Respiratory Therapy Exam Review
Respiratory Therapy Study Notes
Endotracheal Intubation Confirmation
- A respiratory therapist is assisting during endotracheal intubation.
- Initial confirmation methods for tracheal intubation:
- A. cm marking on the endotracheal tube
- Definition: Indicates the depth of insertion but does NOT confirm correct placement in the trachea.
- B. Observable condensation in the tube
- Definition: Associated with tracheal intubation but not a confirmation of correct placement.
- C. Pulse oximetry
- Definition: Used to assess oxygenation; does NOT provide confirmation of tracheal intubation.
- D. Colorimetric capnography (Correct Answer)
- Definition: Assesses CO2 presence and confirms tracheal intubation when CO2 is detected.
APGAR Scoring for Newborns
- A respiratory therapist reviewing a newborn's history post-birth collects information:
- 1-minute Appearance: Acrocyanosis (score 1) - 5 minutes Appearance: Pink (score 2)
- 1-minute Heart Rate: 70/min (score 1) - 5 minutes Heart Rate: 110/min (score 2)
- 1-minute Reflex: Cough (score 2) - 5 minutes Reflex: Active motion (score 2)
- 1-minute Muscle Tone: Weak (score 1) - 5 minutes Muscle Tone: Active motion (score 2)
- 1-minute Respiratory Rate: 20/min (score 1) - 5-minute Respiratory Rate: 40/min (score 2)
- APGAR scores:
- 1-minute: 6 (total from scores: 1 + 1 + 2 + 1 + 1)
- 5-minute: 10 (total from scores: 2 + 2 + 2 + 2 + 2)
Management of Bronchiectasis
- A 58-year-old woman diagnosed with bronchiectasis reports:
- Increased cough and difficulty clearing secretions.
- Chest radiographs show no significant changes.
- First recommendation by respiratory therapist:
- B. Airway clearance therapy (Correct Answer)
- Treatment includes techniques to loosen and mobilize secretions for bronchiectasis patients.
- Other options:
- A. Transtracheal aspiration: Invasive and not needed as patient can produce sputum.
- C. Bronchodilator treatments: Alone, won't aid in secretion clearance.
- D. Respiratory isolation: Not applicable since no communicable disease is indicated.
Exercise-Induced Asthma Management
- A 24-year-old female diagnosed with exercise-induced asthma using Albuterol as needed:
- Recommended next step by respiratory therapist:
- C. Instruct the patient to use Albuterol 15 minutes before exercising (Correct Answer).
- Other options:
- A. Allergy skin testing not routine for this condition.
- B. Daily peak flow measurements not useful for exercise-induced asthma.
- D. Pursed lip breathing not a standard recommendation for exercise-induced asthma.
Drying of Tracheal Secretions in Intubated Patients
- Conditions leading to drying of tracheal secretions:
- B. Relative humidity of 100% at 22°C (71.6°F) (Correct Answer).
- Other options explained:
- A. Water vapor pressure of 47 mm Hg provides 100% humidity at body temperature, not drying.
- C. Dew point of 37°C (98.6°F) indicates complete saturation, hence no drying.
- D. Absolute humidity of 44 mg/L is significantly above physiological levels.
Suctioning Protocols for Ventilated Patients
- For suctioning endotracheal tube of an adult patient on FIO2 0.40:
- B. Hyperoxygenate the patient before suctioning (Correct Answer).
- Other options reviewed:
- A. Lubricating catheter unnecessary unless nasotracheal suctioning.
- C. Cleansing catheter not required as they are sterile.
- D. Administering FIO2 of 0.40 without positive pressure compromises oxygenation.
Ventilation Support Decisions
- Patient on PC ventilation with apnea:
- A. Set inspiratory pressure increased (Correct Answer).
- C. Sensitivity increase not beneficial here.
- D. Peak flow cannot be set in PC ventilation.
Pneumothorax in Patients Post-CABG
- Patient 68 years old post-CABG is receiving 4-L oxygen with significant shortness of breath:
- Recommended study:
- D. Chest radiograph (Correct Answer) to assess possible pneumothorax or other complications.
- Other options analyzed:
- A. Bedside spirometry not immediately useful post-surgery.
- B. Chest CT with contrast useful but not first line.
- C. V/Q scan specific for suspected embolism.
Anesthesia for Bronchoscopy Procedures
- Medication used to anesthetize the airway:
- A. Lidocaine HCl (Correct Answer) as it reduces airway reflexes.
- Other alternatives explored:
- B. Midazolam: Provides sedation but not local anesthesia.
- C. Ketamine: Increases secretions, may lead to respiratory depression.
- D. Vecuronium: Paralytic, does not provide topical anesthesia.
Positive Pressure Ventilation Adjustments
- A respiratory therapist evaluating a patient (75 kg, 180 cm, on VC, SIMV):
- ABG shows:
- pH 7.27, PaCO2 55 mm Hg - recommending:
- B. Increase mandatory rate to 12 (Correct Answer) to increase ventilation and correct respiratory acidosis.
COPD Patient Interventions
- Patient with COPD, ABG pH 7.40 shows elevated PCO2 57 mmHg:
- Recommend initiation of supplemental oxygen (Correct Answer).
Pulse Oximetry Accuracy in Clinical Conditions
- Accurate indication given:
- A. Congestive heart failure, polycythemia, pulmonary hypertension (Correct Answer).
- Note: Carbon monoxide poisoning misreads oxyhemoglobin as carboxyhemoglobin resulting in inaccuracies with standard pulse oximetry.
Airway Management During Transport
- Required equipment when transporting a mechanically ventilated patient:
- A. Bag-valve mask resuscitator (Correct Answer).
Evaluation of Ventilator Effectiveness
- Evaluation after premature disconnection:
- C. Conduct an evaluation of the mechanical ventilator for any significant changes in operational characteristics.
Home Apnea Monitoring in Infants
- Indication for home apnea monitoring:
- B. Caffeine citrate, administered daily (Correct Answer).
Quality Control for Blood Gas Analyzers
- Requirement per CLIA standards:
- A. Quality control every 8 hours (Correct Answer).
Use of N95 Mask and Infection Control
- Required device for airborne precautions:
- A. N95 face mask (Correct Answer).
Imaging Techniques for Non-Small Cell Lung Cancer
- Recommended imaging technique for metastatic disease assessment:
- A. PET scan (Correct Answer).