, 2, & 3 only Where are the majority of respiratory therapists employed? - Answer- Hospitals or acute care settings What term is used to describe difficulty breathing in the reclining position? - Answer- Orthopnea Which complaint is most closely associated with the diagnosis of chronic bronchitis? - Answer- Chronic productive cough Which of the following mechanisms is an uncommon route for the spread of pneumonia? - Answer- through the bloodstream What is the primary purpose of the respiratory system? - Answer- Continuous absorption of oxygen (O2) and excretion of carbon dioxide By what mechanism does gas exchange across the lung occur? - Answer- Simple diffusion What is the function of the thorax? - Answer- Protect the vital organs. What is the name of the thin serous membrane that covers the inner layer of the thoracic wall? - Answer- parietal pleura 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? - Answer- Sternal angle

Which of the following nerves innervate the diaphragm? - Answer- Phrenic The nerves that innervate the diaphragm arise from which area? - Answer- Spinal nerves C3 to C What is the lowest level on the spinal cord that an injury could cause diaphragmatic impairment or paralysis? - Answer- C As ventilatory muscles, the sternocleidomastoids do which of the following? - Answer- They elevate the upper chest, increasing chest anteroposterior diameter. Which accessory muscles of ventilation work to pull the ribs closer together? - Answer- internal intercostals The apex of the heart (tip of the left ventricle) lies just above the diaphragm at a level corresponding to which intercostal space? - Answer- Fifth Tissue layers making up the heart wall include which of the following?

1. Endocardium
2. Epicardium
3. Myocardium - Answer- 1, 2, & 3 Most of the muscle mass of the heart is located in which chamber? - Answer- Left ventricle (LV) The mitral (bicuspid) valve does which of the following? - Answer- Prevents atrial backflow during ventricular contraction. What in essence is Frank-Starling's law of the heart? - Answer- The greater the stretch, the stronger the contraction. Which of the following statements is true (SVR)? - Answer- SVR is normally approximately 10 times higher than PVR. The underlying goal of the body's cardiovascular control mechanisms is to ensure that all tissues receive which of the following? - Answer- Perfusion according to their metabolic needs The cardiovascular system regulates perfusion by mainly altering which of the following? - Answer- Capacity and resistance of blood vessels What is a normal cardiac ejection fraction? - Answer- 64% Where are the central centers responsible for regulating the cardiovascular system located? - Answer- Brainstem

Interpret the below ABG: 7.53/40/32 - Answer- Uncomp Met Alkalosis Interpret the below ABG: 7.30/35/16 - Answer- Partially comp Met Acidosis Interpret the below ABG: 7.43/17/11 - Answer- Fully Comp Resp Alk Interpret the below ABG: 7.30/68/23 - Answer- Uncomp Resp Acid Which of the following are considered therapeutic gases?

1. Oxygen (O2)
2. O2-NO mixture
3. O2-He mixture
4. N2O - Answer- 1, 2, & 3 only Which of the following statements regarding O2 are true?
5. It is only slightly soluble in water.
6. It is odorless and transparent.
7. It is flammable.
8. It is heavier than air. - Answer- 1, 2, & 4 only Which of the following statements about He are true?
9. It is an inert gas.
10. It is odorless.
11. It is nonflammable.
12. It is heavier than air. - Answer- 1, 2, & 3 only Which of the following gases is used to treat conditions causing hypoxic respiratory failure? - Answer- NO When full, a gas cylinder registers a pressure of 2200 psig. After a few hours of use, the pressure gauge reads 550 psig. The cylinder is now how full? - Answer- One-fourth The gauge on an E cylinder of O2 reads 800 psi. About how long will the cylinder contents last, until completely empty, at a flow of 3 L/min? - Answer- 1 hr 15 min *duration of flow (min) = Pressure (psig) × Cylinder factor/Flow (L/min) Specific clinical objectives of oxygen (O2) therapy include which of the following?

1. Decrease the symptoms caused by chronic hypoxemia.
2. Decrease the workload hypoxemia imposes on the heart and lungs
3. Correct documented arterial hypoxemia.
4. Correct documented respiratory acidosis. - Answer- 1, 2, & 3 only Properly applied O2 therapy can decrease which of the following?
5. Ventilatory demand
6. Work of breathing
7. Cardiac output - Answer- 1, 2, & 3 Which of the following would indicate a need for O2 therapy for an adult or child?
8. SaO2 less than 87% to 90%
9. PaCO2 greater than 45 mmHg
10. PaO2 less than 55 to 60 mmHg - Answer- 1 & 3 only When determining a need for O2 therapy, the respiratory therapist should assess which of the following?
11. Neurologic status
12. Pulmonary status
13. Cardiac status - Answer- 1, 2, & 3 Which of the following signs and symptoms are associated with the presence of severe hypoxia?
14. Tachypnea
15. Tachycardia
16. Cyanosis
17. Paleness - Answer- 1, 2, & 3 only Which of the following affects are seen in hyperoxic acute lung injury?
18. Decreased cardiac output
19. Decreased perfusion to the heart
20. Increased perfusion to skeletal muscles
21. Increased perfusion to the brain - Answer- 1 and 2 only A physician places a patient in respiratory failure on 100% O2. To avoid the hazards of O2 toxicity, you would recommend that every effort is made to reduce this FiO2 to less than 50% within what timeframe? - Answer- 5 days Which of the following are true about absorption atelectasis?
22. It can occur only when breathing supplemental O2.

2. Its risk is increased in patients breathing at low tidal volumes (Vt values).
3. Its risks is decreased through the natural "sigh" mechanism.
4. It results in an increase in the physiologic shunt fraction. - Answer- 2, 3, & 4 only Which of the following statements are true about low-flow O2 delivery systems?
5. The greater the patient's inspiratory flow, the greater is the FiO2.
6. All low-flow devices provide variable O2 concentrations.
7. The O2 provided by a low-flow device is diluted with air.
8. The patient's flow usually exceeds that from a low-flow device. - Answer- 2, 3, & 4 only Low-flow O2 delivery systems used in respiratory care include which of the following?
9. Nasal O2 cannula
10. Nasal O2 catheter
11. Air-entrainment mask
12. Transtracheal catheter - Answer- 1, 2, & 4 only Which of the following are advantages of the nasal cannula as a low-flow O2 delivery system?
13. Stability
14. Low cost
15. Easy application
16. Disposability - Answer- 2, 3, & 4 only A 27-year-old woman received from the emergency department is on a nasal cannula at 5 L/min. Approximately what FiO2 is the patient receiving? - Answer- 40% *Rule of 4s for low-flow on nasal cannula Interpret the below ABG: 7.32/62/23 - Answer- Uncomp Resp Acid Interpret the below ABG: 7.41/20/13 - Answer- Fully Comp Resp Alk Interpret the below ABG: 7.55/41/35 - Answer- Uncomp Met Alkalosis Which of the following patient categories are at high risk for developing atelectasis?
17. Those who are heavily sedated
18. Those with abdominal or thoracic pain
19. Those with neuromuscular disorders - Answer- 1, 2, & 3

What is the major contributing factor in the development of postoperative atelectasis? - Answer- Repetitive, shallow breathing Lung expansion methods that increase the transpulmonary pressure gradients by increasing alveolar pressure include which of the following?

1. Incentive spirometry (IS)
2. Positive end-expiration pressure therapy
3. Intermittent positive-pressure breathing (IPPB)
4. Expiratory positive airway pressure (EPAP) - Answer- 2, 3, & 4 only Which of the following patient groups should be considered for lung expansion therapy using intermittent positive-pressure breathing (IPPB)?
5. Patients with clinically diagnosed atelectasis who are not responsive to other therapies
6. Patients at high risk for atelectasis who cannot cooperate with other methods
7. All obese patients who have undergone abdominal surgery - Answer- 1 and 2 only What is the optimal breathing pattern for intermittent positive-pressure breathing (IPPV) treatment of atelectasis? - Answer- Slow, deep breaths held at end-inspiration Which of the following are potential contraindications for intermittent positive-pressure breathing?
8. Hemodynamic instability
9. Recent esophageal surgery
10. Tension pneumothorax
11. Neuromuscular disorders - Answer- 1, 2, and 3 only The general assessment, common to all patients for whom intermittent positive- pressure breathing (IPPB) is ordered, should include which of the following?
12. Measurement of vital signs
13. Appearance and sensorium
14. Chest auscultation
15. Arterial blood gas analysis - Answer- 1, 2, and 3 only Which of the following positions is ideal for intermittent positive-pressure breathing therapy? - Answer- Semi-Fowler's When adjusting the sensitivity control on an intermittent positive-pressure breathing device, which of the following parameters are you changing? - Answer- Effort required to cycle the device "on" (begin inspiration)

In administering intermittent positive-pressure breathing therapy, which of the following breathing patterns would be most desirable? - Answer- 6 to 8 breaths/min, inspiration/expiration ratio (I:E) of 1: Which of the following conditions are associated with chronic production of large volumes of sputum?

1. Bronchiectasis
2. Pulmonary fibrosis
3. Cystic fibrosis
4. Chronic bronchitis - Answer- 1, 3, and 4 only *think CBABE What are the best documented preventative uses of airway clearance therapy?
5. Prevent retained secretions in the acutely ill.
6. Maintain lung function in cystic fibrosis.
7. Prevent postoperative pulmonary complications. - Answer- 1, 2, & 3 Which of the following laboratory data are essential in assessing a patient's need for airway clearance therapy?
8. Chest radiograph
9. Pulmonary function tests
10. Hematology results
11. ABGs/oxygen saturation - Answer- 1, 2, and 4 only Key considerations in initial and ongoing patient assessment for chest physical therapy include which of the following?
12. Posture and muscle tone
13. Breathing pattern and ability to cough
14. Sputum production
15. Cardiovascular stability - Answer- 1, 2, 3, & 4 The application of gravity to achieve specific clinical objectives in respiratory care best describes which of the following? - Answer- Postural drainage therapy Postural drainage should be considered in which of the following situations?
16. In patients with chronic obstructive lung disease
17. In patients who expectorate more than 25 to 30 ml sputum per day
18. In the presence of atelectasis caused by mucus plugging
19. In patients with cystic fibrosis or bronchiectasis - Answer- 2, 3, & 4 only

A patient about to receive postural drainage and percussion is attached to an electrocardiographic (ECG) monitor and is receiving both intravenous (IV) solutions and O2 (through a nasal cannula). Which of the following actions would be appropriate for this patient? - Answer- Inspect and adjust the equipment to ensure function during therapy. Which of the following are mandatory components of the preassessment for postural drainage?

1. Vital signs
2. Bedside pulmonary function tests
3. Auscultation - Answer- 1 and 3 only If a patient's chest radiograph shows infiltrates in the posterior basal segments of the lower lobes, what postural drainage position would you recommend? - Answer- Head down, patient prone with a pillow under abdomen Which of the following responses indicate that postural drainage should be terminated?
4. Severe tachycardia
5. Complaint of discomfort
6. Irregular blood pressure
7. Severe bradycardia - Answer- 1, 3, & 4 only Interpret this ABG: 7.25/58/22 - Answer- Uncomp Resp Acid Interpret this ABG: 7.42/32/24 - Answer- Fully Comp Resp Alk What is respiratory failure due to inadequate ventilation? - Answer- Hypercapnic Hypercapnic (type II) respiratory failure is a synonym for which one of the following terms? - Answer- Ventilatory failure Which of the following can cause hypoxemia?
8. Diffusion impairment
9. Alveolar hypoventilation
10. V/Q mismatch
11. Intrapulmonary shunting - Answer- 1, 2, 3, & 4 Which of the following clinical signs is most often associated with hypoxemia due to shunt? - Answer- "white" chest radiograph Which of the following could cause hypercapnic respiratory failure?

1. Smoke inhalation
2. Opiate drug overdose
3. Chronic obstructive pulmonary disease
4. Hypothyroidism - Answer- 2, 3, and 4 only Which of the following is a cardinal sign of increased work of breathing? - Answer- Tachypnea Mr. Adams is in the ICU on an FiO2 of 100%. An arterial blood gas reveals the following information: pH of 7.18, PaCO2 of 59 mmHg, PaO2 of 65 mmHg, HCO3 of 24 mEq/L. What action would you recommend? - Answer- Provide ventilatory support. A need for some form of ventilatory support is usually indicated when the adult's rate of breathing rises above what level? - Answer- 35/min A patient with a 10-year history of chronic bronchitis and an acute viral pneumonia exhibits the following blood gas results breathing room air: pH = 7.22; PCO2 = 67; HCO3- = 26; PO2 = 60. Which of the following best describes this patient's condition? - Answer- acute hypercapnic respiratory failure In intubated patients, what do sources of increased imposed work of breathing include?
5. Endotracheal tube
6. Ventilator circuit
7. Auto-PEEP - Answer- 1, 2, & 3 Which of the following best defines a ventilator? - Answer- A machine that is designed to perform some portion of the work of breathing. For which of the following uses might you consider the use of a pneumatically powered ventilator? - Answer- During certain types of patient transport During mechanical ventilation, which of the following is considered one cycle of inspiratory flow followed by a matching expiratory flow? - Answer- Breath During mechanical ventilation, what variable causes a breath to end? - Answer- Cycle If a ventilator, not the patient, initiates a breath, what is the trigger variable? - Answer- Time In which of the following modes are spontaneous breaths between mandatory breaths not possible? - Answer- Continuous mandatory ventilation Which of the following is a reason for ventilator alarms? - Answer- To bring events to the attention of the clinician.

The effects of patient circuit compliance are most troublesome during what mode of mechanical ventilation? - Answer- Volume-controlled ventilation During mechanical ventilation, a spontaneous breath is defined as one that: - Answer- initiated and terminated by the patient. During mechanical ventilation, a mandatory breath is defined as one that is: - Answer- initiated and terminated by the machine. An alert and cooperative 28-year-old woman with no prior history of lung disease underwent cesarean section 16 hours earlier. Her x-ray film currently is clear. Which of the following approaches to preventing atelectasis would you recommend for this patient? - Answer- Incentive spirometry Which of the following are considered airway clearance therapies?

1. Postural drainage and percussion
2. Incentive spirometry
3. Positive airway pressure
4. Percussion, vibration, and oscillation - Answer- 1, 2, and 3 only In which of the following types of ventilation is alveolar expansion during inspiration due to an increase in alveolar pressure?
5. negative-pressure ventilation
6. positive-pressure ventilation
7. spontaneous ventilation - Answer- 2 only Which of the following conditions is associated with a lack of response to increased FiO2 in patients receiving positive-pressure ventilation? - Answer- shunt Which of the following strategies are useful in the management of shunt?
8. Positive end expiratory pressure
9. Permissive hypercapnia
10. Control of membrane permeability - Answer- 1 and 3 Which of the following is the recommended tidal volume for mechanical ventilation in a patient acutely requiring mechanical ventilation? - Answer- 4 to 8 ml/kg Which of the following conditions may require higher initial respiratory rates?
11. Metabolic alkalosis
12. ARDS
13. increased intracranial pressure 4.Metabolic acidosis - Answer- 2,3 and 4

During pressure controlled continuous mandatory ventilation, when the patient's lung compliance indreases, which of he following will occur? - Answer- The tidal volume will increase In which of the following modes of ventilatory support would the patient's work of breathing be greatest? - Answer- Continuous positive airway pressure (CPAP) In which of the following modes of ventilatory support would the patient's work of breathing be least? - Answer- Continuous mandatory ventilation (CMV) Detrimental effects of positive end expiratory pressure(PEEP) includes which of the following? Increased incidence of barotrauma 2 Decreased venous return of cardiac output 3 increased pulmonary vascular resistance

4. increased Cl - Answer- 1,2 and 3 Volume- controlled (VC) modes of mechanical ventilation include which of the following?
5. VC continuous mandatory ventilation 2 VC intermittent mandatory ventilation 3 Volume- assured pressure controlled
6. bilevel positive airway pressure - Answer- 1 and 2 Which of the following is considered an acceptable tidal volume for mechanical ventilation? - Answer- 5 to 7 ml/kg The ABG below is form a patient who is receiving mechanical ventilation. What setting would you change to fix this ABG? 7.32/49/82/24 - Answer- Increase RR Which of the following modes of ventilatory support is used to help decrease airway and alveolar pressures? - Answer- Pressure- controlled continuous mandatory ventilation What are some primary uses for pressure-supported ventilation(PSV)?
7. Recruiting collapsed alveoli and improving oxygenating. 2.Augmenting patient's spontaneous Vt
8. Overcoming the imposed work of breathing - Answer- 2 and 3 For patients with respiratory insuffciency, pressure-supported ventilation(PVS) has all of the following advantages over spontaneous breathing except: - Answer- increased muscle activity. What spontaneous pressure-controlled breath mode allows separate regulation of the inspiratory and expiratory pressures? - Answer- Bilevel positive airway pressure Interpret This ABG. The patient is on RA

7.48/30/52/24 - Answer- uncomp resp alk with moderate hypoxemia. How would you treat this petient if he was on RA? 7.48/30/52/24 - Answer- Place him on an oxygen device. Administration of positive end expiratory pressure (peep) or continuous positive airway pressure(CPAP) is associated with which of the following benefits? 1 Helps maintain open alveoli 2.helps with alveoli stability 3 Helps maintain fluid filled alveoli open 4 Ensures surfactant depleted alveoli remain closed - Answer- 1,2 and 3 Mean airway pressure can be increased by which of the following factors? 1increasinf the inspiratory time

2. increasing compliance
3. increasing level of PEEP
4. Changing from a square to a decelerating ramp waveform - Answer- 1,3 and 4 To prevent muscle fatigue or atrophy, the level of PSV should be adjusted to achieve what work load? - Answer- 0.6 to 0.9 J/L Which of the following factors would tend to increase mean airway pressure?
5. Short inspiratory times. 2 increased mandatory breaths. 3 increased leves of positive inspiratory pressure(PIP) 4 increased levels of positive and expiratory pressure(PEEP) - Answer- 2,3 and 4 in which of the following patients is positive end expiratory pressure(PEEP) most indicated? - Answer- FIO2:0.3,PaO2:50 mm Hg Which of the following are among the top common causes of death in the United states?
6. Heart disease
7. cerebrovascular disease
8. chronic obstructive lung disease
9. cystic fibrosis - Answer- 1 and 3 Which of the following are learning domains
10. cognitive 2.affective 3.psychomotor
11. Analytical - Answer- 1,2 and 3 Teaching physical skills to patients is learning is what domain? - Answer- psychomotor Teaching facts to patients involves learning in what domain? - Answer- Cognitive

What concept will be most emphasized in teaching new skills to patients? - Answer- repetition Which of the following is used to evaluate cognitive objectives? - Answer- Written exam Which of the following is the primary goal of health education? - Answer- Change the behavior. Which of the following factors are linked to one of the major causes of death in the united states?

1. use of tobacco 2 High fat diet
2. Physical inactivity
3. low sodium diet - Answer- 1,2 and 3 Which of the following are verbs the respiratory therapist can use within the cognitive domain to educate patients?
4. cite 2 define
5. identify
6. recognize - Answer- 1,2,3 and 4 What type of information is associated with teaching in the effective domain? - Answer- Motivation and attitude Patients with chronic cardiopulmonary disorders all share an inability to do what? - Answer- cope effective with their diseases process. What is the term used to describe the restoration of individuals to the fullest possible medical, dental, emotional, social, and vocational potential? - Answer- Rehabilitation What are the overall goals of rehabilitation? 1.To reverse the course or progression of the disease process
7. to minimize the disability's impact on the individual or family. 3.to maximize the functional ability of the individual - Answer- 2 and 3 The principal objectives of pulmonary rehabilitation include which of the following?
8. to control and alleviate the symptoms
9. to restore functional capabilities as much as possible
10. To improve quality of life - Answer- 1,2 and 3 Attrition i pulmonary rehabilitation programs is most associated with which of the following? - Answer- Degree to which patients psychosocial needs are met Which of the following elements should ne considered in most pulmonary rehabilitation programs?

1. individual needs
2. patient's education
3. patient's personality 4.patient's aptitudes - Answer- 1,2,3 and 4 Common goals shared by most pulmonary rehabilitation programs include with of the following?
4. improvement in physical activity levels 2.control of respiratory infections
5. Reduction in medical costs and hospitalizations
6. Family educations counseling and supporty - Answer- 1,2,3 and 4 Specific patient objectives for a pulmonary rehabilitation program could include which of the following?
7. proper use of medications O2 and breathing equipment
8. Reconditioning of both skeletal and respiratory muscle 3 adherence to proper hygiene and good nutrition
9. Improvement in the results of pulmonary functions test - Answer- 1,2 and 3 What is the first step in evaluation patients for participation in a pulmonary rehabilitation program? - Answer- Complete patient history Which of the following patients are good candidates for pulmonary rehabilitation?
10. unstable cardiovascular patients who require monitoring
11. patients with exercise limitations due to severe dyspnea
12. patients with malignant neoplasm involving the lungs - Answer- 2 only administrations of positive end expiratory pressure (PEEP) or continuous positive airway pressure(CPAP) id associated with which of the following benefits?
13. Helps maintain open alveoli
14. Helps with alveoli stability
15. Helps maintain fluid filled alveoli open 4 Ensures surfactant depleted alveoli remain closed - Answer- 1,2 and 3 The apex of the heart(tip of the left ventricle) lies just above the diaphragm at a level corresponding to which intercostal space? - Answer- fifth What id the loose membranous sac that encloses the heart? - Answer- Pericardium Where is most postacute respiratory care provided? - Answer- home Under which conditions is the home the best setting for providing subacute care?
16. When the patient is unable to do self-care
17. when adequate caregiver support the unavailable
18. When the patient's physician cannot make home visits - Answer- 3 only

Respiratory home care contributes to achieving which of the following goals?

1. improving patients physical and social well being 2 Ensure cost effective delivery of care 3.supporting and maintaining patients lives
2. Promoting patient and family self sufficiency - Answer- 1,2,3 and 4 What agency is primarily responsible for voluntary accreditation of postacute care providers? - Answer- The joint commission While visiting a home care patient who uses a multidose vial of an expensive bronchodilator you notice that the expiration date for this medication has passed. which of the following actions would you recommend at this time? - Answer- Dispose of the medication as recommended by the manufactured Which of the following is an additional goal of home care of the terminally ill patient near the end of life - Answer- Maximize comfort and well-being What are some desired outcomes of the discharge plan? 1, prevent hospital readmission due to poor panning
3. satisfactory performance of all treatments by caregivers
4. caregivers ability to assess the patient and solve problems
5. Patient's and family's satisfaction - Answer- 1,2,3 and4 Providing regular in home follow up visits and assessing the patient's overall progress in the responsibility if which member of the respiratory home care team? - Answer- Respiratory care practitioner What is the most common respiratory home care modality? - Answer- O2 therapy Home O2 therapy can be justified in patients with PaO2 values greater than 55 mm Hg in all of the following conditions? 1 cor pulmonale
6. Erythrocythemia( hematocrit>56%)
7. congestive heart failure 4 peripheral vascular disease - Answer- 1,2,and 3 CMS regulations require that prescriptions for home O2 therapy be based on - Answer- documented hypoxemia Which of the following is considered a life sustaining treatment - Answer- Dialysis The prospect of recovery as anticipated from the usual course of disease or the peculiarities of the case is best described by which of the following terms? - Answer- Medical prognosis

An '' ethic of care'' approach that can guide ethical decision making includes with of the following concepts?

1. Rights
2. Virtues 3.utilitarianism
3. deontology - Answer- 1,2,3 and 4 Which of the following terms refers to the controlled and monitored use of nonopioid medications intended to lower the patient's level of consciousness to the extend necessary for relief of awareness of refractory and unendurable symptoms? - Answer- Palliative sedations Which of the following terms refers to the act of putting to death someone suffering from painful or prolonged illness or injury? - Answer- Euthanasia What external landmark can be used to show the highest point the dome of the right hemidiaphragm reaches in a healthy individual? - Answer- Eighth rib posteriorly What pulmonary disorder could lead to acute flattening of the diaphragm? - Answer- asthma Which accessory muscles are active during resting and active inspiration and pull up on all the ribs expanding the thorax? - Answer- External intercostals Emphysema is defined as - Answer- destruction of alveolar walls without fibrosis Which of the following signs associated with COPD is considered a late manifestation? - Answer- Accessory muscle usage With which of the following devices are therapeutic aerosols generated? 1.Atomizers 2.Nebulizers
4. humidifiers
5. Soft mist inhalers - Answer- 1,2 and 4 Where do most aerosol particles in the 1 to 5 um range deposit? - Answer- Central airways Which of the following are considered airway clearance therapies? 1.postural drainage and precussion
6. incentive spirometry
7. positive airway pressure 4.percussion,vibration and oscillation - Answer- 1,2 and 3