NBRC TMC Practice Questions

Which of the following is needed to calculate alveolar oxygen tension?

A. VD/VT, PAO2

B. BP and FiO2

C. PetCO2 and PaO2

D. QS/QT, deadspace

B.

Barometric pressure, FiO2, and PaO2 are all included in the formula (BP stands for barometric pressure)

L/min/m2 is the unit of measure for:

A. Systemic vascular resistance

B. Cardiac output

C. Cardiac index

D. Stroke volume

C.

A spontaneously breathing patient has the following arterial blood gas results:

pH 7.38 PaCO2 42 mmHgPaO2 76 mmHgHCO3- 24 mEq/LBE 0 mEq/L

Which of the following supplemental oxygen levels is most appropriate?

A. 2 L/min nasal cannula

B. 5 L/min nasal cannula

C. non-rebreathing mask

D. Venturi mask at 30%

B.

A patient who is showing signs of hypoxemia should receive supplemental oxygen. If the patient is not a COPD patient and the situation is not an emergency, then the proper supplemental oxygen is an adult therapeutic dose, which is 40% to 55%. Of the options available only 5 L/min nasal cannula will approach this. Other options are either insufficient or too much.

Left heart failure would be manifested in which of the following values?

A. CVP and mPAP

B. mPAP and wedge pressure

C. MAP and SVR

D. cardiac output and wedge pressure

D.

The function of the left heart, specifically the left ventricle, is best assessed hemodynamically by looking at those values that precede and come after the left heart. In this case pulmonary capillary wedge pressure and cardiac output (or cardiac index) are the values found before and after the left heart.

Which of the following findings is most closely associated with increased airway resistance?

A. reduced SpO2

B. accessory muscle use

C. altered P50

D. increased PetCO2

B.

Of the options given, use of accessory muscles is most closely associated with an increase in airway resistance. This is especially true with patients who have asthma or other types of upper airway inflammation or bronchoconstriction.

For a patient receiving volume-controlled mechanical ventilation, the lower inflection point on a pressure-volume loop can best be described as:

A. amount of pressure required to keep the alveoli and small airways open

B. optimal PEEP

C. minimal PEEP

D. upper limit of residual volume

A.

The lowest inflection point on a pressure-volume ventilator graphic is an indication of the minimum pressure needed to keep alveoli open.

The results of a V/Q scan shows poor perfusion with adequate ventilation. A chest radiograph shows a wedge-shaped infiltrate over the right lung field. The patient most likely has

A. fluid overload

B. ARDS

C. a pulmonary embolism

D. pneumonia

C.

A VQ scan that shows poor perfusion but adequate ventilation is most closely associated with a pulmonary embolism. Supportive data is found in the radiological report of wedge-shaped infiltrates.

The respiratory therapist notes in the medical record of a 65-year-old male that the patient is ordered to receive bronchodilator therapy with Albuterol. The therapist also notes the patient is receiving beta-blocker medication. The therapist should recommend

A. Administer Dexamethasone (Decadron) in place of Albuterol

B. Add Xopenex to the bronchodilator regimen

C. Replace Albuterol with Beclamethasone (Beclovent)

D. Switch from Albuterol to ipratropium bromide (Atrovent)

D.

Because albuterol is a beta-agonist medication, patients who are taking beta-blockers should utilize other bronchodilation medication.

A hospital has an extremely low incidence of ventilator-associated pneumonia. To which of the following reasons may this be attributed?

A. periodic discontinuation of sedation

B. use of respiratory precautions with the population

C. diversion of infectious patients to other facilities

D. broad use of prophylactic antibiotics

A.

The incidence of ventilator-associated pneumonia, or VAP, is lowered by using a closed system suction catheter, periodically discontinuing sedation, keeping the patient and semi-Fowler's position, and proper handwashing among caregivers. All are correct.

A pressure-volume loop ventilator graphic shows no rise in pressure for the first 200 mL of delivered volume. The therapist should

A. increase inspiratory flow rate

B. increase PEEP

C. decrease tidal volume

D. decrease inspiratory flow rate

B.

In this question the description of the pressure volume loop would indicate a flat bottom as manifested by no rise in pressure with the first 200 mL of delivered volume. We call this a "flat football". The solution is to increase PEEP to a level that the pressure begins to rise immediately as volume is introduced.

Which of the following would be the most effective, appropriate method for resolving atelectasis in a spontaneously breathing, post operative patient who is under the influence of sedation and will not respond to verbal stimuli?

A. IPPB

B. sustained maximal inhalation (incentive spirometer)

C. deep breathing coaching

D. intubation and mechanical ventilation

A.

A postoperative patient under sedation, and possibly in pain, may be tempted to breathe less, causing respiratory acidosis and atelectasis. To correct this problem, IPPB therapy is most appropriate. Incentive spirometry would also help but the patient is unable to respond to verbal stimuli. This alone is an indication for IPPB therapy.

After performing minimum occluding volume technique with a 65-kg (143-lb) patient who is orally intubated with a 7.0-mm ET tube, the respiratory therapist should NEXT

A. check ET tube cuff pressure

B. perform tracheal palpation

C. order a chest radiograph

D. document ET tube markings at the lips

A.

The ET tube cuff pressure may be adjusted correctly by several techniques including minimum leak technique (also called minimum occluding volume, minimal seal technique, and the use of a pressure manometer called a cuffalator. If minimum seal or minimal leak technique is used, the respiratory therapist is still required to monitor the pressure after the technique is performed. Although this is often not done in real life, it is technically part of the procedure.

The respiratory therapist observes an ECG wave form on a patient that is consistent with atrial tachycardia. The patient is complaining of chest pain, dizziness, and nausea. The respiratory therapist should recommend

A. unsynchronized defibrillation

B. Atropine sulfate

C. epinephrine

D. cardioversion

D.

Non-deadly arrhythmias, such as this one, may be addressed through cardioversion. Cardioversion is a form of defibrillation with low wattage and with the synchronization set to "active". This allows the shock to be synchronized to the R wave.

A 38-year-old male presents in the emergency department (ED) complaining of frequent vomiting. The following laboratory data is available: Arterial blood gases

pH 7.55 PaCO2 42 torrPaO2 85 torrHCO3- 31 mEq/LBE +7 mEq/LFIO2 0.21K+ 3.0 mEq/LCl- 95 mEq/LNa+ 135 mEq/L

Which of the following should the respiratory therapist recommend?

A. administer NaCL

B. administer NaHCO3-

C. administer KCL

D. administer volume-expanding fluids

C.

This patient has a CO2 of 42 mmHg, which suggests adequate ventilation. However, the high pH is associated with alkalosis. Because the CO2 is normal, the cause of the alkalosis must be metabolic in nature. One treatment for metabolic alkalosis is to administer potassium chloride or KCl.

A patient is receiving volume-controlled ventilation following bariatric surgery for obesity. Which of the following medications should the respiratory therapist recommend to ensure the patient's comfort and assist in ventilator management?

A. Pronestyl

B. morphine sulfate

C. vecuronium bromide (Norcuron)

D. Mestinon

B.

Morphine sulfate is one of the best medications to administer to patients receiving mechanical ventilatory support to help the patient rest pain-free and to generally sedate and relax the patient.

A patient has idiopathic pneumonia with consolidation in the right lower lobe. The physician suspects a bacterial infection. Which of the following will provide conclusive data to rule out the physician's suspicions?

A. WBC

B. color of sputum

C. sputum acid-fast stain

D. oral temperature

A.

A bacterial infection is diagnosed primarily by examining the white blood cell count, also called the leukocyte count. An elevated temperature and yellow sputum indicate the possibility of an infection but are not confirming in nature.

After making the universal sign of choking, a person collapses. The observer should FIRST

A. check for a pulse

B. call for help

C. perform abdominal thrusts

D. administer 2 rescue breaths

C.

When a person indicates the universal sign of choking, they are unable to verbalize because there is likely something caught in their airway. The person responding must first focus on removing the obstruction, which is done by performing abdominal thrusts. Administering rescue breaths would not be appropriate because the airway is obstructed. Calling for help is tempting but is only related to two-man CPR. The patient is not yet at that point. Performing abdominal thrusts is a one-man maneuver and therefore obtaining additional help is not the first concern.

A home care patient calls into the clinic and complains that his oxygen concentrator is not working even though the machine is plugged in and the switch is in the 'on'. Position. After ensuring the patient is receiving oxygen from a reliable alternate source, the therapist should advise the patient to

A. check and replace the internal in-line fuse

B. find the reset switch in the machine and press it

C. ensure the circuit breaker is in the on position

D. change the filters and cycle the machine off then on again

C.

When a homecare patient reports a problem with their oxygen concentrator, the first action should be to ensure the patient is receiving oxygen from an alternate source (an E cylinder). After that is accomplished, the respiratory therapist may instruct the patient in some basic troubleshooting. This includes ensuring the device is plugged in, changing the filter, and checking the circuit breaker. All other troubleshooting should be done by a professional.

An adult patient with asthma is receiving Albuterol by small volume nebulizer Q.I.D. at a dosage of 0.5 mL. The patient complains of dizziness, tingling in his fingers, and anxiety with each treatment. The therapist should

A. increase dosage to 1.0 mL

B. decrease dosage to 0.15 mL

C. switch to Xopenex 0.63 mg

D. switch to Mucomyst 20%

C.

When a patient experiences an adverse reaction, the first step is to stop the therapy and then modify the therapy to accomplish the same objective. In this case, decreasing the dose of Xopenex is suitable because 0.63 mg is still in the adult therapeutic range.

Which of the following conditions would benefit most from a thoracentesis?

A. atelectasis

B. complete opacification of the right lung

C. small pneumothorax

D. pericardial contusion

C.

A thoracentesis is a procedure that removes air or fluid from the pleural space. This would be appropriate with a small pneumothorax. A large pneumothorax, however, would require chest tubes.

ASK***** A patient with ARDS and asthma could benefit from which of the following medications?

A. Spiriva and decadron

B. exogenous surfactant

C. Tobramycin and albuterol

D. cromolyn sodium

B.

A patient with adult respiratory distress syndrome could benefit from surfactant therapy to decrease the surface tension of the alveoli.

The respiratory therapist should look to which of the following clinical data to determine the effectiveness of incentive spirometry?

A. Arterial blood gas analysis pre and post treatment

B. Breath sounds before and after every treatment

C. Inspiratory capacity predicted volume

D. Maximum voluntary ventilation done periodically

B.

The effectiveness of incentive spirometry can best be determined by auscultating breath sounds before and after the treatment and noting changes in air movement. While achieving inspiratory capacity is the goal, the real goal is to increase lung volume, improve alveolar recruitment, and prevent consolidation of sputum in the lungs.

increased labor of breathing. The mandatory rate is 14/min. Which of the following would most likely help the patient?

A. Use of pressure support

B. Switch to pressure control ventilation

C. Increase the machine flow rate

D. Increase PEEP

A.

During ventilator weaning, a patient must maintain a moderately low respiratory rate, an adequate sized tidal volume, and low work of breathing. In this case, the patient is experiencing increased labor of breathing and an increase in respiratory rate. This is likely due to a reduced spontaneous tidal volume. Although this data is not shown, this condition can be assumed. The solution for a low spontaneous tidal volume and increased work of breathing during weaning is to provide pressure support.

When analyzing the FIO2 for an infant in an oxygen hood receiving oxygen therapy with a blender set at 50%, the respiratory therapist notes an oxygen concentration of 35% near the patient's mouth. The jet nebulizer entrainment setting is set to 50%. To correct the problem, the therapist should

A. adjust blender setting to 60%

B. increase total flow to the oxyhood

C. obtain a smaller oxyhood

D. change the nebulizer entrainment port to 100%

D.

When administering oxygen by oxygen hood with a blender and a nebulizer, the oxygen control on the nebulizer should be set to 100%. This will prevent additional entrainment of room air which will cause a decrease in FIO2.

Following the insertion of a tracheostomy tube, the patient is found to have diffuse crackles upon auscultation secondary to subcutaneous emphysema. Which of the following radiographic findings would be expected with this condition?

A. Hyperlucency in the soft tissues

B. Diffuse pulmonary hyperlucency

C. Tracheal shift from midline

D. Scattered patchy infiltrates

A.

Hyperlucency, seen on a chest x-ray is darker in color. Air is radiolucent. Therefore, air located in the soft tissue, as seen with subcutaneous emphysema would result in a hyperlucent X-ray over soft tissue areas. Subcutaneous emphysema by itself will not shift the trachea from midline. Scattered patchy infiltrates are associated with ARDS, not subcutaneous emphysema.

Placement of a pulmonary artery catheter is associated with which of the following most common complications?

A. hypotension

B. pulmonic valve damage

C. cardiac arrhythmias

D. internal bleeding

C.

Several complications may arise from the placement of a pulmonary artery catheter, otherwise called a Swan-Ganz catheter. The development of cardiac arrhythmias is the most common complication of the options offered. Another serious complication is perforation of a vessel or cardiac muscle during the insertion.

A galvanic fuel cell oxygen analyzer may read erroneously high under which of the following conditions?

A. when the analyzer batteries are depleted

B. during a sudden increase in the partial pressure of oxygen

C. when a volume-controlled ventilator at high inspiratory pressures

D. when liquid gets on the membrane

C.

A galvanic fuel-cell oxygen analyzer may read erroneously when ambient pressures change significantly, such as when a patient is receiving high inspiratory pressure or when a patient changes altitude quickly.

Results of a quality control maneuver for a spirometer using a 3.0 L calibration syringe as follows:

Volume 1 2.65 L Volume 2 2.68 LVolume 3 2.66 L

According to ATS Standards, the spirometer is

A. inaccurate

B. proof that the syringe requires calibration

C. lacking in precision

D. operating correctly

A.

These calibration results are all very close together, indicating the machine is very precise. However, the results are too far from the 3.0 L of gas introduced by the calibration syringe. The maximum variance is 2.85 L - 3.15 L. Therefore, although the machine is precise, it is considered inaccurate and should not be used for patient testing and reporting.

Which of the following will be most helpful at preventing complications for a 48-year-old male patient who has just undergone bariatric surgery for obesity?

A. Incentive spirometry every hour

B. Small volume nebulizer therapy with Albuterol every 4 hours

C. Ambulation twice a day

D. IPPB with 3.0 mL normal saline every 4 hours

A.

One of the best methods to prevent postoperative complications is the use of incentive spirometry, also called maximal sustained inspiration or SMI.

Which of the following results should the respiratory therapist evaluate to determine the adequacy of oxygen transport on a patient who is diagnosed with carbon monoxide poisoning and is being treated with FIO2 of 1.0?

A. arterial-venous oxygen content difference

B. cardiac output

C. arterial oxygen content

D. oxygen consumption at the tissues

C.

Oxygen transport refers to the ability for blood to carry oxygen from the alveoli to the tissues. In a case involving carbon monoxide poisoning, it is transport that is most affected. This is true because hemoglobin becomes occupied with carbon monoxide rather than oxygen. Hemoglobin is 19 times more attracted to carbon monoxide compared to oxygen. Of the options listed, the best method to monitor the adequacy of oxygen transport would be to evaluate the arterial oxygen content. This value takes into account the amount of oxygen tied to the hemoglobin as well as the oxygen dissolved in the plasma of the blood

A patient complains of shortness of breath during a nebulizer treatment is hypertonic saline. The respiratory therapist should do which of the following?

A. Discontinue therapy and notify the physician

B. Add Albuterol to the nebulizer treatment

C. Switch to normal saline

D. Switch to hypotonic saline

A.

Adverse reactions during any therapy should be responded to initially by discontinuing therapy and notifying the physician.

In preparation for a helium dilution study, a respiratory therapist is calibrating the helium analyzer. While exposing the analyzer to ambient room air, what will the analyzer read for helium concentration?

A. 21%

B. 0%

C. 2%

D. 79%

B.

To calibrate a helium analyzer, sometimes called a Wheatstone Bridge, the device must be calibrated to room air for the low calibration and to a known level of helium for the high calibration. Because room air has no significant level of helium, helium analyzers should read 0% when exposed to ambient room air conditions.

Which of the following will result in a decrease in mean airway pressure for a patient on a mechanical ventilator in the assist/control mode?

A. use of expiratory retard

B. institution of a 1.0 sec inspiratory plateau

C. decrease in inspiratory time

D. decreasing inspiratory flow

C.

Decreasing inspiratory time will lower the amount of time a patient is exposed to positive pressure and will therefore result in a decrease in mean airway pressure. Use of expiratory retard, increasing inspiratory flow, and institution of an inspiratory plateau will all lead to increased mean airway pressure.

A chest radiograph of an abdominal post-operative patient shows abnormal elevation of the left hemidiaphragm. Which of the following conditions explains the observation?

A. pneumothorax on the left

B. herniation of the left hemidiaphragm

C. hemothorax

D. atelectasis in the left lower lobe

D.

Abnormal elevation of the left hemidiaphragm is an indication that the lung on that side is smaller for some reason. This could be due to a partial pneumothorax or profound atelectasis. Oftentimes, atelectasis can develop as a result of surgery. Therefore, the raised hemidiaphragm, combined with the postoperative status of the patient, indicate the most likely problem is atelectasis in the left lower lobe.

Immediately following oral endotracheal intubation, the respiratory therapist should confirm proper placement by doing which of the following?

A. Assess end-tidal CO2 with a colorimetric capnometer

B. Obtain a anterior-posterior chest radiograph

C. Auscultate the neck

D. Ensure tube markings are between 20-24 at the teeth

B.

To determine the location and placement of an endotracheal tube a chest x-ray is appropriate. Because the patient is intubated it is not likely that the patient is ambulatory and therefore must undergo a chest x-ray in bed. When shooting a chest x-ray bed, the proper technique is called an AP chest radiograph, or anterior-posterior x-ray.

The physician orders mechanical ventilator settings:

Mode assist/control VT 600 mLMandatory rate 10/minI:E 1:2FIO2 0.40PEEP 5 cm H2O

Which of the following represents the minimum inspiratory flow setting the respiratory therapist should select?

A. 24 L/min

B. 60 L/min

C. 18 L/min

D. 40 L/min

C.

There are several methods to determine the minimum flow needed to accomplish specific minimum flow settings on a mechanical ventilator. One shortcut method is to add the I:E ratio numbers together and multiply it by the minute ventilation. In this case, 1+2 = 3. Minute ventilation = (.6L x rate of 10) = 6.0 L. 6.0 L x 3 = 18 L/min. This is the minimum flow. When answering this question if the exact number is not available in the options, the correct choice would be the next highest number. For instance, if 18 L per minute was not an available option, the next best answer in this question would be 24 L per minute.

A 65-kg (143-lb) male patient is in the intensive care unit after being found unconscious and unresponsive with a suspected drug overdose. The following ABG and clinical data are observed.

- pH: 7.30

- PaCO2: 50 mmHg

- PaO2: 82 mmHg

- HCO3-: 24 mEq/L

- BE: 0 mEq/L

- RR: 24 breaths per min

- VT: 260 mL

The respiratory therapist should recommend which of the following:

A. Intubate, VC, A/C ventilation

B. Oral intubation, CPAP 5 cm H2O, PS 6 cm H2O

C. Non-invasive ventilation with IPAP 10 cm H2O, EPAP 5 cm H2O

D. Manual resuscitation administer Narcan (naloxone)

B.

Which of the following is an emergency and requires that the patient receive 100% oxygen supplementation?

A. Impending ventilatory failure

B. Massive loss of blood

C. Ventilatory failure

D. Vital capacity below 1.0 L

B.

Which of the following is an indication for the use of FiO2 1.0 on a patient?

A. Evidence of pulmonary embolism

B. Ventilatory failure

C. Impending ventilatory failure

D. Myasthenia gravis

A.

Of the options listed, only the suspicion and evidence of pulmonary embolism is suggestive of and emergency and necessitates the use of FiO2 1.0

For a patient who is unconscious, due to ingestional error of barbiturates, which of the following assessments is the most important?

A. Arterial blood gas analysis

B. The patient's ability to protect their airway

C. Tension test

D. A drug toxicology screen

B.

Which of the following types of patients are most often good candidates for alveolar recruitment maneuvers?

1. Post-surgical

2. Acute lung injury

3. Pulmonary emphysema

4. Acute respiratory distress syndrome

5. Tuberculosis

A. 1, 2, 3, and 4 only

B. 1, 2, and 3 only

C. 1, 3, and 5 only

D. 3, 4, and 5 only

A.

Which of the following is most attributed to effective alveolar recruitment?

A. Varying peak pressures applied to the airway

B. Using high peak flows to 'pop' open alveoli

C. Applying pressure above that which is applied during tidal volume delivery

D. Disallowing the patient to exhale tidal volume completely

C.

The central concept behind alveolar recruitment relates to higher-than-normal pressure applied to the alveoli compared to the pressure associated with normal tidal volume delivery

If the scale of the ventilator graphic is not changed, in which way will the pressure-volume ventilator graphic change in appearance when alveolar recruitment is effective? It will:

A. Become skinny and retracted

B. Become wider and protracted

C. Move upward away from the x-axis

D. Become increasingly parallel to the x-axis

C.

As alveoli are recruited, the lungs become more compliant. This will cause a shift of the pressure-volume graphic from "lying down" on its side, parallel to the x-axis; to a higher angle, closer to 45 degrees from the origin

Which of the following methods is associated with alveolar recruitment>

A. Airway pressure applied above a patient's plateau pressure

B. PEEP greater than 1/4th of peak pressures

C. Airway pressure release ventilation

D. Peak pressures above 50 cm H2O

A.

Effective alveolar recruitment will be manifested by which of the following clinical outcomes?

1. Decrease in the A-a

2. Increase in PF ratio

3. Decrease in VT

4. Decrease in Qs/Qt

A. 1, 2, and 4 only

B. 1 and 4 only

C. 2 and 3 only

D. 1, 2, 3, and 4

A.

Which of the following PEEP levels, set above the patient's plateau pressure, is appropriate as an initial setting during alveolar recruitment maneuvers?

A. 10 cm H2O

B. 40 cm H2O

C. 30 cm H2O

D. 20 cm H2O

A.

Which of the following ventilator modes is most suitable to help recruit alveoli?

A. PRVC

B. PCV

C. APRV

D. Inverse positive pressure ventilation

C.

To qualify for ventilator weaning, a patient's Qs/Qt should be below

A. 60%

B. 5%

C. 10%

D. 20%

D.

A patient receiving VC SIMV ventilation has a spontaneous tidal volume of 500 mL and a respiratory rate of 20/min when removed momentarily from the ventilator. What is the RSBI value?

A. 10

B. 25

C. 40

D. 0.025

C.

RSBI is calculated by RR/VT (L).

RSBI = 20 / 0.5 L

RSBI = 40

To be considered for weaning from VC A/C ventilation, a patient's A-aDO2 should be less than:

A. 100 mm Hg

B. 65 mm Hg

C. 300 mm Hg

D. 200 mm Hg

C.

An A-aDO2 greater than 300 mm Hg would suggest that the patient requires PEEP to maintain adequate PaO2.

Which of the following generally represents the quickest, most effective method for ventilator liberation?

1. APRV

2. Cold cessation and extubation

3. SBT

4. Gradual decrease in rate and pressure support

C.

A patient is being weaned from VC SIMV ventilation. ABGs are normal. MIP is -32 cm H2O and RSBI is 96. A small amount of beige secretions are being suctioned from the ETT every few hours. The patient shows some disorientation and confusion related to time, person, and place. The RT should recommend:

A. Considering SBTs

B. Reducing sedation

C. Discontinuing mechanical ventilation and performing ABGs in 20 minutes

D. Discountinuing weaning efforts

D.

Disorientation and confusion are commonly associated with a lack of cerebral perfusion of oxygen

Which of the following are the advantages of a tracheostomy airway?

1. Reduce airway resistance

2. Facilitate weaning in COPD patients

3. Provide long-term mechanical ventilation

4. Help with bronchial hygiene

A. 1, 3, and 4 only

B. 2 and 4 only

C. 1, 2, 3, and 4

D. 3 and 4 only

C.

What positioning would be most helpful in draining the lower lobes and posterior and basal segments?

A. Prone

B. Semi-fowler's

C. Supine

D. Flat with a quarter turn to the affected side

A.

What is the best position to drain the lingular, later, and medial segments?

A. Trendelenburg - down 20 inches

B. Semi-Fowler's

C. Supine

D. Trendelenburg - down 15 inches

D.

What postural drainage position is most conducive to draining the basal, anterior, and lateral segments?

A. Prone

B. Supine

C. Lateral side, quarter turn

D. Trendelenburg - head down 30 degrees

D.

A patient is in the ICU for treatment of right-sided pneumonia and cor pulmonale. What patient positioning would optimize gas exchange?

A. Supine

B. Semi-Fowler's

C. Lying on the right side with the left lung up

D. Lying on the left side with the right lung up

C.

For optimal gas exchange, the unaffected lung should be kept up high

Which of the following would indicate that the prescribed airway clearance efforts are effective?

A. Expectoration of secretions dissipates

B. Patient develops rhonchi during clearance procedure

C. Patient indicates they can breathe better

D. Breath sounds become less diminished

B

Which of the following conditions would contraindicate chest percussion for the purpose of airway clearance?

A. Bacterial pneumonia

B. ARDS

C. Cystic fibrosis

D. Untreated tuberculosis

D.

May promote destruction and expectoration of lung tissue in patients with untreated tuberculosis

Which of the following would be most helpful in determining where to focus chest physiotherapy on a patient who has mucoviscidosis and requires assistance with airway clearance?

A. Auscultation of breath sounds

B. Autogenic drainage

C. Bronchogram

D. Diagnostic chest percussions

C.

A respiratory therapist has achieved the following weaning parameters on a post-operative patient who experienced a total knee replacement. The SpO2 is 97% on 35% oxygen.

Spont VT 480 mL VC 1600 mLVE 7.0 LMIP -4 cm H2O

The next best action would be to

A. return to full mechanical ventilation

B. reduce FIO2 to 0.30

C. check the pressure manometer for leaks

D. evaluate the MEF

C.

Most of the weaning parameters listed are very good and suggest that the patient is strong enough for weaning. The respiratory therapist should not believe the NIF result of -4 cm H2O because it is not consistent with the remainder of the results. A leak is likely present in the manometer set up.

A 5-year old patient with acute epiglottitis has just received a tracheotomy and is returned to the emergency department for monitoring. The patient is now breathing through a tracheostomy tube. Which of the following is most important at this time?

A. keep the tracheostomy tube cuff inflated

B. provide heated humidity

C. mechanical ventilatory support

D. provide cool aerosol therapy

B.

A patient who has a tracheostomy tube in place is unable to naturally humidify inspired gases because the natural humidification processes of the body, including the nasal passages and oropharynx, are bypassed. In this case, providing heated humidity, which can make up the entire humidity deficit, is paramount.

The respiratory therapist is asked to estimate the alveolar minute ventilation on a spontaneously breathing 68 kg (150 lb) female who is receiving oxygen therapy by air-entrainment mask at FIO2 0.50. The following data is available

Exhaled VT 450 mL mPAP 15 torrPaCO2 40 torrPaO2 70 torrRespiratory rate 12/min

The therapist should report an alveolar minute ventilation of:

A. 4.6 L/min

B. 12.0 L/min

C. 3.6 L/min

D. 5.4 L/min

C.

To determine alveolar ventilation, dead space should be subtracted from each tidal volume. The amount of dead space per tidal volume is equivalent to 1 mL/lb of ideal body weight. In this case, the patient weighs 200 lbs and therefore has 150 mL of dead space for every inhaled tidal volume. The amount of gas that goes to the alveoli is, therefore, 300 mL per breath or 3.6 L per minute. This is calculated by subtracting 150 mL from 450 mL (the patient's VT) and then multiplying by the respiratory rate.

A 9-year-old asthmatic patient has previously responded well to Xopenex via small-volume nebulizer. The patient is intubated and has been placed on mechanical ventilation for acute respiratory failure. The physician orders Xopenex to be delivered via SVN through the ventilator circuit. Which of the following is an important consideration for effective medication delivery?

A. tachycardia is more likely

B. particle deposition will be increased

C. Placement of the nebulizer can result in variation of medication delivery

D. an alpha I response is increased

C.

Administering aerosolized bronchodilators through a mechanical ventilator circuit requires careful judgment by the respiratory therapist. Several factors including all listed in this scenario limit the therapist's ability to properly deliver medication. These factors must be taken into consideration for all mechanically ventilated patients, including pediatric patients.

While assessing a patient receiving positive pressure ventilation with a Servo adult ventilator, the therapist notes a sudden low return volume alarm begins sounding. Which of the following could be the cause?

A. pulmonary embolism

B. excess condensate in the ventilator circuit

C. bronchopleural fistula

D. ARDS

C.

The solution to this problem is to determine which answer could lead to a low-pressure alarm. Excess condensate in the ventilator circuit and adult respiratory distress syndrome would more likely lead to high-pressure alarms. A pulmonary embolism is not related to any particular alarm. That leaves a bronchopleral fistula as the only possible cause.

When considering appropriate staffing levels and proper care of patients, a respiratory therapy supervisor would include which of the following

A. frequency of declined therapy

B. Individual skills of staff members

C. previously missed therapy

D. staff member preference

B.

When planning appropriate staffing levels for patient care, frequency of therapy, type of therapy ordered, and the individual skills of the staff are all important considerations. Department budgetary goals should not affect staffing.

A respiratory therapist is preparing a patient who will be transferred home and will be ventilator dependent during the night. Which of the following devices would be most helpful to ensure adequate hydration of the patient's airway during the night?

A. Large volume nebulizer

B. Cascade humidifier

C. Heat moisture exchanger (HME)

D. Heated wire ventilator circuit with water traps

C.

An HME device is intended for short-term use. Patients who are ventilator-dependent during the night may use this device.

After noting profuse bubbling in the water-seal chamber of a disposable three-chamber chest drainage system, the RT places a clamp on the chest tube proximal to the patient. In doing so, the bubbling dissipates and stops. What can be concluded?

A. The leak must be in the tubing leading to the chest drainage system

B. Suction pressure at the wall is excessive

C. The patient may have perforation in lung tissue

D. Leaking is most likely occurring inside the three-chamber system

C.

A 22-year-old, 6-ft, 3-in Caucasian male is in the ER for sudden, unexplained onset of tachypnea. Chest radiography shows hyper lucency in the left chest, dominated by a large dark area over the entire left lung field. The physican decides to install a chest tube drainage system and asks for your recommendation on chest tube placement. You will suggest which of the following?

A. Right side, mid-axillary line, 5th intercostal space

B. Right side, left side, 4th intercostal space, mid-clavicular line

C. Left side, mid-axillary line, 5th intercostal space

D. Left side, 2nd intercostal space, mid-clavicular line

D.

In a patient with a partial pneumothorax, what percent of collapse is the threshold that indicates the need for chest tube insertion?

A. 50%

B. 20%

C. 10%

D. 15%

B.

By what route is Xolair (omalizumab) administered?

A. Subcutaneously

B. Aerosolized

C. IV

D. Intra-muscular

A.

How many milliliters of aerosolized medication should be prepared to deliver 30 mg of that same drug if the strength is 1.5%

A. 2.0 mL

B. 4.5 mL

C. 20 mL

D. 45 mL

A.

Strength of 1.5% x 10 = 15 mg/mL

30 mg / 15 mg/mL = 2.0 mL

An aerosolized bronchodilator is being administered to a patient. The dose is 5.0 mL and the drug strength is 2.0%. How many milligrams of the drug will be administered?

A. 2.5 mg

B. 0.4 mg

C. 100 mg

D. 10 mg

C.

Strength of 2.0% x 10 = 20 mg/mL

5.o mL x 20 mg/mL = 100 mg

A bronchodilator medication whose strength is 0.5% must be delivered by continuous bronchodilator therapy at 10 mg/hr for 2.5 hours. How many mL will be required to be added to the nebulizer?

A. 25 mL

B. 5.0 mL

C. 1.25 mL

D. 10 mL

B.

Strength of 0.5% x 10 = 5 mg/mL

2.5 x 10 = 25 total milligrams

# of mL needed = 25 total mg / 5 mg/mL = 5.0 mL

Hazards associated with oxygen therapy include absorption atelectasis, safety issues such as fire, and oxygen toxicity. For oxygen toxicity to be a concern, which of the following conditions might be present?

A. Any FiO2 above 0.40 for more than 24 hours

B. When the barometric pressure exceeds 742 mm Hg

C. FiO2 greater than 0.6 for 12 hours or more

D. Use of 100% oxygen for 1-2 hours

C.

What modality is most suitable for administering helium-oxygen therapy at a mixture of 70/30%?

A. Air-entrainment mask

B. Simple mask

C. Nonrebreather mask

D. Nasal cannula

C.

A patient with moderate ventilatory distress is placed on 70/30% heliox by a nonrebreather. Immediately after the institution of the therapy, the RT notices the reservoir on the mask collapses completely with each breath. After a few minutes, the reservoir begins to collapse only partially. The therapist should:

A. Switch to 80/20% heliox

B. Switch to 60/40% heliox

C. Continue the current therapy

D. Increase the gas flow to the mask

C.

What joule setting should be used on a bi-phasic defibrillator during unsynchronized conditions for the treatment of V-tach?

A. 50-100 joules

B. 300-360 joules

C. 150-200 joules

D. 10-25 joules

C.

While performing ACLS on a patient who is in complete cardiac arrest, the physician orders arterial blood gas analysis. The RT is unable to palpate a radial pule. BP is 25/5 mm Hg. The RT should:

A. Obtain blood from the femoral artery

B. Use venous blood for the blood gas analysis

C. Perform an Allen's test

D. Attempt a brachial artery puncture

A.

While performing cardiac compressions on a patient in complete cardiac arrest, the physician suspects a gastric rupture has occurred. The RT should anticipate the order to:

A. Prepare for echocardiography

B. Continue compressions

C. Transfer the patient to CT scan

D. Cease compressions for needle puncture of the abdomen

B.

Which of the following medications may be delivered by instillation down the ETT during ACLS efforts?

A. Atropine

B. Prostaglandin

C. Racemic epinephrine

D. Nitroglycerine

A.

Which of the following antibiotics would be appropriate for a patient with gram-positive organisms and who is resistant to penicillin?

A. Cephalexin

B. Nafcillin

C. Carbenicillin

D. Amoxicillin

B.

Which medications can be used to treat candidiasis?

1. Oxacillin

2. Tobramycin

3. Amphotericin B

4. Nystatin

A. 3 and 4 only

B. 2 and 3 only

C. 1 and 2 only

D. 1 and 4 only

A.

Which of the following would constitute a therapeutic use of a flexible bronchoscope?

A. Extracting tracheal tissue for biopsy

B. Determining the presence of any mucus plugs

C. Locating an aspirated foreign body

D. Removal of a large food particle from the airway

D.

While suctioning blood from the trachea with a bronchoscope following tissue extraction, the scope suddenly demonstrates no suction pressure at the end of the scope. The RT should check the:

A. Suction pressure at the wall

B. Integrity of the suction line

C. Bodai adapter

D. Suction channel on the scope

D.

The suction channel is most likely clogged and is the cause of the problem

Which of the following may be used to facilitate a bronchoscopy while providing mechanical ventilatory support?

A. King airway

B. Bodai adapter

C. Fenestrated tracheostomy tube

D. Combitube

B.

Device which attaches to the end of the ETT and has a 90-degree connection for the ventilator and a port that allows insertion of a bronchoscope straight into the airway

Blood is found in the exudate retrieved during a thoracentesis. This is most likely associated with:

A. Infection

B. Cancer

C. Pleural effusion

D. Tuberculosis

A.

A thoracentesis is performed by inserting a large bore needle into the pleural space between the:

A. 5th and 6th ribs

B. 7th and 8th ribs

C. 3rd and 4th riibs

D. 10th and 11th ribs

B

A patient complains of an inability to stare at his computer screen at work without a tendency to fall asleep. He also indicates he falls asleep during red lights at intersections when driving. What can be done to screen the patient for sleep apnea?

A. Nocturnal EEG

B. Holter monitoring

C. Overnight pulse oximetry trending

D. Polysomnography

C.

Which of the following is the most determinant of cough effectiveness?

A. FRC size

B. MIP

C. Spontaneous VT

D. Depth of inhalation

D.

While transporting a patient in a helicopter who is receiving VC ventilation with a portable fluidic ventilator, the RT notices the ventilator frequency and delivered tidal volume are gradually decreasing. The RT should suspect the cause is (a):

A. Significant change in barometric pressure

B. Depleted batteries in the ventilator

C. Depleted compressed gas source

D. The negative affects of altitude

C.

What is the best method for determining if a patient who received instruction for MDI use understood the instructions given?

A. Ask the patient to explain the directions back to the instructor

B. Ask the patient to do a return demonstration

C. Provide a written test

D. Have the patient write down he instructions as given

B.

Which of the following can be used to control withdrawal symptoms in a patient who has an 80-pack-year history of smoking?

A. Ativan

B. Zyban

C. Lopressor

D. Romazicon

B

A 12-year-old patient who has no known allergies seems to experience increased asthma exacerbations during stressful times at school. This is most closely associated with:

A. Intrinsic asthma

B. Allergic asthma

C. Extrinsic asthma

D. Childhood asthma

A.

Asthma that is not caused by exposure to the environment, but, rather, by internal feelings and stress, is to be considered to be intrinsic

When adjusting the mandatory rate on a volume control ventilator of a patient who has COPD, the RT should monitor which of the following to ensure adequate ventilation?

A. HCO3

B. PaCO2

C. pH

D. PaO2

C.

In case of a ventilation emergency, the COPD patient should receive:

A. Oxygen not to exceed 35%

B. 50% oxygen

C. 100% oxygen

D. No more than 2 L/min by nasal cannula

C.

What would be the most likely shape of a flow-volume pulmonary function loop on a patient with COPD?

A. Short and narrow

B. Tall and narrow

C. Short and wide

D. Tall and wide

C.

Because a COPD patient has difficulty expiring, the flow volume loop will be wide as they require longer to exhale. Consequently, the volume will be reduced, causing the loop to be short (low in volume indicated on the Y axis)

While doing an ECG on a patient who is asymptomatic, the RT notes pronounced 'Q' waves on the ECG. The RT should:

A. Look for a detached chest lead

B. Note the observation, otherwise take no immediate action

C. Begin treatment protocols for myocardial infarction

D. Call a code

B

While performing a routine check of a patient receiving mechanical ventilatory support, the respiratory therapist makes a small adjustment to the ET tube cuff pressure by injecting 2.0 cc of air into the cuff. Immediately after, the high-pressure alarm on the ventilator is activated. The therapist should

A. silence the alarm and monitor the patient closely.

B. remove the ET tube.

C. readjust the cuff using the minimal leak technique.

D. attempt to pass a suction catheter through the ET tube.

D.

The activation of the high-pressure alarm is an indication of an occlusion. Since this occurred immediately after adding air to the ET tube cuff, the therapist should suspect the possibility of cuff herniation. To rule this suspicion in or out, a suction catheter should be inserted into the airway to determine if there is an obstruction near the distal end of the tube.

A 6-minute walk test is used to evaluate

A. a patient's physical stamina and aerobic endurance.

B. pulmonary ventilatory ability.

C. PF ratio.

D. Oxygen desaturation tendency.

A.

A 6-minute walk test (6MWT) is a way of evaluating a patient's physical performance ability, especially given certain cardiopulmonary limitations. The test evaluates the distance a person can walk in 6 minutes. This is known as a 6-minute walk distance (6MWD).