TMC self assessment examination A Anotherr

A respiratory therapist is assisting a physician with endotracheal intubation. Which of the following should be used initially to confirm tracheal intubation?

A. Cm marking of the endotracheal tube

B. Observable condensation in the tube

C. Pulse oximetry

D. Colorimetric capnography

D. Colorimetric Capnography

Explanation: calormetric capnography asseses the presence of co2 and provides confirmation of tracheal intubation when co2 is detected

A respiratory therapist is asked to review a newborn's history. The following information is available about the first few minutes after birth:

Appearance 1 min- acrocyanosis 5 min pink

Heart rate 70/min 110/min

Reflex cough Cough

Muscle tone weak active motion

Respiratory rate 20/min. 40/min

Which of the following APGAR scores should the therapist expect to see for this infant?

1 min / 5 min

1. 4 / 8

2. 5/ 8

3. 6 / 10

4. 7 / 10

A. 1

B. 2

C. 3

D. 4

C. 3

explanation: score for 1 minute is 6: acrocyanosis= 1, heart rate 70/min =1, cough= 2, weak activity = 1, RR 20 = 1

Score for 5 mins is 10: pink= 2 HR 110= 2, cough = 2 active motion = 2 respiratory rate of 40=2

A 58 year old female was diagnosed with bronchiectasis 3 years ago. She reports increased cough and difficulty clearing secretions for the past 4 weeks. A chest radiograph shows no significant changes. Which of the following should the respiratory therapist recommend first?

A. Transtracheal aspiration

B. Airway clearance therapy

C. Bronchodilator treatments

D. Respiratory isolation

B. Airway clearance therapy

Explanations:

A. While a sputum sample may be requesting, transtrscheal aspiration would be unnecessarily invasive as the patient is able to produce sputum samples on her own.

B. The history, clinical presentation, and chest radiograph findings suggest worsening bronchiectasis. The treatment of bronchiectasis includes techniques to loosen and mobilize Viscid secretions. Postural drainage enhances sputum clearance.

C. Bronchodilator therapy alone will not aid in secretion removal

D. There is no indication of this patient having a communicable disease. The diagnosis of bronchiectasis was established 3 years ago.

A 24 year old female is diagnosed with excercise induced asthma and albuterol prn is ordered. A respiratory therapist should next:

A. Refer the patient for allergy skin testing

B. Educate the patient on obtaining daily peak flow measurements

C. Instruct the patient to use albuterol 15 mins before exercising

D. Suggest the patient use pursed lip breathing while exercising

C. Instruct the patient to use albuterol 15 mins before exercising

Explanation: patient understanding their disease process and triggers is important part of patient education, as well as knowing when and which medication should be taken

In which of the following circumstances will tracheal secretions tend to dry in an intubated patient?

A. A water vapor pressure of 47 mm hg

B. A relative humidity of 100% at 22•C

C. Dew point of 37•C

D. An absolute humidity of 44 mg/L

B. A relative humidity of 100% at 22•C

Explanations:

A. Water vapor pressure of 47 mmHg provides 100% humidity at body temperature

B. The absolute humidity at this temperature is inadequate

C. A dew point of 37•C indicates the gas is completely saturated at that temperature

D. The absolute tracheal humidity must be greater than or equal to 30mg/L

Prior to suctioning the endotracheal tube of an adult patient who is receiving ventilation with an FiO2 of .4 a respiratory therapist should first

A. Lubricate the catheter

B. Hyperoxygenate the patient

C. Cleanse the catheter with water

D. Administer an FiO2 of .4 by t-piece

B. Hyperoxygenate the patient

Explanation:

A. Lubricating the catheter is not necessary unless nasotracheal suctioning will be performed

B. The FiO2 should be increased prior to each suctioning attempt to minimize hypoxemia

C. Sterile suction catheters do not need to be cleansed prior to use

D. Administration of the same FiO2 without positive pressure will compromise the patients oxygenation and ventilation

A 25-year-old patient with apnea is receiving PC ventilation. ABG analysis results are as follows:

pH 7.20

PCO2 65 mm Hg

PO2 70 mm Hg

HCO3- 25 mEq/L

BE -4 mEq/L

SO2 (calc) 94%

A respiratory therapist should recommend increasing the

A. set inspiratory pressure.

B. expiratory time.

C. sensitivity.

D. peak flow.

A. Set inspiratory pressure

EXPLANATIONS:

A. In PC ventilation, increasing the inspiratory pressure will result in an increased tidal volume and minute ventilation, potentially causing a decrease in the PCO2.

B. Increasing expiratory time will decrease tidal volume and minute ventilation, potentially causing an increase in PCO2 and a further decrease in pH.

C. Increasing sensitivity will not increase ventilation in this patient.

D. Peak flow cannot be set in PC ventilation.

A 68-year-old patient who is post-CABG was extubated 4 hours ago and complains of increasing shortness of breath. Breath sounds are decreased over the right lung field. The following data are available while the patient receives 4-L oxygen by nasal cannula:

HR 103/min

RR 27/min

BP 155/90 mm Hg

SpO2 90%

Which of the following studies should a respiratory therapist recommend FIRST?

A. bedside spirometry

B. chest CT with contrast

C. ventilation/perfusion scan

D. chest radiograph

D. Chest radiograph

√

EXPLANATIONS:

A. While spirometry may be performed prior to surgery to determine the presence of pulmonary abnormalities, it will not provide useful diagnostic information this soon following extubation.

B. A CT scan with contrast could identify a pulmonary embolus or fluid collection, but this would not be the most appropriate next step in evaluating this patient.

C. V̇/Q̇ scans are useful to identify pulmonary embolus in select patient populations, but this would not be the most appropriate next step in evaluating this patient.

D. Based on the timing and symptoms, the dyspnea could be due to pneumothorax, chest tube malfunction, lobar collapse, or accumulation of pleural fluid. A chest radiograph can be obtained quickly to identify the issue for rapid intervention.

Which of the following medications should a respiratory therapist use to anesthetize a patient's airway prior to a flexible bronchoscopy procedure?

A. lidocaine HCl

B. midazolam HCl (Versed)

C. ketamine (Ketalar)

D. vecuronium bromide (Norcuron)

A. Lidocaine HCL

EXPLANATIONS:

A. Lidocaine HCl is a topical anesthetic and will reduce airway reflexes during the procedure.

B. Midazolam HCl (Versed) is a sedative that is administered systemically and will relax the patient, but it will not reduce airway reflexes.

C. Ketamine (Ketalar) is not a local anesthetic, and it will increase airway secretions. This may also lead to respiratory depression and hypoventilation.

D. Vecuronium bromide (Norcuron) is a paralytic agent and does not provide topical anesthesia to the airways.

A respiratory therapist is evaluating a 75-kg (165-lb), 180-cm (5-ft 11-in) male who is receiving VC, SIMV. The following patient data are obtained:

FIO2 0.40

Mandatory rate 8

Total rate 8

VT 550 mL

PEEP 8 cm H2O

pH 7.27

PaCO2 55 mm Hg

PaO2 94 mm Hg

HCO3- 25 mEq/L

BE -3 mEq/L

SaO2 (calc)

97%

Which of the following should the therapist recommend?

A. Maintain current settings.

B. Increase the mandatory rate to 12.

C. Decrease the FIO2 to 0.30.

D. Decrease the tidal volume to 450 mL.

b. increase the mandatory rate to 12.

EXPLANATIONS:

(u) A. The patient is being hypoventilated and his acid/base balance indicates a respiratory acidosis. V̇E should be increased.

(c) B. Increasing the mandatory rate will increase the V̇E. This should correct the respiratory acidosis.

(u) C. The PaO2 is acceptable with the FIO2 at 0.40. Decreasing the FIO2 may cause a significant decrease in the PaO2 and will not correct the respiratory acidosis.

(h) D. Decreasing the VT will worsen the respiratory acidosis.

A 63-year-old patient with COPD is seen in the pulmonary clinic for a routine appointment. The analysis results of an ABG sample drawn while the patient is breathing air are:

pH 7.40

PCO2 57 mm Hg

PO2 42 mm Hg

HCO3- 35 mEq/L

BE +8 mEq/L

SO2 (calc) 77%

Which of the following is the most appropriate NEXT step?

A. Schedule polysomnography.

B. Initiate supplemental oxygen.

C. Perform a 6-minute walk test.

D. Coach on deep breathing.

B. Initiate supplemental O2

(Look at PO2 and SO2)

EXPLANATIONS:

A. Polysomnography will provide information about the patient's sleep or presence of sleep apnea. It will not address the patient's hypoxemia.

B. Administering oxygen and observing the patient is the appropriate therapy for a hypoxemic patient with COPD, as indicated by the ABG analysis.

C. A 6-minute walk test may worsen the patient's hypoxemia.

D. Although deep breathing can improve oxygenation, the degree of hypoxemia in this patient warrants supplemental oxygen.

A pulse oximeter can provide an accurate indication of a patient's oxyhemoglobin saturation in which of the following clinical conditions?

1. congestive heart failure

2. polycythemia

3. pulmonary hypertension

4. carbon monoxide poisoning

A. 1, 2, and 3 only

B. 2, 3, and 4 only

C. 1, 2, and 4 only

D. 1, 3, and 4 only

A. 1, 2, and 3 only

EXPLANATIONS:

A. Carbon monoxide poisoning will result in carboxyhemoglobin. Standard pulse oximetry is unable to distinguish oxyhemoglobin from carboxyhemoglobin, which will lead to a falsely elevated SpO2 reading. B. Pulse oximetry can provide an accurate assessment of oxygen saturation in patients with congestive heart failure.

C. Pulmonary hypertension is an elevation of the pulmonary artery pressure. Accurate assessment of a patient's SpO2 by pulse oximeter is not affected.

D. Polycythemia is an elevation of hemoglobin and red blood cell count. Accurate assessment of a patient's SpO2 by pulse oximeter will not be affected.

A patient receiving mechanical ventilation by a portable ventilator is being transported from the ED to radiology. Which of the following is required during transport?

A. bag-valve mask resuscitator

B. point-of-care blood gas analyzer

C. demand valve respirator

D. crash cart

A. bag-valve mask resuscitator

EXPLANATIONS:

(c) A. A bag-valve mask resuscitator is required in case of transport ventilator failure. B. If there is a concern about ventilation and oxygenation during transport, a pulse oximeter and end-tidal CO2 monitor will be more appropriate. C. Demand valve respirators require an additional high-pressure gas source and will not be helpful if gas runs out. D. A crash cart is not needed during transport, but should be available in radiology if the patient experiences distress.

Mechanical ventilation was initiated for a patient, after which the PaCO2 decreased from 53 to 40 mm Hg. A respiratory therapist should expect which of the following will increase?

A. HCO3-

B. pH

C. PETCO2

D. VD/VT

B. pH

EXPLANATIONS:

A. A decrease in carbon dioxide will not have any direct effect on bicarbonate and may indirectly cause a slight decrease.

B. Carbon dioxide and pH move in opposite directions, so a decrease in carbon dioxide will result in an increase in pH.

C. A decrease in arterial carbon dioxide will result in a decrease in end-tidal carbon dioxide.

D. Decreasing the arterial carbon dioxide tension has no effect on dead space ventilation.

According to CLIA standards, quality control must be performed for blood gas analyzers every

A. 8 hours.

B. 48 hours.

C. 72 hours.

D. 24 hours.

A. 8 hours

EXPLANATIONS:

A. Eight hours is the CLIA-approved time frame for quality control of blood gas analyzers.

B. See explanation A.

C. See explanation A.

D. See explanation A.

While performing a patient-ventilator assessment, a respiratory therapist observes very little condensation in the heated wire circuit. The reservoir of the heated wick humidifier is full of water. The most likely explanation is that the

A. minute ventilation is greater than 15 L/min.

B. patient circuit is operating normally.

C. flow is set at too low of a value.

D. room temperature is lower than normal.

B. Patient circuit is operating normally

EXPLANATIONS:

A. The minute ventilation will not impact condensation in the circuit.

B. The heated wire circuit is designed to maintain gas temperature to prevent condensation.

C. Condensation is not significantly affected by low flow.

D. A lower than normal room temperature may result in an increase in tubing condensation.

Which of the following devices must be used to comply with airborne precautions?

A. N95 face mask

B. vinyl gloves

C. barrier gown

D. full face shield

A. N95 face mask

EXPLANATIONS:

A. An N95 face mask will provide protection against airborne microorganisms.

B. Protection against the inspiration of fine particles is not achieved by vinyl gloves, a barrier gown, or a full face shield.

C. Protection against the inspiration of fine particles is not achieved by vinyl gloves, a barrier gown, or a full face shield.

D. Protection against the inspiration of fine particles is not achieved by vinyl gloves, a barrier gown, or a full face shield.

Which of the following imaging techniques is preferred when identifying metastatic disease associated with non-small cell lung cancer?

A. PET scan

B. chest radiograph

C. ultrasound

D. ventilation scan

A. PET scan

EXPLANATIONS:

(c) A. The metabolically active tissue of a malignant mass will be shown in a PET scan.

(u) B. Malignant and benign tumors cannot be differentiated with a chest radiograph.

(u) C. Ultrasound is not typically used to assess tumor activity.

(u) D. A ventilation scan is not helpful in determining tumor malignancy.

A patient has been receiving mechanical ventilation through a tracheostomy tube for 16 days. The patient begins to thrash about in the bed following withdrawal of a drug-induced coma. The patient's tracheostomy tube has become dislodged. After the patient is pharmacologically sedated, a respiratory therapist should NEXT

A. obtain an ABG sample.

B. perform nasal intubation.

C. reinsert the tracheostomy tube.

D. initiate oxygen therapy.

C. Reinsert the tracheostomy tube

EXPLANATIONS:

A. Reinsertion of the tracheostomy tube should be the first response of the therapist.

B. Nasal intubation is not indicated for a patient with a well-established tracheostomy tract.

C. After 16 days, the tracheostomy tract should be well established, and the tube should be easily reinserted.

D. This will not address the need to provide airway patency for the patient.

Following a bariatric surgery procedure 2 days ago, a patient with a PBW of 55 kg (121 lb) remains hospitalized with signs of sepsis. The patient is intubated and receiving VC, A/C ventilation with the following settings:

FIO2 0.50

Mandatory rate 18/min

VT 350 mL

PEEP 12 cm H2O

After returning from radiology, the patient's peak inspiratory pressure is 45 cm H2O and plateau pressure is 35 cm H2O. ABG analysis reveals:

pH 7.39

PCO2 38 mm Hg

PO2 49 mm Hg

HCO3- 23 mEq/L

BE -2 mEq/L

SO2 (calc) 84%

A respiratory therapist should recommend

A. increasing the mandatory rate.

B. decreasing the tidal volume.

C. inline bronchodilator therapy.

D. a lung recruitment maneuver.

d. a lung recruitment maneuver

EXPLANATIONS:

(u) A. The PaCO2 was normal on the prior settings. There is no need to increase the mandatory rate.

(u) B. Decreasing the tidal volume is important to try to reduce plateau pressure, but will not correct refractory hypoxemia.

(u) C. Inline bronchodilator therapy is necessary because of the high transpulmonary pressure, but will not correct refractory hypoxemia.

(c) D. The presentation suggests acute atelectasis. A lung recruitment maneuver can be used to reopen atelectatic lung units.

An 18-year-old male with cystic fibrosis is admitted for pneumonia and increasingly thick pulmonary secretions. The patient's home regimen consists of albuterol and HFCWO. A physician has ordered albuterol, HFCWO, and aztreonam (Cayston). A respiratory therapist should anticipate the addition of which of the following inhaled medications?

A. dornase alfa (Pulmozyme)

B. tobramycin (TOBI)

C. pentamidine isethionate (NebuPent)

D. iloprost (Ventavis)

A. Dornase Alfa (Pulmozyme)

EXPLANATIONS:

A. Dornase alfa (Pulmozyme), a mucolytic, is indicated for patients with cystic fibrosis that have increasing thick secretions.

B. Tobramycin (TOBI) is not indicated because the patient is already receiving an inhaled antibiotic, and it will not thin or break down thick secretions.

C. Pentamidine isethionate (NebuPent) is for pneumocystis pneumonia in immunocompromised patients.

D. Iloprost (Ventavis) is for pulmonary arterial hypertension.

Twenty-four hours following thoracic surgery, a 61-year-old male who is 180 cm (5 ft 11 in) tall and weighs 88 kg (194 lb) is receiving VC, A/C ventilation with the following settings:

FIO2 0.40

Mandatory rate 12

VT 600 mL

PEEP 5 cm H2O

The patient is alert and oriented. A respiratory therapist notes the following data:

SpO2 98%

MIP -32 cm H2O

Exhaled VT 420 mL

The best weaning method for this patient is

A. a spontaneous breathing trial.

B. SIMV mode, mandatory rate 14, and set tidal volume 600 mL.

C. PS ventilation at 20 cm H2O.

D. PC ventilation at 25 cm H2O and mandatory rate of 12.

a. a spontaneous breathing trial

EXPLANATIONS:

(c) A. The patient is alert and has very good inspiratory muscle effort. A spontaneous breathing trial will provide the best method for rapid weaning.

(h) B. Increasing the mandatory rate is unnecessary and will prolong the course of mechanical ventilation.

(u) C. The patient is alert, oriented, and has adequate inspiratory muscle effort and tidal volume. High levels of pressure support may not be needed to support the patient's spontaneous breathing.

(u) D. Data indicates weaning from mechanical ventilation is appropriate. Changing to PC ventilation at this time will not facilitate weaning.

A respiratory therapist intends to change the I:E during VC ventilation. Flow is constant during inspiration. Which of the following can be adjusted to accomplish this change?

volume mandatory rate sensitivity inspiratory flow

1. yes yes yes no

2. yes yes no yes

3. yes no yes yes

4. no yes yes yes

A. 1

B. 2

C. 3

D. 4

b. 2

EXPLANATIONS:

(u) A. Sensitivity does not alter I:E, only patient triggering. Changing the inspiratory flow will change the inspiration time on a VC, flow-limited ventilator.

(c) B. Changing the volume or inspiratory flow will change the inspiratory time on a VC, flow-limited ventilator. Changing the mandatory rate will change the total cycle time and thus impact the I:E.

(u) C. Sensitivity does not alter I:E, only patient triggering. Changing the mandatory rate will change the total cycle time and thus impact the I:E.

(u) D. Sensitivity does not alter I:E, only patient triggering. Changing volume in VC ventilation will alter the I:E by changing the inspiratory time.

An adult patient who is spontaneously breathing and receiving an FIO2 of 0.40 by air-entrainment mask has the following ABG analysis results:

pH 7.46

PCO2 33 mm Hg

PO2 48 mm Hg

HCO3- 23 mEq/L

BE 0 mEq/L

SO2 (calc) 83%

A respiratory therapist should FIRST

A. sedate the patient.

B. intubate the patient.

C. administer 2.5 mg albuterol.

D. switch to nonrebreathing mask.

D. Switch to a nonbreathing mask

EXPLANATIONS:

A. Sedating the patient will depress respirations and worsen the degree of hypoxemia.

B. The patient is able to maintain adequate ventilation; therefore, intubation is not indicated at this time.

C. There is no indication for the administration of albuterol.

D. A nonrebreathing mask will provide a higher FIO2 than the air-entrainment mask.

Following placement of a subclavian venous catheter, the high pressure alarm on a patient's ventilator begins sounding. After 10 minutes, the patient's peak inspiratory pressure has increased from 40 to 60 cm H2O and mean arterial pressure decreased from 80 to 40 mm Hg. A respiratory therapist should FIRST

A. increase the peak flow.

B. suggest administering a vasopressor.

C. suction the endotracheal tube.

D. recommend needle decompression.

D. Recommend needle decompression

EXPLANATIONS:

A. Increasing the peak flow is not indicated when peak pressures are increasing.

B. Administering a vasopressor will not correct increased airway pressures.

C. Accumulated airway secretions can increase inspiratory pressures, but should not cause a decrease in mean arterial pressure. Therefore, suctioning is not indicated.

D. Tension pneumothorax is a possible complication of venous catheter insertion and can result in increased airway pressure. This would sound the high-pressure alarm and decrease arterial pressure. Needle decompression is indicated.

While counseling a patient during a smoking cessation session, the patient expresses concern about weight gain. A respiratory therapist should address the patient's concern by explaining that this is partially the result of

A. decreased metabolism.

B. increased loss of self-control.

C. reliance on nicotine replacement therapy.

D. lack of available aversive conditioning.

A. Decreased metabolism

EXPLANATIONS:

A. Metabolism decreases when nicotine is withdrawn. If dietary intake remains unaltered and exercise is not included, there may be a resulting weight gain.

B. This message would be considered negative feedback. It will be more important to encourage someone who is trying to eliminate an addiction.

C. Nicotine replacement therapy will often reduce the withdrawal symptoms, but should not be considered a reliable way to prevent weight gain.

D. It is not conclusive that any of these methods actually work. Usually incorporated into a smoking cessation program is positive reinforcement or a reward system.

While assessing an adult male receiving invasive mechanical ventilation, a respiratory therapist notes breath sounds suddenly are markedly decreased, the cuff pressure is 5 cm H2O, and airflow is coming from the patient's mouth during each positive pressure breath. The tube depth remains at 22 cm at the lip. Air is added to the cuff, but the cuff pressure is not maintained. Which of the following should the therapist recommend?

A. Perform an ABG analysis.

B. Increase the tidal volume setting on the ventilator.

C. Reintubate using an endotracheal tube exchanger.

D. Advance the endotracheal tube 4 cm.

c. Reintubate using an endotracheal tube exchanger.

EXPLANATIONS:

(u) A. An ABG analysis will not address the air leak and likely cuff rupture.

(a) B. While increasing the tidal volume could temporarily compensate for a small leak, it will not address the underlying issue of a likely cuff rupture.

(c) C. The sudden loss of cuff pressure and air noted coming from the mouth indicates a ruptured cuff and must be addressed immediately. An endotracheal tube exchanger is a safe means to reintubate successfully.

(h) D. As the tube does not appear to have moved, a cuff rupture is most likely. Advancing the tube may result in a mainstem intubation that may worsen ventilation.

A patient with severe COPD continues to complain of dyspnea on a home regimen that includes tiotropium bromide (Spiriva) and albuterol. A respiratory therapist should recommend adding

A. fluticasone/salmeterol (Advair).

B. montelukast (Singulair).

C. n-acetylcysteine.

D. guaifenesin (Robitussin).

A. Fluticasone/Salmeterol (Advair)

EXPLANATIONS:

A. Fluticasone/salmeterol (Advair) is a long-acting bronchodilator and inhaled steroid that is the generally accepted care for COPD.

B. Montelukast (Singulair) is a leukotriene-modifying agent. There is no documented clinical basis for its use in the management of severe COPD.

C. N-acetylcysteine is a mucolytic agent and may promote additional bronchospasm in the patient.

D. Guaifenesin (Robitussin) is an over-the-counter expectorant. Its use will not decrease symptoms of dyspnea.

For which of the following are PEF measurements indicated?

A. Establish readiness for weaning.

B. Evaluate lung compliance.

C. Determine ventilatory reserve.

D. Monitor airways obstruction.

D. Monitor airway obstruction

EXPLANATIONS:

A. MIP and RSBI are useful to establish readiness for weaning.

B. Lung compliance is measured by tidal volume, peak pressure, plateau pressure, and PEEP.

C. FVC and MVV can be used to establish ventilatory reserve.

D. PEF measurements are routinely used to monitor airways obstruction in patients with asthma.

A respiratory therapist is reviewing the medical record of an infant to determine whether any respiratory care is indicated in the home. Which of the following suggests the need for home apnea monitoring?

A. albuterol aerosol every 4 hours prn

B. caffeine citrate daily

C. APGAR scores of 3 and 4

D. oxygen by cannula at 0.25 L/min

B. Caffeine Citrate daily (stimulate)

EXPLANATIONS:

A. The need for albuterol prn does not indicate the infant is at risk for apnea.

B. Caffeine citrate is used to treat apneic conditions and indicates the need for home apnea monitoring.

C. APGAR scores at birth do not have any correlation to the need for home apnea monitoring.

D. The need for home oxygen therapy is not directly related to the risk for apneic episodes.

A DLCO measuring device requires evaluation after being taken out of service because of erroneous values. Which of the following is critical to evaluate?

A. linearity of pressure drops

B. verification of shutter response

C. verification of He percentage

D. linearity of analyzed gas concentrations

D. Linearity of analyzed gas concentrations

EXPLANATIONS:

A. The integrity of the gas analysis system and its ability to return expected results are critical elements in DLCO measurement.

B. Faulty shutter response is unlikely to cause erroneous values.

C. Verification of He percentage is not required.

D. The integrity of the gas analysis system and its ability to return expected results are critical elements in DLCO measurement.

An adult patient is receiving PC, SIMV and the following data are observed:

FIO2 0.80

Mandatory rate 15

Spontaneous rate 32

Set inspiratory pressure 20 cm H2O

PEEP 10 cm H2O

SpO2 92%

On inspection, the patient demonstrates suprasternal retractions during spontaneous breaths. Which of the following should a respiratory therapist do NEXT?

A. Decrease the rise time setting.

B. Switch to A/C mode.

C. Increase the FIO2 to 0.90.

D. Change set inspiratory pressure to 25 cm H2O.

B. Switch to A/C mode

EXPLANATIONS:

A. Rise time is not an active setting.

B. The suprasternal retractions are indicative of increased work of breathing and may be resolved by changing the mode to A/C. The respiratory rate may also come down.

C. The patient is adequately oxygenated with the current FIO2.

D. Increasing inspiratory pressure will not affect the tidal volume of the spontaneous breaths or breathing effort.

Which of the following is the most significant factor leading to the development of tracheomalacia?

A.cuff pressure

B. trauma during intubation

C. intracuff volume

D. tube length

a. cuff pressure

EXPLANATIONS:

(c) A. Excessive cuff pressure will obstruct mucosal blood flow to the tracheal wall. The resulting ischemia weakens the tracheal wall and tracheomalacia develops.

(u) B. Tracheal trauma can result in scar formation and stenosis, but not tracheomalacia.

(a) C. Intracuff volume is significant only if it resulted in excessive pressure being exerted against the tracheal wall.

(u) D. Endotracheal tube length has no relationship to tracheomalacia.

A respiratory therapist is using an oxygen-calibrated flowmeter to administer 70/30 heliox. To deliver a flow of 16 L/min, the therapist should set the oxygen flowmeter to

A. 8 L/min.

B. 16 L/min.

C. 14 L/min.

D. 10 L/min.

D. 10 L/min (Correction factor of 1.6 [10L/min * 1.6= 16L/min])

EXPLANATIONS:

(u) A. See explanation D.

(u) B. See explanation D.

(u) C. See explanation D.

(c) D. The correction factor for a 70/30 heliox is the oxygen flow multiplied by 1.6 (10 L/min X 1.6 = 16 L/min.)

Which of the following should a respiratory therapist recommend to aid in secretion removal for a patient with COPD who has a strong cough?

A. incentive spirometry

B. abdominal thrust

C. insufflation-exsufflation device

D. vibratory PEP

D. Vibratory PEP

EXPLANATIONS:

A. This would be an unnecessary use of an appliance since the patient has an adequate cough.

B. Abdominal thrust would be potentially harmful and risk emesis. The patient has an adequate cough and the ability to mobilize secretions without additional support.

C. An insufflation-exsufflation device is not needed for a patient with an adequate cough.

D. Vibratory PEP aids in secretion removal.

A 22-year-old patient with a history of intermittent wheezing has the following pulmonary function test results:

Prebronchodilator Postbronchodilator

FEV1 (% of predicted) 84 88

FVC (% of predicted) 85 86

FEV1/FVC (%) 84 86

Peak flow (% of predicted) 98

96

Which of the following should a respiratory therapist recommend?

A. lung volume measurements

B. inhalation challenge

C. DLCO testing

D. polysomnography

B. inhalation challenge

EXPLANATIONS:

A. An inhalation challenge is indicated when there is a negligible improvement in postbronchodilator lung function in a patient with a history of wheezing. Lung volume measurements will add no diagnostic value.

B. An inhalation challenge uses bronchoprovocative stimulus (e.g., methacholine), to test the hyperactiveness of the airway. Patients with asthma demonstrate an excessive response to various doses of this substance.

C. DLCO is the measurement of the ability of the lungs to transfer gases across the alveolar-capillary membrane. There is no indication that the patient has a diffusion impairment.

D. Polysomnography is a test to diagnose sleep apnea. There is no indication that this study is needed.

A 65-year-old patient with congestive heart failure is receiving 10 cm H2O CPAP and an FIO2 of 0.60. ABG analysis results are:

pH 7.41

PCO2 40 mm Hg

PO2 150 mm Hg

HCO3- 25 mEq/L

BE 0 mEq/L

SO2 (calc) 99%

Which of the following should a respiratory therapist conclude?

A. The patient is acidotic.

B. Hyperoxemia is present.

C. The patient is tachypneic.

D. Hypocapnia is present.

B. Hyperoxemia is present

EXPLANATIONS:

A. The patient's pH falls within the normal range of 7.35 - 7.45; therefore, the patient is not acidotic.

B. A PaO2 of 150 mm Hg is above the normal range of 75 - 100 mm Hg; therefore, hyperoxemia is present.

C. There is no respiratory rate given for the patient; therefore, it cannot be determined if the patient is tachypneic.

D. The patient's PaCO2 of 40 mm Hg is a normal value; therefore, the patient is not hypocapnic.

A respiratory therapist is evaluating a patient who has OSA. CPAP pressure is delivered at 7 cm H2O through a nasal mask. The patient complains of dryness of the mouth the next morning despite maximal humidification settings. Which of the following should the therapist recommend?

A. Initiate bi-level ventilation.

B. Change to a full face mask.

C. Increase the ramp time.

D. Switch to nasal pillows.

B. Change to a full face mask

EXPLANATIONS:

A. The patient's complaint of dry mouth indicates breathing through the mouth instead of the nose. In this situation, the humidification is ineffective. Bi-level ventilation will not improve this.

B. Changing to a full face mask will direct humidified gas from the machine through the nose and mouth.

C. Ramp time may increase comfort when using the device; however, it will not address the patient's mouth dryness.

D. As with the current nasal mask, nasal pillows will direct gas and humidification to the nose. This will not address the patient's mouth dryness.

A respiratory therapist is called to the ED for a 1 year old who is having difficulty breathing. Severe suprasternal, subcostal, and substernal retractions are observed. The child has a harsh, barking cough. Stridor is present. The therapist should anticipate treatment for

A. cystic fibrosis.

B. pneumonia.

C. croup.

D. asthma.

C. Croup

EXPLANATIONS:

A. There is no evidence to suggest that the patient has cystic fibrosis. This would be characterized by recurrent lung infections at this age.

B. Pneumonia does not typically present with a harsh, barking cough and stridor.

C. The patient has some degree of upper airway obstruction cause by some type of viral illness. The barky cough is a classic finding for patients experiencing croup.

D. Asthma is a lower airway disease; there is no indication of wheezing or other signs of asthma.

Fluticasone/salmeterol (Advair Diskus) has been added to the treatment plan of a 68-year-old male who has COPD. A respiratory therapist teaches him how to use the device and asks him to demonstrate his technique. The patient pushes the lever, places the device in his mouth, exhales fully, inhales rapidly, holds his breath for 10 seconds, and rinses his mouth. Which of the following corrective instructions should the therapist provide?

A. Eliminate the breath hold.

B. Rinse your mouth before using the medication.

C. The inhalation should occur slowly.

D. Exhale before placing the device in your mouth.

D. Exhale before placing the device in your mouth

EXPLANATIONS:

A. A 10-second breath hold after inhalation is the correct technique.

B. Patients should rinse their mouths after using an inhaled steroid to prevent oral candidiasis.

C. A slow deep breath will fail to pull the dry powder into the airstream and will minimize deposition.

D. Exhaling into the device will disperse the powder throughout the device and the moisture in the exhaled air can make the medication occlude the device.

An adult patient is receiving mechanical ventilation. Which of the following should be recommended to improve oxygenation and recruit collapsed alveoli?

A. PEEP

B. SIMV mode

C. mechanical dead space

D. in-line suction system

A. PEEP!

EXPLANATIONS:

A. Application of PEEP minimizes the potential for end-expiratory alveolar collapse and then maintains the alveoli in an open position because it exceeds the force of surface tension.

B. Using SIMV mode alone will not prevent alveoli from collapsing.

C. The use of mechanical dead space may impact the patient's PaCO2; however, it has no impact on oxygenation and the recruitment of collapsed alveoli.

D. An in-line suction system can prevent worsening collapse; however, its primary purpose is to remove accumulated secretions.

a patient who is conscious with an intact gag reflex requires an artificial airway to prevent obstruction of the upper airway by the tongue. Which of the following types of airways is most appropriate in this situation?

A. nasopharyngeal

B. oropharyngeal

C. oral endotracheal tube

D. tracheostomy tube

A. Nasopharyngeal

EXPLANATIONS:

(c) A. A nasopharyngeal airway is the least invasive device to use to prevent upper airway obstruction in a conscious patient.

(h) B. An oropharyngeal airway rests on the base of the tongue and usually stimulates a gag reflex in a conscious patient, which can result in vomiting and possible aspiration.

(h) C. Oral endotracheal intubation is more invasive than a nasopharyngeal airway and is indicated when mechanical ventilation is required.

(h) D. A tracheostomy tube requires surgery with risks of complications greatly exceeding other procedures that are less traumatizing.

After performing tracheostomy care for a patient with a TBI, a respiratory therapist observes that the low exhaled tidal volume alarm is sounding on the ventilator and audible noises are heard coming from the patient's mouth. The therapist should conclude that

A. the patient is experiencing bronchospasms.

B. air has been lost from the patient's cuff.

C. the patient is agitated from the tracheostomy care.

D. the tracheostomy tube tip is lodged against the tracheal wall.

B. air has been lost from the patient's cuff.

EXPLANATIONS:

(u) A. A bronchospasm would cause a high pressure alarm on the ventilator.

(c) B. A low volume alarm with the audible noise from the mouth indicates a leak.

(u) C. If the patient is agitated, then this could cause the low tidal volume alarm, but does not explain the leak.

(u) D. A tracheostomy tube lodged against the tracheal wall would cause a high pressure alarm.

A respiratory therapist is caring for a 185-cm (6-ft 1-in), 85-kg (187-lb) male patient with ARDS who is receiving VC, A/C ventilation. The following data are observed:

FIO2 0.80

Mandatory rate 12

VT 600 mL

Inspiratory time 1.0 sec

PEEP 14 cm H2O

PIP 40 cm H2O

Pplat 34 cm H2O

An ABG analysis shows:

pH 7.37

PCO2 43 mm Hg

PO2 62 mm Hg

HCO3- 25 mEq/L

BE -1 mEq/L

SO2 (calc) 92%

According to ARDSnet, the therapist should

A. increase the FIO2.

B. decrease PEEP.

C. increase the inspiratory time.

D. decrease the tidal volume.

D. Decrease the tidal volume.

EXPLANATIONS:

(u) A. The PaO2 is within the target range of 55-80 mm Hg. There is no need to increase the FIO2.

(h) B. Decreasing the PEEP may worsen oxygenation.

(u) C. Increasing the inspiratory time will likely decrease PIP without significant change in plateau pressure.

(c) D. Given a plateau pressure of greater than 30 cm H2O, the next step in the ARDSnet protocol is to decrease the tidal volume in 1 mL/kg PBW increments (to a minimum of 4 mL/kg of PBW) until plateau pressure is less than 30 cm H2O.

Which of the following is a side effect of inhaled nitric oxide?

A. decreased cardiac output

B. methemoglobinemia

C. systemic hypotension

D. increased WBC count

B. Methemoglobinemia

EXPLANATIONS:

A. Inhaled nitric oxide will likely increase left ventricular filling pressure, resulting in increased cardiac output.

B. As inhaled nitric oxide breaks down, methemoglobin is formed. This may lead to methemoglobinemia.

C. Inhaled nitric oxide is unlikely to cause systemic hypotension.

D. Inhaled nitric oxide does not affect white blood cell count.

Which of the following best reflects the adequacy of ventilation?

A. PaO2

B. PaCO2

C. vital capacity

D. FEF25-75%

B. PaCO2

EXPLANATIONS:

(u) A. PaO2 may be influenced by ventilation, but is primarily a reflection of oxygenation.

(c) B. The arterial level of CO2 reflects the alveolar CO2 and is the best indication of the adequacy of ventilation.

(u) C. Vital capacity is a volume measurement of the air within the lung. It is a static volume and cannot reflect the status of ventilation.

(u) D. FEF25-75% is a measure of the flow during the midportion of a forced exhalation. It is measured during a single breath; therefore, it cannot reflect the adequacy of ventilation.

Which of the following types of nebulizer can be used to deliver aerosolized medications to a ventilator circuit without altering delivered tidal volume?

A. vibrating mesh

B. air entrainment

C. small-volume jet

D. breath actuated

A. Vibrating Mesh

EXPLANATIONS:

A. Vibrating mesh nebulizers place only the aerosolized medications into the circuit.

B. Air-entrainment nebulizers add flow in the circuit and will change the tidal volume.

C. Small-volume jet nebulizers add flow in the circuit and will change the tidal volume.

D. A breath-actuated nebulizer will not work in a ventilator circuit.

Which of the following values for arterial carbon dioxide tension is consistent with alveolar hyperventilation?

A. 30 mm Hg

B. 40 mm Hg

C. 50 mm Hg

D. 60 mm Hg

A. 30 mm Hg

EXPLANATIONS:

A. An arterial carbon dioxide tension of less than 35 mm Hg reflects alveolar hyperventilation as it results in a decreased arterial carbon dioxide tension in the blood.

B. An arterial carbon dioxide tension between 35 and 45 mm Hg reflects normal alveolar ventilation.

C. An arterial carbon dioxide tension of 50 mm Hg is elevated from the normal range of 35 to 45 mm Hg and reflects CO2 retention.

D. An arterial carbon dioxide tension of 60 mm Hg is elevated from the normal range of 35 to 45 mm Hg and reflects CO2 retention.

While reviewing a medical record, a respiratory therapist notes a patient has shortness of breath, pleuritic chest pain, low-grade fever, tachypnea, tachycardia, and a swollen, tender right leg. The patient has a 50 pack-year history of smoking and known coronary artery disease. These findings are MOST consistent with

A. pneumonia.

B. pulmonary embolism.

C. myocardial infarction.

D. acute exacerbation of COPD.

B. pulmonary embolism.

EXPLANATIONS:

(u) A. Swelling and tenderness in one or both legs is not associated with pneumonia.

(c) B. The signs and symptoms are consistent with pulmonary embolism.

(u) C. Pleuritic chest pain and swelling and tenderness in one or both legs are not associated with a myocardial infarction.

(u) D. Pleuritic chest pain and swelling and tenderness in one or both legs are not associated with an exacerbation of COPD.

A 58-year-old male presents to the ED with a chief complaint of acute chest pain. Which of the following diagnostic tests should be done FIRST?

A. electrocardiography

B. chest radiograph

C. CT scan of the chest

D. cardiac ultrasound

a. electrocardiography

explanations:

(c) A. An ECG is required to rule out an acute myocardial infarction or arrhythmia before considering other diagnoses.

(u) B. A chest radiograph may be an appropriate diagnostic test after an ECG is performed.

(u) C. CT scan of the chest may be an appropriate diagnostic test after an ECG is performed.

(u) D. Cardiac ultrasound may be an appropriate diagnostic test after an ECG is performed.

A respiratory therapist observes the following ventilator graphics for a 3-month-old infant with bronchiolitis who is receiving PC, A/C ventilation:

The infant has a normal pH and is hemodynamically stable. Which of the following should the therapist recommend?

A. Maintain current settings.

B. Decrease FIO2.

C. Change to VC ventilation.

D. Increase mandatory rate.

A. maintain current settings

EXPLANATIONS:

(c) A. Though there is evidence of auto-PEEP in the flow-time graphic, the patient's normal pH and stable hemodynamics indicate no intervention is currently needed.

(u) B. There is no indication of a need to decrease the FIO2.

(u) C. There is no indication to change to VC ventilation.

(h) D. An increase in mandatory rate will cause a decrease in expiratory time and will result in increased auto-PEEP.

Furosemide (Lasix) and oxygen therapy are initiated for a patient with pulmonary edema. Which of the following should a respiratory therapist recommend?

A. monitoring of electrolyte levels and a PA catheter

B. a CBC and pulse oximetry

C. pulse oximetry and monitoring of electrolyte levels

D. a PA catheter and a CBC

C. pulse oximetry and monitoring of electrolyte levels

EXPLANATIONS:

(u) A. A PA catheter is not necessary for the treatment or management of pulmonary edema.

(u) B. A CBC is not impacted by the treatment of pulmonary edema with furosemide or oxygen therapy.

(c) C. Pulse oximetry to monitor the SpO2 in a patient with pulmonary edema is essential to track the patient's status. As furosemide will impact fluid levels, monitoring the patient's electrolyte levels is essential to ensuring a correct sodium level.

(u) D. A PA catheter is not necessary for the treatment or management of pulmonary edema. A CBC is not impacted by the treatment of pulmonary edema with furosemide or oxygen therapy.

Which of the following questions should a respiratory therapist ask to determine whether a patient has orthopnea?

A. "Can you climb one flight of stairs?"

B. "Do you snore when sleeping?"

C. "Have you experienced any chest pain?"

D. "Are you short of breath while lying flat?"

D. "Are you short of breath while lying flat?"

EXPLANATIONS:

(u) A. Stair-climbing ability will provide information on exertional dyspnea, not orthopnea.

(u) B. Snoring is associated with obstructive sleep apnea, not orthopnea.

(u) C. Presence or absence of chest pain does not rule out the presence of orthopnea.

(c) D. Orthopnea is defined as the shortness of breath while lying flat.

Moderate stridor with retractions is noted immediately after extubation of a patient. A respiratory therapist should recommend

A. cool, bland aerosol therapy.

B. inhaled steroids.

C. nebulized racemic epinephrine.

D. a nasopharyngeal airway.

C. Nebulized Racemic Epinephrine

EXPLANATIONS:

A. With this presentation, glottic edema is the likely etiology of the stridor. Bland aerosol therapy will be ineffective to treat this.

B. Nebulized steroids are not the treatment of choice for glottic edema that occurs postextubation. A fast-acting vasoconstrictor is indicated to reduce airway swelling after extubation.

C. Given its strong alpha-adrenergic vasoconstrictive properties, racemic epinephrine is the first choice to help reduce the glottic edema that has occurred in this patient.

D. A nasopharyngeal airway will not be effective to provide a patent airway for a patient who has developed glottic edema following extubation.

A patient who is receiving mechanical ventilation requires an FIO2 of 0.70 and 10 cm H2O PEEP 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

A. sedative.

B. mucolytic.

C. neuromuscular blocker.

D. pulmonary vasodilator

A. sedative

EXPLANATIONS:

A. Sedation is required to eliminate excessive activity so the patient's cardiopulmonary status can be properly evaluated and treated.

B. A mucolytic will thin secretions, which will not correct this patient's problem.

C. A neuromuscular blocker will paralyze the patient but is not recommended without a sedative.

D. Decreasing pulmonary vascular resistance will not ease the patient's restlessness.

Three liters of air are injected into a spirometer from a certified-volume standard syringe. The measured value is 2.6 L. Which of the following should a respiratory therapist conclude?

A. The plunger was pushed too slowly.

B. The spirometer is ready for patient testing.

C. The time scale was incorrectly calibrated.

D. The calibration is outside the accepted range.

D. The calibration is outside the accepted range

EXPLANATIONS:

A. The flow of gas into the spirometer should not affect the accuracy of its volume.

B. The calibration is outside the 3% acceptable error range.

C. The volume deflection is unaffected by the time scale.

D. A leak is the likely cause for the difference of 400 mL and is one of the reasons for checking spirometers with a calibrated syringe.

A respiratory therapist is assessing a ventilator for readiness of use. To evaluate the integrity of the circuit, the therapist should check the

A. pressure during tidal volume delivery.

B. compressible volume of the circuit.

C. peak pressure change when the circuit is capped.

D. volume delivery distal to the exhalation valve.

C. Peak pressure change when the circuit is capped (Should maintain peak pressure)

EXPLANATIONS:

A. Measurement of pressure will not evaluate the volume delivered or any volume lost due to a leak in the tubing circuit.

B. Determining the compressible volume of the circuit does not assess the integrity of the circuit.

C. Maintaining peak pressure when the circuit is capped indicates a tight circuit without leaks.

D. Although this measures the volume leaving the humidifier, it does not include volume through the circuit and could potentially miss volume lost through any leak distal to the humidifier.

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?

A. insufflation/exsufflation device

B. nebulized ipratropium (Atrovent)

C. inhaled

D. HFCWO

d. hfcwo

EXPLANATIONS:

(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 (Atrovent) 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.

When calibrating a fuel cell oxygen analyzer, the analyzer should be set to

A. 40% while exposed to nitrous oxide.

B. 21% while exposed to room air.

C. 70% while exposed to oxygen.

D. 0% while exposed to carbon dioxide.

B. 21% while exposed to Room Air

EXPLANATIONS:

A. Nitrous oxide is not used to calibrate a fuel cell oxygen analyzer.

B. Room air is used for the low calibration of an oxygen analyzer and should be set at 21%.

C. The fuel cell should be set to 100%, not 70%, when exposed to oxygen.

D. A fuel cell oxygen analyzer does not use CO2 for the calibration process.

An air-entrainment mask will deliver an FIO2 higher than intended when

A. the flow is set too high.

B. nebulized water is being added through the air-entrainment ports.

C. corrugated tubing was added between the air-entrainment adapter and mask.

D. the air-entrainment ports have been blocked.

D. The air-entrainment ports have been blocked

EXPLANATIONS:

A. Increasing the flow will entrain more room air while maintaining the same FIO2.

B. Adding nebulized water will have no effect on the FIO2.

C. Additional tubing placed between the mask and air-entrainment adapter will have no effect on the FIO2.

D. Blocked air-entrainment ports prevent air from being added to the inspired gas flow and results in a higher FIO2.

Which of the following will most accurately and quickly assess a patient's response to changes in FIO2?

A. transcutaneous monitoring

B. pulse oximetry

C. capillary refill

D. absence of cyanosis

B. Pulse oximetry

EXPLANATIONS:

A. Transcutaneous monitoring responds slowly and may be inaccurate.

B. Pulse oximetry gives a rapid response to changes in oxyhemoglobin saturation and is the most accurate of the options given.

C. Capillary refill usually checks perfusion and cardiac status, not oxygenation.

D. The absence of cyanosis does not necessarily indicate adequate oxygenation.

Which of the following values is the best indicator of an individual's response to inhaled bronchodilators?

A. FVC

B. FEV1

C. FEF200-1200

D. diffusing capacity

B. FEV1

EXPLANATIONS:

(u) A. FVC is used to assess the patient's ability to cough and breathe deeply.

(c) B. FEV1 is the best indicator of reversible airway obstruction in response to inhaled bronchodilators.

(u) C. FEF200-1200 is a good indicator of large airway function, but is not useful in evaluating small airway response to bronchodilators.

(u) D. Diffusing capacity measures the ability of gases to diffuse across the alveolar-capillary membrane.

A patient receiving continuous heated aerosol therapy with air by a T-piece develops subcutaneous emphysema around the tracheostomy site, neck, and chest. After noting unequal breath sounds, a respiratory therapist should recommend obtaining

A. a chest radiograph.

B. a MIP measurement.

C. timed forced expiratory volumes.

D. an arterial blood gas analysis.

A. Chest radiograph

EXPLANATIONS:

A. Subcutaneous emphysema may indicate the presence of a pneumothorax. A chest radiograph is the most appropriate initial diagnostic test when a pneumothorax is suspected.

B. A MIP measurement may worsen a pneumothorax.

C. Timed forced expiratory volumes may worsen a pneumothorax.

D. Although an ABG analysis may be useful to later assess the extent of respiratory compromise, it is not the appropriate action to take in diagnosing a pneumothorax.

A 188-cm (6-ft 2-in), 84-kg (185-lb) male patient who has undergone a right lower lobectomy is receiving VC, A/C ventilation with the following settings:

FIO2 0.50

Mandatory rate 12

Total rate 14

VT 500 mL

The following ABG analysis results are available:

pH 7.32

PCO2 47 mm Hg

PO2 83 mm Hg

HCO3- 24 mEq/L

BE -2 mEq/L

SO2 (calc) 96%

A respiratory therapist should recommend

A. changing to SIMV.

B. initiating 10 cm H2O PEEP.

C. maintaining current therapy.

D. increasing the tidal volume.

C. Maintaining current therapy

EXPLANATIONS:

A. Changing to SIMV and retaining the same settings will likely result in a reduction in ventilation.

B. Due to the presence of a bronchial stump, 10 cm H2O PEEP is not indicated.

C. Although the patient has a mild respiratory acidosis, the values are acceptable for this patient.

D. Due to the presence of a bronchial stump, increasing the tidal volume is not indicated.

A 61-year-old male with dyspnea and nonproductive cough has the following examination results noted over the right lower lung field:

- dullness to percussion

- decreased tactile fremitus

- diminished breath sounds

Which of the following is most likely to produce these findings?

A. pulmonary embolism

B. pneumonia

C. pneumothorax

D. pleural effusion

D. Pleural Effusion

EXPLANATIONS:

A. Decreased tactile fremitus and dullness to percussion are not associated with pulmonary embolism.

B. Pneumonia is associated with increased tactile fremitus, a productive cough, and bronchial breath sounds.

C. While pneumothorax is associated with decreased tactile fremitus and diminished breath sounds, it will result in hyperresonance to percussion.

D. These findings are consistent with a pleural effusion.

A respiratory therapist is administering 2.5 mg of albuterol to a patient by small-volume nebulizer. Five minutes after the treatment is started, the patient's heart rate increases from 110 to 140/min. Which of the following should the therapist do?

A. Continue therapy as ordered.

B. Add 1 mL of saline to the nebulizer.

C. Recommend a beta-blocker.

D. Terminate the treatment.

D. Terminate the treatment

EXPLANATIONS:

(h) A. There has been an increase in the patient's heart rate of greater than 20/min, signaling a tachycardic reaction to the medication. Continuing the treatment may worsen the patient's response.

(u) B. By adding saline to the nebulizer, the albuterol will continue to be administered, only now over a longer period of time.

(u) C. The tachycardia is associated with the administration of a beta agonist. A beta-blocker is not indicated in this scenario.

(c) D. There has been an increase in the patient's heart rate of greater than 20/min, signaling a tachycardic reaction to the medication. Termination of the treatment is advisable.

A respiratory therapist is evaluating a 57-year-old male with the following vital signs:

HR 143/min

RR 25/min

BP 76/54 mm Hg

SpO2 85%

When examining the patient's chest, the therapist notes an absence of breath sounds in the left chest with a hyperresonant percussion note. Which of the following should the therapist recommend FIRST?

A. Insert a chest tube in the left chest.

B. Obtain a chest radiograph.

C. Insert a 14-gauge needle in the left chest.

D. Obtain ABG analysis result

C. Insert a 14-gauge needle in the left chest.

EXPLANATIONS:

(u) A. The patient's vital signs indicate immediate intervention is required. A chest tube may be inserted eventually, but it will take too long at this point.

(u) B. A chest radiograph will confirm the diagnosis of a tension pneumothorax, but will take too long and is not necessary based on the patient assessment.

(c) C. The patient has a tension pneumothorax. Inserting a needle in the chest is the quickest action based on the vital signs.

(u) D. An ABG analysis in not indicated and may delay treatment.

Monitoring of serum electrolytes is indicated in patients who are receiving

A. surfactant.

B. sedatives.

C. analgesics

D. diuretics.

D. Diuretics

EXPLANATIONS:

A. Surfactant will not affect serum electrolyte levels.

B. Sedatives will not affect serum electrolyte levels.

C. Analgesics will not affect serum electrolyte levels.

D. Diuretics may cause fluid shifts and excretion of certain electrolytes in the urine. Therefore, electrolytes should be monitored to detect electrolyte imbalances (particularly in sodium, potassium, and calcium) as these can be life threatening.

Following surgery, a 37-year-old female who is 168 cm (5 ft 6 in) tall and weighs 60 kg (132 lb) is sedated and receiving VC, A/C ventilation. The following data are available:

FIO2 0.50

Mandatory rate 12

Total rate 12

VT 450 mL

Inspiratory flow 50 L/min

PEEP 8 cm H2O

pH 7.50

PCO2 29 mm Hg

PO2 75 mm Hg

HCO3- 23 mEq/L

BE +1 mEq/L

SO2 (calc) 95%

A respiratory therapist should

A. Decrease the tidal volume.

B. Increase the inspiratory flow.

C. Decrease PEEP.

D. Increase the mandatory rate.

A. Decrease the Tidal Volume

(Decreasing the Tv will reduce the overall Mv, basically, a smaller breath results in blowing off a little less Co2 with every breath.)

EXPLANATIONS:

A. The patient is experiencing respiratory alkalosis. Decreasing the tidal volume will reduce the overall minute ventilation and help reduce the pH.

B. Changing the patient's peak flow rate will have no effect on respiratory alkalosis, only timing of breath delivery.

C. Decreasing PEEP will not correct the respiratory alkalosis.

D. Increasing the mandatory rate may worsen respiratory alkalosis.

A patient with a laryngeal tumor is receiving 80/20 heliox by a nonrebreathing mask connected to an oxygen flow meter set at 5 L/min. The patient is alert, but appears agitated. Vital signs are:

HR 130/min

RR 30/min

BP 140/90 mm Hg

SpO2 90%

Which of the following is a respiratory therapist's most appropriate action?

A. Recommend sedating the patient.

B. Change to 70/30 heliox.

C. Increase the gas flow to the mask.

D. Recommend nebulized racemic epinephrine.

c. Increase the gas flow to the mask

EXPLANATIONS:

A. Initiating sedation could further reduce the patient's ability to provide adequate ventilation.

B. Increasing the FIO2 may improve oxygenation, but does not address the insufficient flow to the mask.

C. The flow to the mask is insufficient and will result in dilution of both the oxygen and helium concentrations with air. Increasing the flow will ensure the patient receives the desired gas mixture.

D. Administering racemic epinephrine will have no effect on the obstruction caused by the laryngeal tumor.

A patient complains of a productive cough that started 4 months ago. Which of the following should a respiratory therapist suspect?

A. asthma

B. pneumonia

C. emphysema

D. bronchitis

D. Bronchitis

EXPLANATIONS:

A. Asthma is a condition marked by acute, recurrent attacks of a paroxysmal dyspnea with wheezing due to bronchospasm.

B. Although pneumonia is associated with sputum production, it is rarely a chronic problem.

C. Emphysema is not associated with sputum production, except when complicated by bronchitis or pneumonia.

D. Bronchitis is characterized by chronic cough and sputum production.

A patient receiving mechanical ventilation had a total fluid intake of 4100 mL and a total fluid output of 1100 mL over a 24-hour period. Which of the following might increase in this situation?

A. P(A-a)O2

B. serum HCO3-

C. lung compliance

D. hematocrit

A. P(A-a) O2

EXPLANATIONS:

A. An excess in interstitial fluid can impair oxygen diffusion into the capillaries and increase the P(A-a)O2.

B. An excess in interstitial fluid will not increase the serum HCO3-.

C. Fluid output indicates an excess in interstitial fluid that can potentially decrease lung compliance.

D. Excessive fluid administration can result in a reduction of hematocrit.

A 165-cm (5-ft 5-in), 70-kg (154-lb) female is undergoing an SBT by a T-piece with an FIO2 of 0.30. The patient is awake and alert. The following information is available:

VT 400 mL

Vital capacity 1200 mL

MIP -42 cm H2O

pH 7.39

PaCO2 42 mm Hg

PaO2 78 mm Hg

HCO3- 25 mEq/L

BE 0 mEq/L

SaO2 (calc) 96%

Which of the following is a respiratory therapist's most appropriate recommendation?

A. Maintain current therapy.

B. Initiate bronchodilator therapy.

C. Switch to PS ventilation.

D. Extubate the patient.

D. Extubation

EXPLANATIONS:

(u) A. The patient's ventilatory parameters along with the accompanying ABG analysis results indicate that continuing current therapy is unnecessary.

(u) B. There is no indication for bronchodilator therapy.

(h) C. Switching to PS ventilation is not indicated, and may be harmful. The patient is able to support her ventilator needs.

(c) D. The ventilatory parameters and the accompanying ABG analysis results indicate the patient is ready for extubation.

A respiratory therapist is preparing to perform an arterial puncture on a nonresponsive patient whose medical history includes a diagnosis of HIV. For the protection of the patient and therapist, the therapist should

A. have another medical professional in the room when performing the puncture.

B. confirm the diagnosis with the patient's family before performing the puncture.

C. use universal precautions when obtaining the sample.

D. wear gloves, a gown, and a mask when obtaining the sample.

C. Use universal precautions when obtaining the sample

EXPLANATIONS:

A. There is no need for another medical professional to be present when performing the puncture.

B. Universal precautions are appropriate for all patients, therefore confirmation of the HIV diagnosis with the family is unnecessary. Further, to do so without authorization from the patient would be a violation of HIPAA regulations.

C. Universal precautions should be used when obtaining an ABG sample.

D. There is no indication for the gown or mask to be used.

A respiratory therapist is evaluating the recent polysomnography report in the medical record of a patient with a BMI of 23 kg/m2. The report notes an AHI of 28. Which of the following should the therapist expect to see in the patient's care plan?

A. PAP therapy

B. low-flow oxygen therapy

C. oral appliance therapy

D. weight loss

A. PAP therapy

EXPLANATIONS:

A. An AHI of 28 is categorized as moderate to severe sleep apnea. PAP therapy is the treatment of choice.

B. Low-flow oxygen therapy alone will not treat apneas/hypopneas associated with airway obstruction.

C. Oral appliance therapy is not indicated for moderate to severe sleep apnea.

D. The patient's BMI of 23 kg/m2 is in the normal range. And although weight loss can be a beneficial behavioral modification for mild sleep apnea, it is not effective for moderate to severe sleep apnea as indicated by the patient's AHI of 28.

Which of the following should a respiratory therapist emphasize as a critical infection control step to a patient who will administer aerosol therapy at home?

A. disinfecting equipment every 96 hours

B. soaking nondisposible equipment in bleach

C. boiling the nebulizer cup each day

D. handwashing before and after each treatment

D. Handwashing before and after each treatment

EXPLANATIONS:

A. Disinfection of equipment in the home should occur after each use.

B. Bleach is no longer an acceptable agent for disinfecting respiratory equipment in the home.

C. Disinfection of equipment in the home should occur after each use.

D. Handwashing before and after use prevents contamination of equipment and transmission of microorganisms.

To minimize airway trauma during nasotracheal suctioning on an adult patient, a respiratory therapist should

A. apply negative pressure during insertion and removal of the catheter.

B. lubricate the catheter with water-soluble lubricant prior to insertion.

C. use the same nostril each time suctioning is indicated.

D. suction immediately following gastric tube

b. lubricate the catheter with water-soluble lubricant prior to insertion.

EXPLANATIONS:

(h) A. Intermittent negative pressure should only be applied during removal of the suction catheter.

(c) B. To reduce complications of trauma, the catheter should be lubricated with a water-soluble lubricant to aid catheter passage through the nostril.

(u) C. If resistance is felt during insertion of a catheter, the catheter should be withdrawn and inserted into the other nostril.

(h) D. One of the complications of nasotracheal suctioning is gagging and regurgitation. To avoid this risk, suctioning should be avoided for at least 30 minutes after tube feedings have been stopped.

A 73-year-old male, who had smoked for 25 years, but recently quit, complains of shortness of breath with exertion. Breath sounds are clear, but diminished bilaterally. During the evaluation for entry to a pulmonary rehabilitation program, the following results are obtained after a 6-minute walk test while the patient breathes room air:

distance walked 140 m

number of stops 2

SpO2 nadir 85%

Baseline End of test

HR 98/min 120/min

SpO2 92% 85%

A respiratory therapist should recommend

A. initiating oxygen with activity.

B. scheduling a cardiopulmonary exercise test.

C. administering bronchodilator pre-exercise.

D. ordering an inhalation challenge test.

A. initiating oxygen with activity.

EXPLANATIONS:

(c) A. The patient exhibits oxyhemoglobin desaturation with exercise and should have oxygen administered with activity.

(u) B. A cardiopulmonary exercise test will not add to the evaluation of this patient.

(u) C. Administration of a bronchodilator prior to exercise is not often performed for a patient who has COPD and is beginning rehabilitation.

(u) D. An inhalation challenge test is useful for a patient who has dyspnea that is believed to be secondary to asthma/reactive airways disease. It is not indicated in this patient.

A 56-year-old male requires continuous mechanical ventilation following cardiac arrest. His heart rate is 110/min and blood pressure is 96/50 mm Hg. A pulmonary artery catheter has been inserted. Patient data are:

Body surface area 2 m2

Cardiac output 3.6 L/min

PPA 30 mm Hg

PCWP 12 mm Hg

A respiratory therapist should recommend administering

A. a beta blocker.

B. a pulmonary vasodilator.

C. a diuretic.

D. an inotropic agent.

D. An inotropic agent (Increases cardiac contractility and blood pressure)

EXPLANATIONS:

A. A beta blocker is used to treat abnormal heart rhythm and hypertension. It is not indicated for this patient who is hypotensive.

B. A pulmonary vasodilator is not indicated for this patient.

C. A diuretic is not indicated for this patient given the normal PCWP.

D. The data suggests a low cardiac index and cardiogenic shock. An inotropic agent should be used to increase myocardial contractility, which in turn, should increase blood pressure.

These flow-volume loops show the results of FVC maneuvers by a patient before and after an albuterol treatment:

Which of the following should a respiratory therapist recommend NEXT?

A. bronchoscopy for airway obstruction

B. noninvasive positive-pressure ventilation

C. inhaled bronchodilator therapy

D. supplemental oxygen therapy

C.

inhaled bronchodilator therapy

EXPLANATIONS:

A. Given the improvement in the flow-volume loop after bronchodilator administration, there is no indication for bronchoscopy.

B. NPPV is not useful for reversible airways disease.

C. The flow-volume loop obtained after bronchodilator administration demonstrates a significant improvement in expiratory flow.

D. This flow-volume loop indicates reversible airway obstruction, and there is no information regarding the presence of hypoxemia to justify the use of supplemental oxygen therapy.

Which of the following indicates auto-PEEP in a patient receiving mechanical ventilation?

A. Expired volumes are lower than the inspired volume.

B. The pressure-volume loop shows a duck-billed appearance.

C. The pressure-time graph is concave and the flow-curve is constant.

D. Expiratory flow does not return to zero before the next mandatory breath.

D. Expiratory flow does not return to zero before the next mandatory breath

EXPLANATIONS:

(u) A. Expired volumes are often lower than inspired volumes due to benign things such as circuit compliance and oxygen consumption, or could be a sign of a leak in the system. This would not typically be used to diagnose auto-PEEP.

(u) B. A duck-billed appearance of the pressure-volume loop is indicative of overdistention.

(u) C. A concave pressure-time graph with a constant inspiratory flow suggests flow starvation.

(c) D. Auto-PEEP is caused by gas trapping. Expiratory flow will not return to baseline because expiration has not completed before the next breath is delivered.

A 20-year-old patient with an acute asthma exacerbation is receiving 2.5 mg of albuterol by hand-held nebulizer. During the treatment, the patient complains of palpitations and has a heart rate of 140/min. Which of the following should the respiratory therapist recommend for the next treatment?

A. Change to a fluticasone/salmeterol (Advair HFA).

B. Change to 0.63 mg of levalbuterol (Xopenex).

C. Change to 3 puffs of beclomethasone dipropionate (QVAR).

D. Administer the treatment with saline.

B. Change to .63 mg of levalbuterol (Xopenex) (Decreases tachycardia and palpations)

EXPLANATIONS:

A. Changing to an inhaled steroid and long-acting beta agonist is not appropriate for a patient with an acute exacerbation.

B. Changing to levalbuterol (Xopenex) may decrease the incidence of tachycardia and palpations.

C. Beclomethasone dipropionate (QVAR) is not a bronchodilator and will not provide acute relief to the patient.

D. Administering saline will not provide treatment for this patient's condition.

Which of the following is suggestive of a malfunctioning arterial catheter?

A. patient complaints of pain at the site

B. an increase in the systolic pressure reading

C. the presence of a hematoma

D. difficulty aspirating blood

D. difficulty aspirating blood

EXPLANATIONS:

(u) A. The throbbing sensation may be due to nerve irritation and not related to catheter function.

(u) B. The systolic pressure reading would not increase; rather, the pressure tracing would be damped.

(u) C. A hematoma is a possible complication of arterial cannulation, but not a sign of catheter malfunction.

(c) D. Difficulty withdrawing blood through an arterial catheter is a sign of malfunction.

A respiratory therapist notes a patient's soft palate cannot be viewed. What is the patient's Mallampati score?

A. IV

B. III

C. I

D. II

A. IV (4)

EXPLANATIONS:

A. Mallampati score IV is characterized by the visualization of only the hard palate. None of the soft palate is visible.

B. Mallampati score III is characterized by the visualization of the soft palate including the base of the uvula only.

C. Mallampati score I is characterized by complete visualization of the soft palate, uvula (including the tip), fauces, and tonsillar pillars.

D. Mallampati score II is characterized by complete visualization of the soft palate, fauces, and most of the uvula (but notably with the tip obscured).

What is the approximate total flow that will be delivered from a 40% air-entrainment mask receiving 12 L/min of oxygen?

A. 72 L/min

B. 48 L/min

C. 52 L/min

D. 12 L/min

B. 48 L/min

EXPLANATIONS:

(u) A. See B for the correct calculation.

(c) B. A 40% air-entrainment mask entrains air at a ratio of 3 parts air to 1 part oxygen. To determine the total flow provided with a 40% mask and 12 L/min, use the following formula to solve for x, with x being oxygen flow in L/min:

3x = air entrained

3x + x = total flow

3(12) + 12 = total flow

= 48 L/min.

(u) C. See B for the correct calculation.

(u) D. See B for the correct calculation.

A respiratory therapist is preparing a bronchoscope for a scheduled procedure. The bronchoscope is plugged into the light source and powered on. No light appears at the distal end of the bronchoscope. The therapist should FIRST

A. replace the light bulb in the bronchoscope.

B. notify the physician that the procedure should be rescheduled.

C. ensure the light cable is seated correctly in the connection port.

D. connect the light source to a different outlet.

c. ensure the light cable is seated correctly in the connection port

EXPLANATIONS:

(u) A. The positioning of the light cable in the connection port should be checked before replacing the light bulb.

(u) B. Additional troubleshooting steps should be performed before rescheduling the procedure.

(c) C. The most common cause of issues with the light source of bronchoscopes is the connection port.

(u) D. Since the bronchoscope is powered on, trying a different outlet is unlikely to solve the issue.

Spontaneous breathing trials with a T-piece have been initiated for a 50-year-old patient who has been receiving mechanical ventilation for 2 weeks. With each trial, the patient becomes agitated, dyspneic, and tachypneic, and must be returned to the ventilator. Which of the following should the respiratory therapist recommend?

A. Sedate the patient.

B. Terminate weaning trials.

C. Extubate the patient.

D. Initiate pressure support mode.

D. Initiate pressure support mode

(wean slower)

EXPLANATIONS:

(h) A. Sedating the patient may result in accentuation of hypopnea and a decrease in voluntary effort.

(u) B. After 2 weeks of ventilatory support, every opportunity should be given to make weaning successful.

(h) C. The patient is likely to require re-intubation fairly rapidly.

(c) D. For a patient who has been receiving mechanical ventilation for a long period of time, an abrupt loss of ventilation may lead to anxiety and dyspnea. Initiating pressure support is most likely to lead to successful weaning.

The following capnographic tracing is noted for a patient receiving mechanical ventilation:

[image]

A respiratory therapist should

A. check the exhalation valve for a malfunction.

B. recommend the SIMV mode of ventilation.

C. evaluate the patient for airways obstruction.

D. calculate the gradient between PaCO2 and PETCO2.

evaluate the patient for airways obstruction.

EXPLANATIONS:

(u) A. The curve is not indicative of a malfunctioning exhalation valve.

(u) B. The tracing does not provide data indicating the need for a change in the mode of ventilation.

(c) C. The lack of a plateau and upward sloping shape of the curves demonstrate impairment of exhalation due to an obstructive process or airways collapse.

(u) D. Calculating the gradient between PaCO2 and PETCO2 will not explain the abnormal shape of the curve.

A 28-year-old male who is 173 cm (5 ft 8 in) tall and weighs 70 kg (155 lb) is receiving VC, SIMV with the following settings:

FIO2 0.50

Mandatory rate 12

VT 500 mL

The low volume alarm begins to sound, and the ventilator displays an inspiratory pressure of 5 cm H2O. A respiratory therapist should

A. check the exhalation valve function.

B. straighten the inspiratory line kink.

C. empty condensate from the breathing circuit.

D. switch to the A/C mode.

A. Check the exhalation valve function

EXPLANATIONS:

A. A malfunctioning exhalation valve can cause a significant leak and prevent the development of normal pressures during the inspiratory phase of ventilation.

B. A kink in the inspiratory line will cause a higher back pressure rather than a lower pressure as in this case.

C. Condensate in the inspiratory line will cause an increase in system pressure, and should have no effect on tidal volume.

D. A change to the A/C mode of ventilation will not correct a leak or low system pressure.

A 77-year-old male patient is scheduled to undergo open heart surgery. Preoperative spirometry results show the patient's FEV1 is 80% of predicted and the FEV1/FVC is 83%, indicating

A. high risk for postoperative pulmonary complications.

B. low risk for postoperative pulmonary complications.

C. the patient has obstructive lung disease.

D. the patient has restrictive lung

B. low risk for postoperative pulmonary complications.

EXPLANATIONS:

(u) A. The FEV1 and FEV1/FVC values are within normal ranges. High risk for postoperative pulmonary complications is associated with below normal values.

(c) B. The FEV1 and FEV1/FVC values are within normal ranges. The patient should be able to deep breathe and cough after surgery.

(u) C. Obstructive lung disease is typically associated with FEV1/FVC values of less than 70%.

(u) D. Restrictive lung disease is typically associated with FEV1 and FVC values of less than 80%. The FEV1/FVC value is typically above 70%.

Which of the following clinical observations is most commonly associated with right heart failure?

A. tracheal deviation

B. peripheral edema

C. muscle wasting

D. skin flushing

B. Peripheral edema

EXPLANATIONS:

A. Tracheal deviation results from asymmetrical changes in pressures or volumes in the thoracic cavity and is not related to right heart failure.

B. Right heart failure inhibits venous return and results in edema in the periphery.

C. Muscle wasting has no direct relationship to right heart failure.

D. Skin flushing is a result of peripheral vascular dilation and is not related to right heart failure.

While testing the proper function of a flow-inflating bag, a respiratory therapist notes the bag does not fully inflate with occlusion of the patient connector. Which of the following may be the cause of the problem?

A. malfunctioning inlet valve

B. excessive oxygen flow

C. open-flow control valve

D. missing oxygen reservoir

C. Open-flow control valve

EXPLANATIONS:

A. There is no inlet valve contained in a flow-inflating bag.

B. Excessive gas flow into the bag will not cause it to collapse.

C. The flow control valve in conjunction with the gas flow into the bag regulates the filling of the bag. With the flow control valve open, the gas going into the bag will immediately leave the bag through the open-flow control valve.

D. There is no separate oxygen reservoir to the self-inflating bag.

To determine the need for ventilatory support in a patient with Guillain-Barré syndrome, which of the following clinical information should be obtained?

A. chest radiograph and V̇O2max

B. V̇O2max and MIP

C. MIP and vital capacity

D. vital capacity and chest radiograph

C. MIP and vital capacity

(MIP is an indication of respiratory muscle strength, Vital capacity lets us know how much respiratory reserve this patient has, both important for treatment of a neuro disease)

EXPLANATIONS:

A. A chest radiograph will not assist in measuring muscle strength and respiratory reserve. The V̇O2max measures the maximum amount of oxygen used during physical activity and is not appropriate.

B. The V̇O2max measures the maximum amount of oxygen used during physical activity and is not appropriate.

C. MIP is an indication of respiratory muscle strength. Vital capacity provides information regarding respiratory reserve. Both provide data about the need for ventilatory support in a patient with neuromuscular disease.

D. A chest radiograph will not assist in measuring muscle strength and respiratory reserve.

Apnea monitoring should be used for an infant during

A. night time and breastfeeding.

B. naps and night time.

C. breastfeeding and bathing

D. bathing and naps.

B. Naps and night time

(Most common while asleep)

EXPLANATIONS:

A. Infants are usually awake and being directly observed during feeding.

B. An apnea monitor is indicated when an infant is asleep or when not being observed; therefore, it should be used during naps and at night.

C. Infants are usually awake and being directly observed during feeding and bathing.

D. Infants are usually awake and being directly observed during bathing.

After a transcutaneous electrode is attached to a patient's skin, a respiratory therapist should wait a few minutes for the values to stabilize. This wait is associated with

A. capillary dilatation.

B. electrode calibration.

C. barometric pressure equilibration.

D. cerebral blood perfusion.

A. Capillary dilatation

EXPLANATIONS:

A. The site must be heated for 2-5 minutes to facilitate capillary dilatation. Once dilatation occurs, transcutaneous values will stabilize.

B. Electrode calibration is performed prior to application of the electrode.

C. Barometric pressure equilibration is part of the calibration procedure performed prior to application to the skin.

D. Cerebral blood perfusion is not assessed during transcutaneous monitoring and has no effect on the values.

A 44-year-old patient presents to the ED with diabetic ketoacidosis. Which of the following respiratory patterns is most consistent with this diagnosis?

A. irregular breathing with periods of apnea

B. regular, slow, deep breathing

C. rapid, deep breathing

D. slow, shallow breathing

c. rapid, deep breathing

EXPLANATIONS:

(u) A. Irregular breathing with periods of apnea is called ataxic breathing. Ataxic breathing occurs when there is an injury to the medulla.

(u) B. Regular, slow, deep breathing does not describe breathing that is associated with diabetic ketoacidosis.

(c) C. To attempt to compensate by blowing off CO2, there is an increase in rate and depth of breathing. This is called Kussmaul's breathing and is the result of diabetic ketoacidosis.

(u) D. Slow, shallow breathing is bradypnea and is associated with respiratory depression.

A respiratory therapist is assisting a physician perform a tracheotomy on a patient who is receiving PC ventilation. After the stoma is opened and the tracheostomy tube is inserted, the therapist observes increased heart rate, decreased exhaled tidal volume, and distant breath sounds over the right chest. This information is most indicative of a

A. circuit leak.

B. right pneumothorax.

C. kink in the ventilator circuit.

D. right mainstem intubation.

B. Right pneumothorax

EXPLANATIONS:

A. A leak in a patient ventilator system will cause a loss of exhaled volume; however, the breath sounds would be diminished over both lung fields, not just the right lung field.

B. Keeping the current invasive procedure in mind, the diminished breath sounds over the affected area and an increased heart rate are consistent with a pneumothorax.

C. An obstruction in the circuit can cause a decrease in the exhaled volume, but would produce decreased breath sounds bilaterally.

D. Intubation of the right mainstem bronchus will produce decreased or absent breath sounds over the left chest, not the right.

A patient is found comatose in a car with the engine running in an enclosed garage. On arrival to the ED, the patient is receiving oxygen at 15 L/min by nonrebreathing mask and has the following vital signs:

HR 147/min

RR 36/min

SpO2 100%

Which of the following should a respiratory therapist recommend?

A. capnography and hemoximetry (CO-oximetry)

B. spirometry and capnography

C. hemoximetry (CO-oximetry) and ABG analysis

D. ABG analysis and spirometry

C.

hemoximetry (CO-oximetry) and ABG analysis

EXPLANATIONS:

(u) A. Capnography will not provide useful information in evaluating the potential cause of the coma in this patient.

(u) B. Spirometry is used to determine pulmonary mechanics which would not be useful in this patient. Capnography will not provide useful information in evaluating the potential cause of the coma in this patient.

(c) C. An ABG will indicate the patient's ventilatory status. Hemoximetry (CO-oximetry) will indicate the patient's carboxyhemoglobin level, which is essential in CO poisoning, in addition to true oxygen saturation.

(u) D. Spirometry is used to determine pulmonary mechanics which would not be useful in this patient.

A patient receiving oxygen at 2 L/min through a transtracheal catheter complains that the supply tubing keeps popping off of the catheter. To correct this problem, a respiratory therapist should

A. decrease the flow of oxygen.

B. check the catheter for obstruction.

C. perform endotracheal suctioning.

D. tape the connection securely.

B. Check the catheter for obstruction

EXPLANATIONS:

(h) A. Decreasing the flow will not correct the problem and could possibly affect the patient's oxygenation.

(c) B. The description suggests obstruction of the catheter due to kinking or mucous, resulting in significant back pressure causing the supply tube to pop off.

(u) C. Endotracheal suctioning will not clear an obstruction in the transtracheal catheter.

(h) D. Taping the connection will not correct the problem and could be potentially harmful to the patient.

A respiratory therapist is evaluating a 25-year-old male with asthma. The patient currently uses 2 puffs of albuterol at least four times a week. The patient complains of occasional limitations to normal activity, waking at least 1 night a week, and having two exacerbations requiring an ED visit within the last 6 months. According to NAEPP guidelines, which of the following should a respiratory therapist recommend?

A.budesonide (Pulmicort)

B. montelukast (Singulair)

C. ipratropium (Atrovent)

D. omalizumab (Xolair)

a. budesonide (Pulmicort)

EXPLANATIONS:

(c). A. Based on NAEPP guidelines, the patient meets criteria for step 2 and requires the addition of an inhaled corticosteroid.

(u) B. Montelukast (Singulair) is a leukotriene inhibitor, which could be used as an alternative for step 2 treatment. However, the addition of an inhaled corticosteroid is the more appropriate next step in managing this patient's asthma.

(u) C. Ipratropium (Atrovent) is not indicated in long-term management of asthma.

(u) D. Omalizumab (Xolair) is indicated for moderate to severe allergic asthma that is not controlled with inhaled corticosteroids.