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QUESTIONS
100 A respiratory therapist is asked to instruct the patient recently diagnosed with asthma white performing and recording peak flow measurements are important. The therapist should tell the patient:
- Peak flow measurements help your doctor decide if your asthma is under control
- if the peak flow meter is used every day at home, you can find breathing problems even before you start to release or cough
- a drop in peak flow is a good way to recognize early signs of a coming asthma attack
- it helps to see how bad asthma is 1, 2, and 3 only 1 and 3 only 1, 2, 3, and 4 2 and 4 only – A NSWER ANS: 1, 2, 3, and 4 EX: all of the options listed are important reasons why and asked the patient should perform and record peak flow measurements.
101 While reviewing the patient's chart prior to administering and albuterol (Proventil) treatment, the respiratory therapist notes that the patient is scheduled for pre—bronchodilator and post - bronchodilator spirometry in one hour. The respiratory therapist should do which of the following? A. Tell the patient that he will get the treatment in one hour B. notify the pulmonary function laboratory of the conflict in therapy C. administer the treatment as ordered D. administer the treatment with normal saline only
- ANSWER ANS: B. - Notify the pulmonary function laboratory of the conflict in therapy EX: because the patient will receive a bronchodilator by the pulmonary function technician within an hours time span and the patient is scheduled to receive a bronchodilator now, there is a conflict in therapy. The practitioner needs to consult the pulmonary function lab and ascertain whether the patient should receive the albuterol treatment now and have the pulmonary function lab reschedule that spirometry test or whether the patient can wait one hour and received a bronchodilator during the spirometry tests. It would be inappropriate to perform any of the remaining options 102 A patient with allergic asthma has been prescribed albuterol (Proventil), nedocrmil sodium (Tilade), and flunisolide (Aerobid). The respiratory therapist should provide the patient with which of the following information?
- Albuterol and nedocromil do not interact
- during an acute asthmatic attack, take flunisolide 1st
EX: orthopnea is a condition in which the patient feels discomfort in breathing while lying down and must sit upright to relieve the difficulty in breathing. Tachypnea means a rapid respiratory rate. Platypnea mean discomfort in breathing while in the upright or seated position. Dyspnea is a generic term that simply means difficulty in breathing. Dyspnea may I may not occur in any body position. 104 During the aerosol therapy with a metered dose inhaler (MDI) without a spacer, the respiratory therapist instructs the patient to hold the mouthpiece approximately 1 inch away from the mouth. The therapist explains that this will: A. Help with the ordination of canister actuation B. reduce the likelihood that the drug will be deposited at the back of the throat C. enhance particle stability D. deliver a smaller sized particle to the deeper recesses of the lungs
- ANSWER ANS: B. _ reduce the likelihood that the drug will be deposited at the back of the throat EX: my holding the mouthpiece 1 inch away from the mouth there is an increase in the distance between the aerosol in the back of the throat. This makes it more likely that the aerosol particles will remain in the inspired gas and travel into the lungs instead of depositing out in the back of the throat. 105 Ideally, a 1 - point calibration is performed on a blood gas analyzer: A. At least once every 50 blood gases B. at least once every 8 hours
C. prior to each sample analysis D. at least once in a 24 - hour period
- ANSWER ANS: C. - Prior to each sample analysis EX: 106A patient's PaO2 measured by blood gas analysis is to 255 mm HG. The blood gas analyzer on which the sample is analyzed is calibrated to a PO2 of 150 mm HG. Which of the following is the most acceptable action? A. The patient's value is accurate, reported to the physician B. correlate the accuracy of the value via tonometry C. recalibrate the blood gas analyzer to accommodate this unusual value D. reanalyze the blood gas sample on a different analyzer
- ANSWER ANS: C. - recalibrate the blood gas analyzer to accommodate this unusual value EX: when the patient's PaO2 is considerably higher than the calibrated range of a blood gas analyzer, the analyzer should be recalibrated to accommodate this unusual value (using "calibration override "function and high oil 100% oxygen standard gas). 107 Blood gas analyzer troubleshooting should be initiated when: A. The analyzer takes more than 30 seconds to complete its analysis B. quality control results are outside predefined acceptability limits
A. They are designed to prevent bodily contact with the patient B. they are designed to protect the patient from practitioners who have a cold C. they are designed to prevent exhaled moisture from becoming contagious D. they are designed to filter most airborne species of bacteria
- ANSWER ANS: D. - They are designed to filter most airborne species of bacteria EX: In the case of patients that have a contagious airborne disease, masks are worn by a practitioner to protect the practitioner from the patient's airborne disease by filtering out the airborne bacteria from being briefed by the practitioner. 110Following the sterilization of respiratory equipment by Steve autoclave, heat sensitivity changes color. This indicates that: The equipment has been sterilized take the out dated conditions required for sterilization to occur have been met the equipment is not fully sterilized - ANSWER ANS: C. - conditions required for sterilization to occur have been met EX: a heat sensitivity changes color when exposed to a given temperature for a sufficient period of time. This indicates that the conditions required for sterilization to occur have been met. However, it does not sure the process is effective or the equipment is truly sterile. Only biological indicators can provide these assurances.
111 The effectiveness of infection control techniques is best monitored by obtaining random cultures from respiratory therapy equipment at which of the following times? A. Prior to sterilization B. after 24 hours patient use C. immediately after patient use D. prior to patient use - ANSWER ANS: B. - After 24 hours a patient use EX: the purpose for obtaining random cultures from equipment is to prevent the spread of pathogens to the patient. Because once introduced into equipment, bacteria can multiply enough within 24 hours to cause infection, infection control surveillance procedures usually involve random sampling and culturing up in - use equipment after 24 hours a patient use. Random sampling of equipment prior to patient use is used to assess packaging adequacy and shelf life. Random sampling prior to sterilization is the necessary because it cannot yield any useful information and cannot prevent the spread of infection if it has already occurred. Random sampling immediately after patient use is an inappropriate option because it does not allow infection control intervention when it is most needed and does nothing to prevent the spread of infection if it has already occurred. 112 While attempting to suction the patient who has a tracheostomy tube, the respiratory therapist experiences difficulty in passing the catheter through the tracheostomy tube. Therapist should do which of the following? A. Switch to smaller size suction catheter B. remove and inspect outer cannula of the tracheostomy tube C. remove and inspect the inner cannula of the tracheostomy tube
would activate. The I: E ratio alarm only activates in the event that inspiration exceeds expiration, which is not the case in this situation. 114 While performing a routine ventilator check, the respiratory therapist observes that peak inspiratory pressures have increased from the 25 to 30 cm H2O range to the 40 to 45 cm H2O range. All of the following may have caused this EXCEPT: A. secretion accumulation in the patient's airway B. an underinflated cuff C. a partially kinked endotracheal tube D. water accumulation in the wide-bore tubing - ANSWER ANS: B. - an underinflated cuff EX: in increasing inspiratory pressure indicates that there is an increased amount the back pressure somewhere in the patient - ventilator system. Water accumulation in the wide - bore tubing, a partially kinked endotracheal tube, and secretions in the airway all placed an increased amount of pressure in the system by increasing the resistance to airflow into and through the partial occlusion. And underinflated cuff would cause the loss of pressure due to volume loss around the cuff and out the mouth. 115 While using a mechanical percussor for chest physiotherapy, that percussor overheats. The respiratory therapist should do which of the following? A. Leave the patient in the current drainage position and let the unit cool B. continue therapy C. complete the treatment manually
D. discontinue therapy and chart the reason for early termination of treatment - ANSWER ANS: C. - complete the treatment manually EX: the most appropriate action when a mechanical percussor overheats is to turn it off and finished chest physiotherapy manually. The remaining traces are either not warranted or could jeopardize the patient. 116 When responding to a ventilator alarm, the respiratory therapist notes that the exhalation valve leak alarm has activated. Which of the following is the most correct action at this time? a. increase the FIO2 to 1.0 to prevent the onset of hypoxia b. disconnect the patient from the ventilator and manually ventilate c. increase the flow rate setting d. tighten all circuit connections - ANSWER ANS: b EXP: An exhalation valve leak alarm indicates that the ventilator is malfunctioning. The most appropriate action in this case is to disconnect the patient from the ventilator and manually ventilate. The next action would be to replace the ventilator. 117 a vane-type respirometer has been placed in-line at the end of the main expiratory tubing of a volume ventilator. After 24 hours of continuous in-line use, the respirometer would: a. record volumes that are higher than actual b. record volumes that are lower than actual c. accurately record volumes only if the unit is off between measurements d. accurately record volumes as long as the unit remains on - ANSWER ANS: b EXP: After 24 hours of in-line use, the respirometer would collect the condensate from the wet exhaled air. When the vanes inside the device become wet and
d. the inflatable bag acts as an oxygen reservoir - ANSWER ANS: a EXP: All of the choices are true except it has valves that direct inspired gases to the atmosphere. The correct statement would be it has valves that direct exhaled gases to the atmosphere. 120 Which of the following will alter the oxygen concentration of an air- entrainment mask? a. increasing the flowmeter setting b. occluding the air-entrainment ports c. altering the size of the jet's orifice A. 1 and 3 only B. 2 only C. 2 and 3 only D. all - ANSWER ANS: c EXP: a is false. The size of the jet's orifice and air-entrainment ports determine the oxygen concentration of an air-entrainment system. Increasing eh flowmeter setting will only increase the total flow delivered by the system. B is true. Occluding the air-entrainment ports will decrease the amount of air being entrained, resulting in an increase in the oxygen concentration. C is true. Altering the size of the jet's orifice will affect the amount of oxygen allowed into the system. By increasing the size of the orifice more oxygen will be allowed into the system, resulting in an increase in the oxygen concentration. 121 Which of the following are essential components of a positive pressure breathing circuit?
- a main inspiratory line
- a patient connector
- one-way valves
- an expiratory valve a. 1,2 and 3 only b. 2 and 4 only C. 1,2,and 4 only d. all - ANSWER ANS: c EXP: 1 is true. The main inspiratory line is the wide-bore tubing that connects the positive pressure machine to the patient connector. 2 is true. The patient connector is the adapter that is connected to the end of the main inspiratory line and the patient delivery device (e.g., mask, mouthpiece, endotracheal tube). 3 is false. There are no one-way valves in a positive pressure breathing circuit. 4 is true. An expiratory valve is placed within the expiratory limb of the breathing circuit and serves to dump exhaled volume to the atmosphere. 122 Which of the following will occur when the high pressure limit is reached on a volume ventilator?
- The duration of expiration will be prolonged.
- Inspiration is immediately terminated.
- The FIO2 will be lower than expected. a. 1,2, and 3 b. 1 and 2 only c. 2 and 3 only d. 2 only - ANSWER ANS: d EXP: When the high pressure limit alarm is activated on a volume ventilator, any remaining volume is dumped to the atmosphere and inspiration is immediately terminated. The duration of expiration and FIO are not affected when the high pressure limit alarm is activated.
b. 50% air-entrainment mask c. Simple oxygen mask with a flow meter setting of 5 L/min d. 2 L/min nasal cannula - ANSWER ANS: d EXP: A patient with mild hypoxemia only needs a low concentration of oxygen to increase the PaO2 back toward normal. The most appropriate choice therefore, is 2 L/min nasal cannula. The remaining oxygen concentrations are indicated for moderate to severe hypoxemia. 125 A code has just been initiated on a 3-year-old pediatric patient in the recovery room. At this point, an airway would best be maintained by: a. A tracheostomy tube b. A cuffed oral endotracheal tube c. A cuffed nasal endotracheal tube d. An uncuffed oral endotracheal tube - ANSWER ANS: d EXP: Because the cricoid cartilage is the narrowest area in the upper airway prior to the age of 8, an uncuffed endotracheal tube is indicated for patients less than 8 years old. Therefore, a cuffed oral or nasal endotracheal tube would be inappropriate for this child. A tracheostomy tube is not indicated for this situation. 126 A full E cylinder of oxygen with a flowmeter setting of 3 L/min has been in use for 3 hours. This cylinder may be used for how many additional hours? a. 3 hours b. 1 hour c. 2 hours d. less than ½ hour - ANSWER ANS: d EXP: The formula for calculating the duration of oxygen left in an E cylinder is (0. x 2200/liter flow)-( minutes the cylinder has been used). Where; 0.28 is the
cylinder factor for an E cylinder. 2200 is the amount of pressure in psig of a full E cylinder. Liter flow is the oxygen flow per minute ( in this case, 3L/min). The amount of time the cylinder has been in use in minutes in this case is 180 minutes (3x60=180). Solving the equation(0.28x2200/3)-180=25min(which is less than ½ hour!) 127 Which of the following procedures is recommended for establishing a patent airway in an emergency situation? a. Emergency cricothyrotomy b. Orotracheal intubation c. surgical tracheotomy d. Nasotracheal intubation - ANSWER ANS: b EXP: Orotracheal intubation is the procedure of choice in an emergency situation. This is because it is the quickest and easiest means of establishing a patent airway. 128 An adult patient is orally intubated and receiving continuous mechanical ventilation. While preforming a routine cuff pressure measurement, the respiratory therapist observes that the cuff pressure manometer's indicator needle continuously reads zero pressure. No ventilator alarms are activated and the patient appears to be resting comfortably. The therapist should do which of the following to correct this situation? a. Add air to the cuff and place a clamp on the pilot connecting line b. Add air to the cuff and re-measure the cuff pressure c. Extubate the patient and reintubate with a smaller size endotracheal tube d. Replace the cuff pressure manometer - ANSWER ANS: d EXP: In this situation, all indicators (cuff pressure manometer reads zero, no ventilator alarms are activated, and the patient is resting comfortably) point to the fact that the cuff pressure manometer should be replaced. There is no data
patients. A 2 liter anesthesia bag is an extreme size for any patient. Additionally, anesthesia bags do not incorporate intake valves. 131 Which of the following are essential components of a CPAP system?
- Wide-bore tubing
- Resistor to exhalation
- Flow source
- Low pressure monitor a. 1,3 and 4 only b. 1,2, and 3 only c. 2 and 3 only d. all - ANSWER ANS: d EXP: 1 is true. Wide-bore tubing is the primary component of the breathing circuit. It connects the flow source to the patient connector. 2 is true. A resistor to exhalation provides the desired CPAP level. 3 is true. A flow source is required in an amount that meets or exceeds the patient's flow demands. 4 is true. A low pressure manometer is essential in monitoring the delivered CPAP levels. It provides the capability of evaluating the system for delivery of excess CPAP levels as well as for loss of CPAP.
- An aneroid manometer equipped with a maximum value indicator would be appropriate to use in measuring which of the following?
- FVC
- PEAK FLOW RATE
- VT 4 MIP 5.MEP
A. 1,4, and 5 only b. 1,2, and 3 only c. 4 and 5 only d. 2 and 3 only - ANSWER ANS: c EXP: An aneroid manometer is a device that measures static and dynamic pressures. It is indicated for use to measure the maximum inspiratory pressure as well as the maximum expiratory pressure. Because an aneroid manometer can only measure pressures, it cannot measure lung volumes or capacities (vt and vc) or flow rates. 133 Cool aerosol mist tents are used primarily to: a. Deliver precisely controlled supplemental oxygen b. Increase the water content of inspired gas c. Provide a neutral thermal environment d. Decrease mucosal edema - ANSWER ANS: d EXP: Because the application of a cool aerosol helps shrink swollen membranes, a cool aerosol mist tent would be most appropriate and most indicated to relieve mucosal edema such as that which occurs in croup. Precise control of oxygen in a tent is difficult owing to the large volume and frequent opening of the enclosure. An incubator is designed to provide a neutral thermal environment while a mist tent cannot. Although there is an associated increase in the water content of inspired gas with a cool aerosol mist tent, this is not the primary purpose for the use of the tent. 134 Which of the following provides the best indication of the presence of ventilatory failure? a. VD/VT B. FEV1%
