TMC EXAM A with well answered questions, Exams of Nursing

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TMC EXAM A with well answered

questions

A 48 year-old female is admitted to the ED with diaphoresis, jugular venous distension, and 3+ pitting edema in the ankles. These findings are consistent with - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ IPPB A healthy adult female can exhale what portion of her forced vital capacity in the first second? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ Reintubation Which of the following patients would most likely benefit from pressure support ventilation? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ obtain a sputum gram stain Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing?

1. FEV
2. PEFR
3. FRC
4. RV - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ elevated intracranial pressure What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 55 L/min Which of the following measurements is most indicative of congestive heart failure? - ** VERIFIED ANSWERS ** ✔✔ pulmonary capillary wedge pressure of 30 mmHg Sleep apnea can be defined as repeated episodes of complete cessation of airflow for - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ hypoxemia What size endotracheal tube would be appropriate for an adult female patient? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ IV fluid challenge What is the primary advantage of volume-controlled ventilation as compared to pressure-controlled ventilation? - ** VERIFIED ANSWERS ** ✔✔ VC provides a constant minute ventilation Bronchial breath sounds heard over the lung periphery indicate - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ change to airway pressure release ventilation In order to verify the accuracy of a lab-based spirometer device, the respiratory therapist should utilize a - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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, per mm3. The respiratory therapist should recommend - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ enough to achieve a pressure of 25-35 cm H2O All of the following conditions can be treated with hyperbaric oxygen (HBO) therapy EXCEPT - ** VERIFIED ANSWERS ** ✔✔ pulmonary hypertension Which of the following factors are determinants of cardiac output? - ** VERIFIED ANSWERS ** ✔✔ 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 - mEq/L. The respiratory therapist should recommend - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ decelerating An intubated patient receiving 30% oxygen has a SpO2 of 80% and ETCO of 40 torr. After administration of 50% oxygen for 30 minutes, the respiratory therapist notes that the SpO2 rises to 98% and the ETCO

remains stable at 40 torr. The major cause of hypoxemia in this patient is - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ increase the FiO The primary source of infection in the health care setting is - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ placing the syringe in an ice bath Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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?
4. Increase the pressure limit
5. Increase the sensitivity
6. Increase the mandatory rate

4. Decrease the inspiratory time - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ left tension pneumothorax The most serious complication associated with airway suctioning is - ** VERIFIED ANSWERS ** ✔✔ hypoxemia

What is the most appropriate position for a female patient who is 5'3" tall, weighs 200 kg and complains of difficulty breathing? - ** VERIFIED ANSWERS ** ✔✔ lateral fowlers Which of the following values for arterial carbon dioxide tension is consistent with significant alveolar hypoventilation? - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ A A capnograph used for continuous monitoring of a patient on mechanical ventilation should be recalibrated every - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ The ventilator circuit has become disconnected. A patient has mild stridor immediately after extubation. This finding is most often associated with - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ Non-rebreathing mask at 15 L/min The primary reason for the use of respiratory care protocols is to - ** VERIFIED ANSWERS ** ✔✔ standardize provision of care What is normal urine output in an adult patient? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ hyperoxygenation Which of the following physiologic values would be present in a patient who has proper fluid balance? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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?

• ** VERIFIED ANSWERS ** ✔✔ 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: - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 1,2 & 3 only

What increase in FEV1 during post-bronchodilator spirometry is needed to confirm reversibility of an obstructive pattern? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 16 L/min Which of the following should the respiratory therapist utilize in order to determine the severity of respiratory distress in a newborn? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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.
2. Hold pressure on the puncture site for a longer time after sample is collected.
3. Recommend that an ABG should be performed on the patient only if absolutely necessary. - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ replace the manual resuscitation bag

decrease inspiratory time - ** VERIFIED ANSWERS ** ✔✔ 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% - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ hypoventilation A respiratory therapist calibrates a thermal conductivity helium analyzer. What should the analyzer read when exposed to room air? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ Hypopnea A patient admitted to the ED is noted to have pulse and blood pressure variations with respirations. This is most indicative of - ** VERIFIED ANSWERS ** ✔✔ cardiac tamponade. Which of the following medications CANNOT be administered by metered dose inhaler? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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. - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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 - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ 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? - ** VERIFIED ANSWERS ** ✔✔ Amplitude (∆P)