TMC test bank wrong questions 6-10/NBRC new latest version 2024-2025, Exams of Nursing

Download TMC test bank wrong questions 6-10/NBRC new latest version 2024-2025 and more Exams Nursing in PDF only on Docsity!

TMC test bank wrong questions 6-10/NBRC

new latest version 2024-2025 best studying

material with verified answers graded A

WITH 150+ QUESTIONS

Which of the following is TRUE regarding humidification during high flow nasal cannula therapy? A. an unheated large volume nebulizer with large-bore tubing is required B. a simple unheated wick humidifier provides adequate humidification C. both a heated humidifier and heated delivery circuit are required D. extra humidity is not needed because the upper airway is not bypassed

• ANSWER For O2 delivery, a high flow nasal cannula system typically requires the following equipment: oxygen blender, high flow flowmeter (up to 40 L/min for adults); heated humidifier (or wick-like cartridge); and O2 analyzer. To prevent condensation, the delivery tubing also must be heated, either via wires or coaxial flow of warm water. The correct answer is: both a heated humidifier and heated delivery circuit are required To get a better view of the glottis before inserting an ET tube, you could ask the attending nurse to: A. place downward pressure on the cricoid cartilage B. maximally flex the patient's neck and head C. insert a second laryngoscope in the mouth D. pass a suction catheter through the nasopharynx
• ANSWER Applying downward pressure to the cricoid cartilage (similar to the Sellick maneuver used to prevent aspiration) displaces the larynx posteriorly, which may help align the

laryngopharynx and trachea and provides better visualization of the glottic opening, at least in some patients. If cricoid pressure fails to improve or worsens the laryngoscopic view (which also can occur), it should be terminated. The correct answer is: place downward pressure on the cricoid cartilage In a neonate, all of the following are indication of HFV except: A. cleft palate before surgical correction B. PPHN C. RDS unresponsive to conventional ventilation D. mechanical ventilation patient with unresolved pneumothorax

• ANSWER An oral or nasal ET tube is inserted into a patient's airway before a cleft palate is surgically repaired; a standard neonatal vent is used if needed. There is no special reason to use HFV. Patients with all of the other clinical situations have been shown to benefit from HFV. The correct answer is: cleft palate before surgical correction Which of the following patients is a poor candidate for IPPB therapy? A. a post-op female patient with clinically diagnosed atelectasis B. a chronically hypercapnic patient with full metabolic compensation C. a patient being treated for acute cardiogenic pulmonary edema D. a patient with acute-on-chronic respiratory acidosis
• ANSWER Hypercapnic patients with full metabolic compensation are poor candidates for IPPB therapy. Rapid reduction of the PaCO2 in such patients may impose an acute "metabolic" alkalosis on top of their compensated state. The best supported indications for IPPB are for treating 1) clinically diagnosed atelectasis, 2) impending hypercapnic respiratory failure (acute-on-chronic respiratory acidosis), and 3) 462 decreased compliance in kyphoscoliosis. Note that in most clinical centers BiPAP has largely replaced IPPB for all of these indications except the treatment of atelectasis.

The correct answer is: a chronically hypercapnic patient with full metabolic compensation Therapeutic gases being delivered to patients need to be humidified because they: A. have low specific gravities B. become less combustible when humidified C. are supplied at low critical temperatures D. are supplied in the anhydrous state

• ANSWER The most common use for humidity therapy is to add water vapor to O2 being administered to patients with normal upper airways. This is necessary because purity standards require medical gases to be in the dry or anhydrous state. For this reason, supplemental humidity may also be provided for anesthetic gases, for gases in the pulmonary function laboratory, or for therapeutic gas mixtures such as oxygen-carbon dioxide or helium-oxygen mixtures. The correct answer is: are supplied in the anhydrous state Continuous positive airway pressure (CPAP) is indicated as a treatment for: A. post-operative atelectasis B. acute exacerbation of COPD C. hypercapnic respiratory failure D. acute pulmonary emboli
• ANSWER CPAP is indicated to treat hypoxemia due to shunting in patients with adequate spontaneous ventilation (e.g., ARDS, IRDS). CPAP is also used to treat patients with atelectasis (intermittent therapy), CHF/pulmonary edema (short term application) and sleep apnea (nocturnal application). CPAP is contraindicated if the patient cannot maintain adequate ventilation on their own, e.g., hypercapnic ventilatory failure, acute exacerbation of COPD. The correct answer is: post-operative atelectasis

A patient with chronic bronchitis is receiving volume controlled A/C ventilation. Wheezing is heard over all lung fields, rhonchial fremitus is felt over the central airways, and secretions are thick. The patient's peak pressure is 45 cm H2O and plateau pressure is 20 cm H2O. Which of the following would be useful to treat the patient's condition? A. triamcinolone (Azmacort) B. cromolyn sodium (Intal) C. pancuronium bromide (Pavulon) 466 D. levalbuterol (Xopenex)

• ANSWER Based on the patient's diagnosis and clinical presentation, the immediate problem is bronchospasm (wheezing) and thick secretions (rhonchial fremitus) causing an increase in airway resistance (increased PIP - plateau). A bronchodilator like levalbuterol AND possibly a mucolytic like acetylcysteine are indicated. Pancuronium is a neuromuscular blocking agent, triamcinolone a corticosteroid and cromolyn a mast cell stabilizer, none of which will aid in bronchodilation or secretion clearance. The correct answer is: levalbuterol (Xopenex A doctor requests that you increase the expiratory time on a patient receiving volume control ventilation, but not alter the minute ventilation. Which of the following settings would you adjust to fulfill the doctor's request? A. tidal volume B. rate of breathing C. trigger sensitivity D. inspiratory flow
• ANSWER On most ventilators operating in the volume control mode, expiratory time is a resultant value, i.e., not set directly but dependent on other settings. Since the expiratory time is essentially the time left over after inspiration, and since the

inspiratory time during volume control is determined by the volume and flow, 465 expiratory time depends on the rate (time factor), volume and flow settings. However, adjusting either the rate or volume will alter the minute ventilation. So in this case, the only way to increase the expiratory time would be to increase the inspiratory flow. Adjusting the sensitivity would only affect the expiratory time if the patient were triggering the ventilator at a rate higher than the set rate (in A/C mode) and you completely 'locked' out breath triggering (pure control mode). Besides potentially causing dyssynchrony, a switch to control mode would also would lower the minute ventilation. The correct answer is: inspiratory flow A patient is receiving oxygen via a 28% air entrainment mask set at the manufacturer's specified input flow of 5 L/min. Which of the following would occur if you were to increase the O2 input flow to 7 L/min? A. the total outflow would increase B. the delivered FIO2 would increase C. the air to oxygen ratio would increase D. the delivered FIO2 would decrease

• ANSWER Increasing the O2 input flow to an air entrainment mask will increase the total outflow flow. However, because the air to O2 ratio remains essentially constant, the delivered O2% remains within 1% to 2% of that specified, regardless of input flow.. The correct answer is: the total outflow would increas While doing a ventilator check on a patient receiving volume controlled ventilation you observe 'scalloping' of the inspiratory airway pressure waveform (Paw) occurring after the beginning of each machine breath. Which of the following can explain this finding? A. improper sensitivity setting

B. presence of auto-PEEP/air-trapping 464 C. a leak in the patient-ventilator system D. inadequate inspiratory flow setting

• ANSWER A drop in pressure ('scalloping') during volume controlled ventilation indicates inadequate inspiratory flow. Normally, pressure should rise after inspiration begins. To correct this problem increase the inspiratory flow until the "scalloping" of the pressure waveform disappear. The correct answer is: inadequate inspiratory flow setti Disadvantages of noninvasive ventilation include which one of the following? A. costs more than invasive ventilation B. requires heavy patient sedation C. limits direct access to lower airway D. increases the likelihood of VAP
• ANSWER Disadvantages of noninvasive ventilation (NPPV) include the following: it can only be used in cooperative patients; it does not provide direct airway access (thus increasing the risk of secretion retention), and more therapist time is needed during the initial period of use. On the other hand NPPV may help decrease the incidence of VAP and typically costs less than invasive ventilation. The correct answer is: limits direct access to lower airway On a patient receiving volume control AC ventilation, you observe a flow-volume with a sawtooth pattern on exhalation. Which of the following actions would you consider most appropriate? A. recommend administering a bronchodilator B. assess the patient's need for suctioning C. measure the endotracheal tube cuff pressure D. switch to pressure control ventilation

• ANSWER The flow-volume loop reveals irregular sawtooth- like oscillations, primarily in the expiratory portion of the loop. This indicates either 1) accumulation of airway secretions in the trachea/large airways (requiring suctioning), or 2) condensate partially blocking the expiratory limb of the ventilator circuit proximal to the expiratory flow sensor. Auscultation of rhonchi or tactile fremitus over the trachea would confirm excess secretions as the problem. The correct answer is: assess the patient's need for suctioning A 30 year-old male was found supine and unresponsive. In the ER it was confirmed he had aspirated while on his back. After the patient is transferred to ICU his physician orders postural drainage and percussion every 4 hours. What is the best position to place him in to drain the affected area? A. prone with a pillow under his hips B. prone with feet elevated 30 degrees C. supine with a pillow under his hips D. supine with feet elevated 30 degrees - ANSWER This patient aspirated while lying flat on his back. Most commonly, this affects the superior segments of both lower lobes. The position which facilitates drainage from this lung region is a prone position with a pillow under the patient's hips. The correct answer is: prone with a pillow under his hips You need to perform nasotracheal suctioning on a patient with retained secretions. As compared to suctioning via a tracheal airway, which of the following complications are unique to this procedure? A. hypotension B. gagging/aspiration C. hypoxemia D. increased ICP - ANSWER Complication/hazards common to both tracheobronchial and nasotracheal suctioning

include hypoxemia, cardiac dysrhythmias, bradycardia, hyper-/hypotension, bronchospasm, atelectasis, increased intracranial pressure and the potential for contamination/infection. Unique complications of nasotracheal suctioning include nasal trauma/epistaxis, pharyngeal trauma, gagging (with potential 241 vomiting/aspiration), and laryngospasm. Also misdirection of the catheter is more common with nasotracheal suctioning. Which of the following indicates a deficit in fluid balance A. Pedal edema B. Poor skin turgor C. cap refill D. JVD - ANSWER Poor skin turgor ARDS patient, what should RT use to evaluate oxygen delivery for optimal PEEP A. ABG B. mixed venous C. serum lactate D. CO - ANSWER mixed venous RT performing a high calibration on a nitric oxide, expected value is A. 45 B. 10 C. 25 D. 80 - ANSWER 45 To help prevent infection after an aerosol drug treatment provided via small volume nebulizer (SVN) you would: A. shake out any residual solution then bag the SVN

B. rinse the SVN with tap water then dry and bag it C. run the SVN at high flows until completely dry D. rinse the SVN with sterile water then dry and bag it - ANSWER To minimize the likelihood of infection in patients receiving aerosol drug therapy via a small volume nebulizer (SVN), you should 1) use a different SVN for each patient, 2) change the SVN and tubing every 24 hours, and 3) perform thorough hand hygiene prior to each therapy session. It is also recommended that the nebulizer NOT be rinsed with tap water, but rather rinsed with sterile water and blown dry between uses. If rinsing with sterile water not feasible, rinse the device with filtered or tap water, then rinse with isopropyl alcohol and dry. The correct answer is: rinse the SVN with sterile water then dry and bag it A doctor orders aerosol drug therapy via small volume nebulizer for a patient receiving mechanical ventilation via a dual-limb breathing circuit. To prevent drug residue from affecting ventilator performance you must make sure that: A. both inspiratory and expiratory HEPA filters are in place B. a HEPA filter is in place on the inspiratory limb of the circuit C. a heat and moisture exchanger is in place at the patient connector D. a HEPA filter is in place on the expiratory limb of the circuit - ANSWER HEPA filters are needed to prevent drug residue from entering the ventilator and affecting its performance. For dual-limb circuits, be sure that inspiratory and expiratory HEPA filters are in place. For single-limb circuits, you normally only need an inspiratory HEPA filter; expiratory filtration may be required on patients with disorders requiring droplet or respiratory precautions. The correct answer is: both inspiratory and expiratory HEPA filters are in place Your patient is receiving aerosolized bronchodilators to treat her asthma. What is the best way to determine whether this treatment is achieving the desired goal? A. measure the patient's MIP before-and-after treatment

B. measure the patient's inspiratory capacity before-and-after treatment C. measure the patient's FEV1% before-and-after treatment D. calculate the patient's alveolar minute volume - ANSWER The best way to determine the effectiveness of bronchodilator therapy at the bedside is to measure the patient's forced expiratory flows before and after treatment. Either the FEV1% or the peak expiratory flow rate (PEFR) can be used, although the FEV1% is a more reliable and valid measure. In general, an improvement of at least 12-15% between the pre- and post-test values is needed to indicate reversibility of the obstruction with the bronchodilator. The correct answer is: measure the patient's FEV1% before-and-after treatment A cooperative patient receiving aerosol therapy with 0.9% NaCl is unable to produce an acceptable volume of sputum for laboratory studies. The most appropriate action would be to A. administer the aerosol continuously B. change to hypertonic saline C. initiate chest physiotherapy D. perform nasotracheal suctioning - ANSWER Hypertonic saline solution can help draw fluid out of the airway mucosa. For this reason, the aerosolization of hypertonic saline solution can help mobilize secretions and can be effective with sputum induction. The correct answer is: change to hypertonic saline A patient with asthma is given an adrenergic bronchodilator agent to combat an acute airway obstruction. Instead of demonstrating improvement in airflow, the patient's symptoms worsen (e.g., increased wheezing, etc.). A possible explanation for this observation is: A. tachyphylaxis or tolerance to the agent

B. alterations in the V/Q ratio (a beta-2 effect) C. the additive effect of other drug agents D. a paradoxical response to the agent - ANSWER Although rare, some patients exhibit a paradoxical response to adrenergic bronchodilators in which the symptoms of acute airway obstruction actually are made worse by drug agent. It is believed that this adverse effect is a result of an allergy to some of the metabolic products of the adrenergic drugs. The correct answer is: a paradoxical response to the agent Which of the following patient instructions for using a dry powder inhaler (DPI) is correct? A. hold the device vertically after loading B. inhale rapidly for 1-2 seconds C. blow slowly into the device D. breath normally in/out of the device - ANSWER The following general guidelines apply to effective use of a DPI: (1) never use a spacer or VHC with a DPI; (2) lips must be tightly sealed around the mouthpiece; (3) after loading, most DPIs must be held horizontally (to avoid loss of drug); (4) patient should inhale rapidly (> 60 L/min for 1-2 sec) and deeply; and (5) patient must exhale to room (not back into the device). The correct answer is: inhale rapidly for 1-2 seconds Which of the following is the preferred delivery method for cromolyn sodium to young children? A. MDI with mask B. small volume nebulizer C. MDI with holding chamber D. dry powder inhaler - ANSWER A small volume nebulizer (SVN) is the method of choice for administering cromolyn sodium to young children. You should use a tightly fitting face mask for any child

unable to a mouthpiece. The correct answer is: small volume nebulizer You are called to the ED to provide a bronchodilator treatment for a patient having a severe asthma attack. When quickly confirming the written order you find it contains some prohibited notations and thus could be read as either '.5 U albuterol by SVN' or 5 c.c albuterol by SVN" The prescribing physician is busy overseeing a code. You should: 272 A. wait until the physician is done with the code so you can clarify the improper notation and the correct order B. administer the treatment using the standard dosage (0.5 mL) and clarify the order as soon as possible thereafter C. cross out the prohibited notations, provide the correct abbreviations and initial and date the changes D. have the nurse review the order and correct the improper notation - ANSWER This order contains at least two improper notations, i.e., c.c. (use mL), and lack of leading zeros before a decimal point (that may be 'lost' on the order line). Normally, if an order contains a prohibited notation, the respiratory therapist must confirm the intent of the order before proceeding. The exception is when order confirmation might delay essential or emergency patient treatment (as here). In these cases, if, in the judgment of the caregiver the order is clear and complete and the delay to obtain confirmation from the prescriber would place the patient at greater risk, then the order should be carried out and the confirmation obtained as soon as possible thereafter. The correct answer is: administer the treatment using the standard dosage (0.5 mL) and clarify the order as soon as possible thereafter A doctor orders 10 mg of 0.5% albuterol (Proventil) in 50 mL normal saline via continuous nebulization for a patient with asthma. How many mL of albuterol

would you place in the nebulizer? A. 0. B. 2 C. 5 D. 20 - ANSWER mL = dosage (mg) ¸ concentration (mg/mL) = 10/5 = 2 mL. Note that a 0.5% solution has a concentration of 5 mg/mL. The correct answer is: 2 Venous return is LEAST impaired by which of the following modes of mechanical ventilation? A. A/C with a mandatory rate of 10/min, 5 cm H2O PEEP B. SIMV with a mandatory rate of 6/min, no PEEP C. SIMV with a mandatory rate of 12/min, 5 cm H2O PEEP D. A/C with a mandatory rate of 15/min, no PEEP - ANSWER In this instance, the absence of PEEP and the lowest number of "machine" breaths would result in the lowest mean airway pressure, thus resulting in the least impairment to venous return. The correct answer is: SIMV with a mandatory rate of 6/min, no PEEP Which of the following parameters would you set to establish the minute volume for a patient being ventilated in the volume control assist/control mode (VC, A/C)? exp. time,rate,vt,insp. flow - ANSWER The minute volume (VE) during VC, A/C ventilation is determined by the respiratory rate or frequency (f) and tidal volume setting (VT), that is VE = f x VT The correct answer is: A A 65-year-old female patient has distended external jugular veins even though her head and body are raised 45 degrees above her legs. This would indicate that

she likely is: A. hypertensive B. fluid-overloaded 268 C. an emphysema patient D. dehydrated - ANSWER Fluid overload cause the jugular veins to be distended. Dehydration may result in the jugular veins being flat. Emphysema and hypertension should not have any effect on the jugular veins. The correct answer is: fluid-overloaded At the bedside of a patient receiving volume control ventilation, you suddenly observe the simultaneous sounding of the high pressure and low volume alarms. Which of following is the most likely cause of this problem? A. a leak in the ET tube cuff B. a mucous plug in the ET tube C. ventilator circuit disconnection D. development of pulmonary edema - ANSWER During volume-control ventilation, a high pressure/low volume condition signals an obstruction (increased impedance). Although either the mucous plug or the development of pulmonary edema increases impedance, only a plugged ET tube would cause a sudden rise in airway pressure. The correct answer is: a mucous plug in the ET tube Which of the following is true regarding synchronous intermittent mandatory ventilation (SIMV)? A. machine breaths cannot be pressure controlled B. asynchrony is prevented during machine breaths C. only partial ventilatory support can be provided

D. patient normally contributes to minute ventilation - ANSWER SIMV allows spontaneous breathing between machine breaths, so that the patient can control both the overall rate and pattern and contribute to the total minute ventilation. SIMV provides full ventilatory support at normal rates and partial support at lower rates. Machine breaths may target either volume (VC, SIMV) or pressure (PC, SIMV) and spontaneous breaths may be pressure supported. Asynchronous breathing still can occur during machine breaths, usually due to improper machine sensitivity or flow settings. The correct answer is: patient normally contributes to minute ventilation To initiate weaning, a patient was changed from volume control A/C ventilation to pressure support. After 30 minutes on pressure support, the high respiratory rate alarm sounds, with the patient breathing at a rate of 25 to 30 per minute. What change should you make to the ventilator settings? A. increase the pressure support level B. increase the high pressure alarm to 50 cm H2O C. increase the high rate alarm to 30- 35 D. switch the patient back to volume control A/C - ANSWER During weaning procedures, a modest increase in respiratory rate is common and generally should be tolerated up to a maximum of 30-35 breaths per minute. In this instance, the high respiratory rate alarm should be increased to 30-35 breaths per minute. The correct answer is: increase the high rate alarm to 30- 35 Which of the following ventilator graphics displays would be the best choice to assess the work of breathing associated with patient triggering? A. volume vs. time display B. flow vs. volume display C. flow vs. time display

D. pressure vs. volume display - ANSWER The best choice to assess the work of breathing associated with patient triggering using ventilator graphics would be a pressure vs. volume loop. The correct answer is: pressure vs. volume display When monitoring a patient during a spontaneous breathing trial (SBT), which of the following observations would cause you to stop the trial and return the patient to ventilatory support? A. decrease in O2 saturation from 91% to 82% B. increase in respiratory rate from 18 to 28/min C. increase in arterial PCO2 from 45 to 53 torr D. increase in heart rate from 98/min to 115/min - ANSWER Measures indicating failure of a SBT include inadequate gas exchange (SpO2 ≤ 85-90% or PaO2 ≤ 50-60 torr; pH ≤ 7.30; increase in PaCO2 ≥ 10 torr); unstable hemodynamics (heart rate > 120-140/min; %change > 20%; systolic BP > 180-200 mm Hg or < 90 mm Hg or %change > 20%); and an unstable ventilatory pattern (respiratory rate ≥ 30- 35/min or %change > 50%; presence of accessory muscle use or thoracoabdominal paradox). The correct answer is: decrease in O2 saturation from 91% to 82% Which of the following categories of patients are good candidates for negative pressure ventilation? A. patients with acute obstructive disorders of the upper airway B. patients suffering acute exacerbations of chronic lung disease C. patients with end-stage chronic obstructive pulmonary disease D. patients with chronic neuromuscular disorders and normal airways - ANSWER Although its use has declined in recent years, negative pressure ventilation remains a viable alternative to the positive pressure approach with certain patient categories. Specifically, patients with permanent neuromuscular impairments who retain adequate upper airway protective and clearance reflexes (thereby not needing an artificial

airway) but cannot tolerate masks/mouthpieces are ideally suited to ventilatory support via negative pressure ventilation, especially for use in the home. The correct answer is: patients with chronic neuromuscular disorders and normal airways Which of the following is the appropriate load to establish for patients receiving inspiratory muscle training? A. at least 33% of the predicted inspiratory capacity (IC) B. at least 10-15 ml/kg of predicted body weight (PBW) C. at least 30% of the maximum inspiratory pressure (MIP/NIF) D. at least - 25 cm H2O, as measured by a calibrated manometer - ANSWER For inspiratory training to be effective, the load against which the patient breathes must be sufficient to increase muscle strength. The minimal resistance load to achieve this end is an inspiratory pressure that is at least 30% of the MIP/NIF. The correct answer is: at least 30% of the maximum inspiratory pressure (MIP/NIF) Which of the following is an indication for positive-end expiratory pressure? A. to provide graded levels of ventilatory support B. to decrease physiologic deadspace C. to decrease hypoxemia due to shunting D. to increase the efficiency of ventilation - ANSWER The primary indication for PEEP is to decrease hypoxemia due to shunting in conditions like ARDS and IRDS. PEEP can also lower FIO2 needs in patients with refractory hypoxemia and help maintain or increase the FRC (e.g., in thoracic surgery). Last, extrinsic PEEP can be applied to decrease auto-PEEP in patients with airway obstruction receiving ventilatory support. The correct answer is: to decrease hypoxemia due to shunting Which of the following are acceptable changes in patient status during a

spontaneous breathing trial for weaning from mechanical ventilation? A. heart rate rises from 103 to 118/min B. SpO2 falls from 90% to 80% C. scalene muscle activity increases D. systolic BP falls from 110 to 75 mm Hg - ANSWER Measures indicating a successful SBT include acceptable gas exchange (SpO2 ≥ 85-90% or PaO2 ≥ 50-60 torr; pH ≥ 7.30; increase in PaCO2 ≤ 10 torr); stable hemodynamics (heart rate <120-140/min; %change < 20%; systolic BP < 180-200 mm Hg and > 90 mm Hg with %change < 20%); and a stable ventilatory pattern (respiratory rate ≤ 30- 35/min, %change < 50%; no accessory muscle use or thoracoabdominal paradox). The correct answer is: heart rate rises from 103 to 118/min In the management of a patient with brain trauma, therapeutic hyperventilation should be used: A. only during the initial 24 hours of management B. prophylactically to prevent an increase in ICP C. in urgent situations such as brain herniation D. to help wean the patient off ventilatory support - ANSWER For patients with traumatic brain injury, therapeutic hyperventilation should be avoided during the first 24 hours after injury (typically the period with the lowest cerebral blood flow). Hyperventilation should be considered only in emergent situations in which there are signs of brain herniation and/or when other treatment strategies have failed to lower ICP. Hyperventilation should not be used prophylactically. The correct answer is: in urgent situations such as brain herniation The most common problem encountered in applying assist-control mode ventilation is: A. hypoventilation/hypercapnia

B. need for neuromuscular paralysis C. hyperventilation/hypocapnia D. increased work of breathing - ANSWER In the assist-control (A/C) mode patients can trigger machine breaths at a higher rate than the ventilator rate setting. Although this generally increases tolerance and 252 comfort, some patients will develop tachypnea and thus be prone to hyperventilation/hypocapnia due to an excessive minute ventilation. This problem is most common in patients suffering from pain, anxiety and other causes of acute distress. Tachypnea in the A/C mode also can cause air-trapping and auto-PEEP, especially in those with obstructive disorders. The correct answer is: hyperventilation/hypocapnia A patient who is receiving mechanical ventilation requires an FIO2 of 0.70 and a PEEP of 10 cm H2O to maintain an acceptable PaO2. The patient is restless and has become disconnected from the ventilator circuit several times, during which she experiences cardiac rhythm disturbances. A respiratory therapist should conclude that the patient will benefit from a: sedative. mucolytic. neuromuscular blocker. pulmonary vasodilator. - ANSWER (c) A. Sedation is required to eliminate excessive activity so the patient's cardiopulmonary status can be properly evaluated and treated. (h) B. A mucolytic will thin secretions, which will not correct this patient's problem. (h) C. A neuromuscular blocker will paralyze the patient, but is not recommended without a sedative. (h) D. Decreasing pulmonary vascular resistance will not ease the patient's restlessness.

A male patient who is 180 cm (5 ft 11 in) tall and weighs 75 kg (165 lb) is intubated and receiving mechanical ventilation. The endotracheal tube is secured at the 23-cm mark at his incisor. The cuff pressure is 30 mm Hg. Which of the following should a respiratory therapist do? Deflate the cuff until a slight leak is heard at peak inspiration. Reintubate the patient with a larger endotracheal tube. Maintain a cuff pressure of 25 mm Hg. Advance the endotracheal tube to the 25-cm mark. - ANSWER (c) A. Establishing the minimal leak technique will determine the pressure needed to maintain the tidal volume. (h) B. There is no indication that the tube is too small or that it has been improperly placed. Therefore, reintubation should not be performed. (h) C. Cuff inflation is based on proper protection of the airway, not specific pressure. (h) D. Depth of insertion should be determined by clinical assessment and chest radiograph, not predefined goals. In the last 6 months, a patient with bronchiectasis who uses postural drainage at home has had three exacerbations requiring hospitalization. Which of the following should a respiratory therapist recommend? insufflation/exsufflation device nebulized ipratropium bromide (Atrovent) inhaled corticosteroid HFCWO - ANSWER u) A. Secretion clearance will not directly improve with an insufflation/exsufflation device. The device acts as a cough in clearing secretions, but it does not loosen the secretions. (u) B. Nebulized ipratropium bromide is indicated for reversible airways bronchoconstriction. It is not helpful in secretion clearance.

(u) C. Inhaled corticosteroids are useful for reducing airways inflammation. This therapy will provide little benefit for clearing airways secretions. (c) D. HFCWO provides an effective method to loosen and mobilize airways secretions. A respiratory therapist is assisting a physician with a tracheostomy for a patient who is receiving PC ventilation. Following percutaneous placement of a tracheostomy tube, the therapist observes increasing heart rate, decreasing exhaled tidal volume, and increasingly distant breath sounds over the right chest. The therapist should anticipate treatment for: cardiac tamponade. a pneumothorax. a lacerated blood vessel. an anteriorly displaced tub - ANSWER A. Cardiac tamponade will present with tachycardia and tachypnea, but should not cause a change in the exhaled volume or ventilation to the right lung. (c) B. A pneumothorax will result in tachycardia, decreased ventilation, and decreased breath sounds on the affected side. (u) C. Lacerating a blood vessel may result in hemorrhage; however, it should have no immediate effect on the exhaled volume or diminish breath sounds. (u) D. Anterior displacement of the tube may result in subcutaneous emphysema or airway obstruction. A patient with neuromuscular disease has been receiving ventilatory support for 4 months through a tracheostomy. The patient uses a speaking valve during the day, but receives VC, A/C ventilation at night. Which of the following should be used?

tracheostomy button foam cuff tracheostomy tube cuffed tracheostomy tube cuffless tracheostomy tube - ANSWER u) A. A tracheostomy button will not provide a patent airway for ventilatory support. (u) B. A foam cuff tracheostomy tube is not designed to have the cuff collapsed for prolonged periods of time. A leak in the system may cause a foam cuff to reinflate, blocking the patient's ability to exhale. (c) C. When using a speaking valve, the cuff can be deflated and then reinflated for mechanical ventilation. (h) D. A cuffless tracheostomy tube will not provide a closed system for periods of volume ventilation between ventilatory support. Which of the following may be caused by the administration of aerosolized pentamidine isethionate (NebuPent)? tachycardia bradycardia bronchospasm hypotension - ANSWER (u) A. No causal relationship between the use of NebuPent and tachycardia has been established. (u) B. No causal relationship between the use of NebuPent and bradycardia has been established. (c) C. Bronchospasm is the most frequently reported adverse effect associated with the use of NebuPent. (u) D. Hypotension is associated with the use of IV or IM pentamidine isethionate (Pentam). It has not been shown to be a problem when the drug is aerosolized.

A fixed-wing medical transport with an unpressurized cabin has ascended to 10,000 ft while transporting a patient with COPD. The patient is receiving nasal oxygen at 2 L/min and becomes agitated and confused. A respiratory therapist should: increase oxygen flow. initiate mask CPAP. recommend a diuretic. recommend a sedative. - ANSWER (c) A. The patient is experiencing hypoxemia associated with altitude and a lower inspired alveolar PO2. Increasing the oxygen flow will increase the inspired FIO2. (u) B. The patient does not need CPAP. An increase in the FIO2 will help alleviate the hypoxemia associated with the high altitude. (u) C. Administration of a diuretic will delay providing appropriate care. (h) D. A sedative may cause hypoventilation and exacerbate the hypoxemia. A patient with COPD is receiving PC ventilation with flow triggering and has significant air trapping displayed on ventilator graphics. The patient's spontaneous breathing efforts are not always detected by the ventilator. Which of the following changes should a respiratory therapist recommend to improve patient-ventilator synchrony? Switch to pressure triggering. Switch to a square-wave flow pattern. Increase peak inspiratory flow. Increase the set PEEP. - ANSWER u) A. Research has shown flow triggering to be more sensitive than pressure triggering in most cases. (u) B. A square-wave flow pattern cannot be used in the PC mode. The decelerating flow pattern generated during the PC mode has been found to improve synchrony when compared with a square- wave pattern.

(u) C. The peak inspiratory flow cannot be independently adjusted in the PC mode. The flow is variable in this mode. (c) D. A patient who demonstrates patient-ventilator dyssynchrony associated with air trapping will often benefit from an increase in the set (extrinsic) PEEP level. The increase in applied PEEP can help reduce the difference between end alveolar pressure and end-inspiratory pressure. A 4-year-old child is seen by a respiratory therapist for a follow-up asthma evaluation. The child denies any dyspnea. The parents report giving the child albuterol by inhaler twice daily. The therapist should: r explain the purpose of the quick-relief medication. demonstrate peak flow monitoring. recommend changing to a small-volume nebulizer. develop an exercise regimen for the child. - ANSWER (c) A. Albuterol is a quick-relief medication. It should be used as needed, not at a scheduled frequency. (u) B. Peak flow monitoring will not address the need to reeducate the parents on the indications and use of a quick-relief inhaler. (u) C. The route of administration does not need to be addressed. Rather, education on the indications and use of a quick-relief inhaler is warranted. (u) D. An exercise regimen will not address the family's educational needs. A patient receiving mechanical ventilation had a total fluid intake of 4200 mL and a total fluid output of 1200 mL over a 24-hour period. Which of the following might increase in this situation? lung compliance serum HCO3- P(A-a)O2

hematocrit - ANSWER (u) A. Fluid output indicates an excess in interstitial fluid which can potentially decrease lung compliance. (u) B. An excess in interstitial fluid will not increase the serum HCO3-. (c) C. An excess in interstitial fluid can impair oxygen diffusion into the capillaries and increase the P(A- a)O2. (u) D. Excessive fluid administration can result in a reduction of hematocrit. A patient lost an unknown quantity of blood as a result of a motor vehicle crash. To fully assess oxygen delivery, a respiratory therapist should recommend: a complete blood count. exhaled nitric oxide. crossmatch of the patient's blood type. serial blood pressure assessment - ANSWER (c) A. A complete blood count will provide a hemoglobin value that is used to calculate oxygen delivery. (u) B. Exhaled nitric oxide can detect an inflammatory process, but it does not measure oxygen delivery. (u) C. A crossmatch of the patient's blood type should be completed in the event of blood loss; however, it does not provide information about oxygen delivery. (u) D. Serial blood pressure assessment should be completed due to volume loss; however, it does not provide information about oxygen delivery. An adult patient in the ICU is receiving beta-blocker medication and requires bronchodilator therapy. Which of the following should a respiratory therapist recommend?