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TMC practice questions
A 44 week old gestational age infant is delivered via C-section and is gasping, grunting and has tachycardia and tachypnea. At one minute his APgar score is 4 and at 5 minutes the score is at 5. The infant is most likely suffering from transient tachypnea of the newborn meconium aspiration bronchopulmonary dysplasia apnea of prematurity - Answer meconium aspiration All of the following could cause a patient's right-hemidiaphragm to be elevated, Except... right lower lobe atelectasis right side hyperlucency, absent vascular markings hepatomegaly right lower lobe consolidation with air bronchograms - Answer right side hyperlucency, absent vascular markings A 64 year old, 70 kg (154 lb) man with severe COPD receives independent (differential) lung ventilation following thoracotomy and right lower lobectomy. Which of the following setting combinations would be most appropriate for this patient? Right Lung 50 mL, left lung 459 mL Right lung 159 ml, left lung 359 ml Right lung 250, left lung 250 ml
Right lung 350 ml, left lung 150 ml - Answer Right lung 150, left lung 350 ml A 2 year old child with croup has been intubated for 4 days with a 4 mm ID uncuffed endotracheal tube. Heated aerosol at an FiO2 of 0.30 has been delivered to the patient. The physician asks the respiratory therapist to evaluate the patient for possible extubation. Which of the following would most likely indicate that the patient is ready for extubation? The patient is making normal quiet ventilatory efforts A negative sputum culture and sensitivity has been reported The patients ABG are within normal range Breath sounds are heard around the tube on auscultation - Answer Breath sounds are heard around the tube on auscultation When instructing a patient prior to a vital capacity maneuver, the respiratory therapist should direct the patient to.... exhale to residual volume and inhale to inspiratory capacity inhale to total lung capacity then exhale to residual volume exhale normally then inhale to TLC inhale normally then exhale to FRC - Answer inhale to TLC then exhale to RV A patient with end-stage pulmonary fibrosis receieves oxygen at 2 L/min via transtracheal oxygen catheter. The patient complains of increased work of breathing and shortness of breath. The RT should... Manually ventilate the patient with a resusitation bag increase the flow to the transtracheal catheter to 6 lpm evaluate the SpO2 with a pulse oximeter flush the transtracheal device with saline - Answer flush the transtracheal device with saline During bedside monitoring the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first A. verify the position of the transducer.
Which of the following would be the most appropriate test to evaluate partial vocal cord paralysis in a patient complaining of difficulty swallowing? SB nitrogen elimination Max Voluntary Ventilation Flow volume loop Diffuse capacity - Answer FVL- flow volume loop While examining the chest drainge system of a mechanically ventilated patient following thoracotomy, the RT observes bubbling in the water seal chamber inspiration. This would indicate.. A leak in the chest drainage system air leaving the pleural space excessive pressure from the suction regulator inadequate water level in the water-seal chamber - Answer air leaving the pleural space A patient with a flail chest is intubated and mechanically ventilated with PEEP therapy. Pancuronium bromide has been administered. Which of the following ventilator alarms would be most important to set correctly for this patient? Peak pressure alarm low pressure alarm I:E ratio alarm Low exhaled volume alarm - Answer low pressure alarm -> remember the low pressure alarm in the most important of the alarms overall During recovery from a resection of an aortic aneurysm, a 65 year old female patient suddenly develops severe substernal chest pain with grave dyspnea. The pain does not appear to be aggravated by her respirations. Auscultation reveals bilateral, basilar, moist, crepitant rales. The patient appears pale, cold, and diaphoretic. Which of the following should the respiratory therapist recommend for initial assessment of this patient? ECG
CBC
Serum elctrolytes Lateral decubitus radograph - Answer ECG Which of the following techniques measures TLC? Helium dilution Body Box Single breath nitrogen elimination - Answer Helium and body box During a cardiopulmonary stress test on a 55 year old man, the RT notes the following changes: increased HR increased BP VD/Vt ratio decreases RR increases Therapist should: continue the test terminate the test contact the physician administer amiodarone - Answer continue the test These are all normal responses Which of the following is a FALSE statement about self-inflating resuscitation devices? A reservoir is utilized to increase the delivered oxygen concentration The RT can sense changes in the patients lung compliance and airway resistance A compressed gas source is necessary for the device to operate excessive gas flow may cause the valve to malfunction - Answer a compressed gas source is necessary for the device to operate -> duh its self-inflating A 72 year old male patient who is 5'10 tall and weighs 75 kg receives MV. The RT notes diminished breath sounds in the bases of both lungs. The patient is on the following settings:
large reservoir nebulizer ultrasonic nebulizer - Answer Ultrasonic nebulizer A 7 year old child suspected of having epiglotittitis would exhit which of following signs Drooling Hyperextended neck stridor unilateral wheeze - Answer Drooling hyper-extended neck Stridor The physician informs the patient that the results of his polysomnogram indicate obstructive sleep apnea. The treatment for this disorder might include... BHT Resp stimulants Tracheostomy Negative pressure ventilation - Answer Tracheostomy treatments include: CPAP, NPPV Weight loss surgery respiratory stimulants(prematurity) Educational programs F- A 17 year-old patient receives 40% oxygen via a Venturi mask following a motor vehicle accident. He suddenly develops acute shortness of breath, is diaphoretic and SpO2 is 85%. Breath sounds are vesicular on the right and extremely diminished on the left. The respiratory therapist should evaluate the patient for the presence of... atelectasis pneumothorax arterial hypertension myocardial infarction - Answer pneumothoax
Which of the following would NOT be required to perform a nasal intubation? Magill forceps stylet larngoscope endotracheal tube - Answer stylet A patient has been intubated with a naso-tracheal tube and is being manually ventilated. As the RT ventilates the patient, he notices that there is no chest movement, minimal breath sounds and air escaping from the mouth as the bag is squeezed. A chest x-ray has determined that the endotracheal tube is in the correct position. What is the most likely cause of this situation? The tube is in the esophagus the patient has developed a tacheosophageal fistula from the intubation process the cuff ruptured during intubation the cuff has herniated over the end of the tube - Answer the cuff ruptured during intubation The following measurements were obtained from a patient being monitored with a balloon tipped, flow directed catheter: CVP 2 cm H2O PAP 12 torr PCWP 3 torr CI 1.2 lpm/m BP 110/ Based on the above information, all of the following parameters would be decreased EXCEPT Right ventricular end diastolic pressure left atrial filling pressure systemic vascular resistance cardiac output - Answer systemic vascular Resistance would not decrease because you CVP is okay along with the BP
A patient performs both a forced vital capacity and a slow vital capacity maneuver with the following results: FVC 2. SVC 2. Which of the following statements is TRUE regarding these results? The data meets ATS-ERS standards and should be reported The SVC shows poor effort and should be repeated The FVC shows poor effort and should be repeated The patient has obstructive lung disease - Answer the SVC shows poor effort and should be repeated Which of the following would NOT cause a capnography reading to change from 36 torr to 30 torr? Tachypnea Hyperventilation Pulmonary emboli Endotracheal tube positioned in the right mainstem bronchus - Answer Endotracheal tube positioned in the right mainstem bronchus A tracheostomy tube has just been changed on a patient receiving coninuous volume cycled ventilation. The patient suddenly becomes dsypneic and develops crepitus around the tracheostomy stoma. The respiratory therapist should suction the patien insert a larger trach tube reposition the trach tube recommend an antihistamine - Answer reposition the trach tube A patient's cardiac output is increased and his Qs/Qt is calculated to be 20%. Based upon this information, the RT would inform the physician this patient has an elevated shunt
a reduced cardiac index increased pulmonary vascular resistance normal lung mechanics - Answer an elevated shunt A 1600 g neonate receives oxygen by oxyhood at an FiO2 of 0.60. The flowmeter is set at 5 lpm. While analyzing the oxygen, the respiratory therapist notices varying FiO reading at different locations inside the oxyhood. The therapist should.... recalibrate the oxygen analyzing device increase the flow to the oxyhood place the neonate in an isolette at an FiO2 of 0. check the water level of the humidier - Answer increae the flow to the oxyhood The following measurements were obtained from a patient with a pulmonary artery catheter in place: CVP 1 mm Hg PAP 10 mm Hg PCWP 8 mm Hg CI 1.6 L/min/m BP 110/90 mm Hg Based on the above information, all of the following values would be decreased EXCEPT RVEDP PVR SVR QT - Answer SVR A 75 kg male is being mechanically ventilated at the following setting: Mode VC SIMV set rate 12 total rate 32 Vt 600 PIP 35 exhaled minute volume 9.2 L
Tricuspid stenosis right ventricular failure cardiogenic pulmonary edema fluid overload - Answer cardiogenic pulmonary edema During inline suctioning of a patient's endotracheal tube, 100% oxygen is being supplied via the ventilator. The RT observes several premature ventricular contractions on the ECG monitor. The therapist should decrease the suctioning time per pass use a smaller suction catheter increase oxygenation time decrease the suction pressure - Answer decrease the suctioning time per pass A patient receives oxygen at home via nasal cannula at 1 lpm. He has 50 feet of extension tubing attached to his oxygen concentrator. The patient complains that there does not seem to be enough oxygen flow reaching the cannula. The respiratory therapist should recommend decreasing the length of the extension tubing increasing the concentrator flow changing to a liquid system analyzing the FiO2 - Answer decreasing the length of the extension tubing A 2 year old child recently diagnosed with laryngotracheobronchitis requires the administration of 40% oxygen. What is the most appropriate method for delivering the oxygen? oxyhood connected to a blender cool aerosol mask venturi mask croup tent - Answer cool aerosol mask Which of the following would modify the expiratory time and change the I:E ratio for a patient receiving PEP therapy?
Expiratory resistance valve Inspiratory flow rate control volume control - Answer expiratory resistance valve A respiratory therapist enters a patients room during oxygen rounds. The patient has end stage emphysema and appears to be sleeping. The patient doesnt respond to questions and his pulse is 20 bpm. The therapist should immediately... confirm DNR status go get help begin rescue ventilation begin chest compressions - Answer confirm DNR status While attempting to calibrate a polarographic oxygen analyzer, the respiratory therapist notices that the analyzer reads 21% when exposed to room air but only reads 64% when exposed to 100% oxygen. The most appropriate action at this time would be to... reset the zero point replace the battery replace the fuel cell add electrolyte solution - Answer replace the battery An healthy adult female can exhale what portion of her vital capacity in the first second? 50% 60% 70% 80% - Answer 70% A patient on VC ventilation demonstrates auto-PEEP on the ventilator graphics. Which of the following controls when adjusted independently, would increase the expiratory time? Vt RR Inspiratory Flow Sensitivity - Answer Vt, RR, and Inspiratory Flow Which of the following would most likely benefit from pressure support ventilation? An intubated patient with an absent respiratory drive
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 3/l min Therapist recommends: IV fluid challenge Positive inotropic agent Inhaled nitric oxide diuretic therapy - Answer IV fluid challenge all numbers are low-> hypovolemia What is the primary advantage of volume controlled ventilation as compared to pressure controlled ventilation? VC limits and controls PIP VC provides a constant Minute ventilation VC ensures better patient-ventilator synchrony VC delivers a deceleration flow pattern - Answer VC provides a constant minute ventilation-> provides a stable ABG At 1 minute post-delivery a newborn has blue extremities with a pink body, heart rate is 90/min, resp 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 of 140/min, resp rate of 40/min, cough reflex is present, and the baby is active with a string cry. What APGAR scores should be assigned? 4 and 8 5 and 9 5 and 10 6 and 10 - Answer 6 and 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? 0.25 mL 0.50 mL 1.25 mL 2.5 mL - Answer 1.25 mL
A 19 year old patient is brought to the ED after taking a handful of pills. The patient is obtunded but is making regular, sonorous respirtory efforts Auscultation reveals coarse rhonchi bilaterally. Which of the following should be done FIRST to assess this patient? obtain a sputum specimen Obtain an ABG Measure peak expiratory flow Determine the Glasgow coma score - Answer obtain an ABG A young health 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 RT recommend? Helium dilution study DLCO Plethysmography Bronchial provocation - Answer Bronchial Provocation All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT carbon monoxide poisoning decompression sickness anaerobic infections pulmonary hypertension - Answer pulmonary hypertension NO is used for it The physician asks the RT 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 physicians request? Decelerating square wave constant accelerating - Answer Decelerating An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO2 of 40 torr. After adminsitration of 50% oxygen for 30 minutes, the resp therapist notes that the SpO2 rises to 98% and the ETCO2 remains stable at 40 torr. The major cause of hypoxemia is this patient is hypoventilation shunt V/Q mismatch
A patient receiving pressure controlled ventilation has acute hypoventilation with an ETCO2 of 70 torr. His vital signs include: HR 90, RR 18, SpO2 94. Which of the following changes will address the situation?
- Increase the pressure limit
- increase the sensitivity
- increase the mandatory rate
- Decrease the inspiratory time 1 and 4 only 1 and 3 only 2 and 3 only 1,2 and 4 only - Answer 1 and 3 only Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? 20 torr 30 torr 40 torr 50 torr - Answer 50 torr-> duh, a high CO2 means acidotic and they are not ventilating well The ability to distinguish central apnea from obstructive apnea during a sleep study requires the RT to monitor electrocardiogram electroencephalogram nasal air flow chest wall compliance - Answer nasal air flow chest wall compliance All of the following are TRUE with regard to cuff inflation techniques EXCEPT minimal leak/minimal occlusion volume techniques negate the need for cuff pressure monitoring minimal leak technique allows a small leak at the end of inspiration at minimal occlusion volume, air leakage around the tube cuff should cease cuff pressure should not exceed 35 cm H2O in order to allow circulation to tracheal mucosa - Answer minimal leak volume techniques negate the need for cuff pressure monitoring A capnograph used for continuous monitoring of a patient on mechanical ventilation should be recalibrated ever
2 hours 4 hours 8 hours 24 hours - 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? The ventilator circuit has become disconnected there is a leak around the endotracheal tube there is an increase in alveolar dead space the carbon dioxide absorber is exhausted - Answer the ventilator circuit has become disconnected The primary reason for the use of respiratory care protocols is to decrease the patient workload for therapists standardize provision of care enhance departmental efficiency increase the autonomy of therapists - Answer standardize provision of care A 60 kg(132 lb) female patient with confestive 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 shunting hyperoxygenation hypoventilation fluid overload - Answer hyperoxygenation Dynamic hyperinflation is a major concern when using Volume Control, Assist/Control ventilation in patients with which of the following conditions? A. Post-traumatic chest trauma B. Community-acquired pneumonia C. Spinal cord injury
