Respiratory Therapy Exam Review

Respiratory Therapy Study Notes

Endotracheal Intubation Confirmation

  • Key Question: A respiratory therapist is assisting a physician with endotracheal intubation. Which method 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
  • Explanations:
    • A: cm marking provides the depth but does not confirm placement in the trachea.
    • B: Condensation may appear but does not confirm correct placement.
    • C: Pulse oximetry measures oxygenation, not confirmation of intubation.
    • D: Colorimetric capnography measures CO2 presence, confirming tracheal intubation when CO2 is detected.

APGAR Scores Assessment of Newborn

  • Key Question: Based on the newborn’s history, what APGAR scores should be expected?

    • 1-minute APGAR: 6
    • 5-minute APGAR: 10

  • Score Breakdown for 1 Minute:

    • Appearance: acrocyanosis = 1
    • Heart rate 70/min = 1
    • Reflex: cough = 2
    • Muscle tone: weak = 1
    • Respiratory rate 20/min = 1

  • Score Breakdown for 5 Minutes:

    • Appearance: pink = 2
    • Heart rate 110/min = 2
    • Reflex: cough = 2
    • Muscle tone: active motion = 2
    • Respiratory rate 40/min = 2

  • APGAR Score Options:

    • 1. 4, 8
    • 2. 5, 8
    • 3. √ 6, 10
    • 4. 7, 10

Management of Bronchiectasis

  • Key Question: What should be recommended FIRST for a 58-year-old female with bronchiectasis who reports increased cough and difficulty clearing secretions?
    • A. transtracheal aspiration
    • B. √ airway clearance therapy
    • C. bronchodilator treatments
    • D. respiratory isolation
  • Explanations:
    • A: Unnecessarily invasive since the patient can produce sputum samples.
    • B: Airway clearance therapy is essential for bronchiectasis treatment, focusing on secretion removal.
    • C: Bronchodilators won’t aid in secretion removal.
    • D: No communicable disease indicated, hence isolation is not necessary.

Exercise-Induced Asthma Management

  • Key Question: What should a respiratory therapist instruct the patient diagnosed with exercise-induced asthma?
    • A. refer for allergy skin testing.
    • B. educate on daily peak flow measurements.
    • C. √ instruct to use albuterol 15 minutes before exercising.
    • D. suggest pursed lip breathing while exercising.
  • Explanations:
    • A: Allergy testing not routine in managing exercise-induced asthma.
    • B: Daily peak flow is less useful for this type of asthma.
    • C: Understanding of disease triggers is crucial.
    • D: Pursed lip breathing is ineffective for exercise-induced asthma.

Humidity and Intubation

  • Key Question: When do 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 (71.6° F)
    • C. a dew point of 37° C (98.6° F)
    • D. an absolute humidity of 44 mg/L
  • Explanations:
    • A: 47 mm Hg provides 100% humidity at body temp.
    • B: Absolute humidity at this temp is inadequate.
    • C: Dew point indicates saturation.
    • D: Tracheal humidity must be > 30 mg/L to prevent drying.

Suctioning Prior to Ventilation

  • Key Question: Prior to suctioning an endotracheal tube of a patient receiving FIO2 of 0.40, what should be done FIRST?
    • A. lubricate the catheter.
    • B. √ hyperoxygenate the patient.
    • C. cleanse the catheter with water.
    • D. administer FIO2 of 0.40 by T-piece.
  • Explanations:
    • A: Lubrication is unnecessary unless nasotracheal suctioning is planned.
    • B: Hyperoxygenation minimizes hypoxemia during suctioning.
    • C: Sterile catheters don’t require prior cleansing.
    • D: Administration of FIO2 without positive pressure can affect patient’s oxygenation.

Patient Management in Mechanical Ventilation into CPR

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  • Key Question: Patient diagnosed with apnea receiving PC ventilation shows ABG results of:
    • pH 7.20
    • PCO2 65 mm Hg
    • PO2 70 mm Hg
    • HCO3- 25 mEq/L
    • BE -4 mEq/L
    • SO2 (calc) 94%
  • Recommendation: Increase the
    • A. √ set inspiratory pressure.
    • B. expiratory time.
    • C. sensitivity.
    • D. peak flow.
  • Explanations:
    • A: Increasing inspiratory pressure aids in tidal volume increase, decreasing PCO2.
    • B: More expiratory time decreases tidal volumes and increases PCO2.
    • C: Increasing sensitivity doesn’t improve ventilation.
    • D: Peak flow isn't set in PC ventilation.

Assessment of a Patient Post-CABG

  • Key Question: An adult post-CABG patient 4 hours extubated complains of dyspnea. Recommendations?
    • A. bedside spirometry
    • B. chest CT with contrast
    • C. ventilation/perfusion scan
    • D. √ chest radiograph
  • Explanations:
    • A: Spirometry isn’t useful so early post-op.
    • B: CT isn’t the priority at this stage.
    • C: Mostly for pulmonary embolism.
    • D: Conditions like pneumothorax may also cause dyspnea and a radiograph can quickly identify issues.

Airway Anesthesia for Bronchoscopy

  • Key Question: For airway anesthesia before bronchoscopy, which medication should be used?
    • A. √ lidocaine HCl
    • B. midazolam HCl (Versed)
    • C. ketamine (Ketalar)
    • D. vecuronium bromide (Norcuron)
  • Explanations:
    • A: Lidocaine HCl reduces airway reflexes during the procedure.
    • B: Midazolam calms but doesn’t reduce airway reflexes.
    • C: Ketamine increases secretions and isn’t a local anesthetic.
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