TMC Problem questions & Answers. 100% Accurate. Graded A

TMC Problem questions & Answers. 100% Accurate. Graded A What is the range for normal pH? - -7.35 -- 7.45 What is the range for normal PaCO2? - -45 -- 35mmHg What is the range for normal HCO3? - -22 -- 24 or 26mmHg What do you think when pH is normal? - -Fully compensated What do you think when pH is abnormal? - -Partially compensated What do you think when HCO3 or PaCO2 is normal? - -Uncompensated What do you think when PaCO2 is decreased? - -Respiratory What is the normal minute ventilation? - -5-8L/min What is normal vital capacity? - -60-70mL/kg What are the indications for ventilatory assistance for a patient with Guillain-Barre? - -VC 20mL/kg MIP 30cmH2O MEP 40cmH2O OR A reduction of 30% in VC, MIP, MEP When calibrating the nitric oxide analyzer, what do you want to calibrate it to? - -45ppm An oxygen concentrator has been used in a patient's home the RT must do what? - -Change the filters A jet nebulizer with an entrainment set at 35% with proper calibration concentration reads 45%. What is the increase due to? - -Water in the tubing Will increase the need for more flow or pressure FEV values should be consistent, what should be done if they are not consistent? - -The test must be re-done What is the highest level for disinfection of non-disposable ventilator tubing? - -Pasteurization An ABG is normal but the PaO2 is 288mmHg, what could be the cause of this? - -There is a lab error A patient with pneumonia on the ventilator with a PIP of 45cmH2O and the high pressure alarms are sounding. What should you do? - -Switch to PC/AC Because the patient needs more pressure or because they need the pressure regulated What supplies do you need for insertion of a chest tube? - -Hemostat and 3-way stopcock What is DLCO? - -The diffuse capacity of the lung for carbon monoxide in a single breath What is pleurodesis? - -A medical procedure in which the pleural space is artificially obliterated and adhesion of the two pleurae What will cause a peak pressure to increase from 20cmH2O to 30cmH2O after 6 hours of monitoring? - -Decreased compliance AND increased airway resistance The less compliant the more pressure is needed to open the alveoli and the more airway resistance the more pressure is needed to allow flow through How many mL is in 1mg? - -0.001mL Albuterol dosage 1.25mg of 0.5%? - -0.25mL 1.25mg/0.5mg= 2.5x0.001mL= 0.0025mLx100mL= 0.25mL What do you examine for a patient with Duchenne muscular dystrophy with a VC of 625mL? - -MIP A patient is intubated, 17cm with 8mm ETT, has gurgling, balloon is inflated from 16cmH2O to 29cmH2O but the gurgling persists. What do you do now? - -Advance the ETT 5cm further It wasn't far enough in What is the best index for O2 transport after carbon monoxide poisoning? - -Arterial Oxygen Content What will produce purulent green and separated into layers with a foul odor sputum? - -Bronchiectasis What will increase methemoglobin? - -Topical silver nitrate Nitroglycerine infusion Inhaled NO What is the reason to aerosolize corticosteroids? - -To reduce systemic side effects What temperature should transcutaneous monitoring be heated to? - -42-45C What should you measure when Myasthenia Gravis MIP changes from -35 to -16 in the last 4 hours? - -VC What does NIPRIDE do? - -Reduces BP What does sodium nitroprusside do? - -Reduces ventricular preload An ER patient with loud wheezing was given 2 treatments and the breath sounds are now diminished, what has happened with the patient? - -The patient has gotten worse The airways have began to close up How is VE calculated? - -Vt x RR With quality control how many standard deviations are allowed with the blood gas analyzer? - -2 What does vesicular breath sounds throughout periphery of the lung mean? - -That is normal What will lower MAP in a patient receiving VC ventilation? - -Decrease the I-time A patient has been intubated for 4 days and secretions have become tenacious, what should be done now? - -Ensure airway temperature is at least 35C A patient with bronchopleural fistula and becomes hypoxic while on VC ventilation, what should you do now? - -Place on HFOV What is a device that provides 100% humidity at body temperature? - -Heated-wick humidifier What is the correct placement for decompression of a tension pneumothorax? - -Over the 3rd rib in the mid clavicular line What is a normal value for sodium? - -138 What will frequent vomiting show for K and Cl? - -3.2 82 What wave do you want to synch with during cardioversion? - -R-wave VC+FRC-EVR= ? - -TLC What should be done after a patient violently coughs after a nasopharyngeal airway is inserted? - -Insert a shorter length There is a suspected drug overdose on VC, A/C ventilation. Weighing 51kg, mandatory rate of 14, Vt of 300mL, inspiratory flow of 20mL.min and pressure limit of 50cmH2O. The patients I:E is 1:1.2, how would you go about making it 1:3? - -Increase the inspiratory flow pH = 7.42 PaCO2 = 31mmHg PaO2 = 38mmHg HCO3 = 20mEq/L BE = -3mEq/L SaO2 = 71% - -Partially compensated metabolic alkalosis With a Mallampati score of 4, what will help intubation? - -Video laryngoscopy During a spontaneous breathing trial, RR is 12/min and exhaled Vt is 300mL. The patient is awake and following commands. What should be done next? - -Extubate the patient The patient is in normal parameters What patient with respiratory compromise should receive priority for mechanical ventilation? - -28 year old with flail chest with multiple pulmonary contusions This is the most emergent need for ventilation What particle size should a nebulizer produce to allow proper deposition of albuterol? - -3-5 micrometers That will reach the distal airways PEEP increased from 5 to 10cmH2O for patient with ARDS on VC, A/C. With each breath, high pressure alarm sounds. The patient is stable, what is done next? - -Evaluate the alarm settings Pulmonary emphysema receiving 24% O2 for 30 minutes, PaCO2 is increased from 45 to 48mmHg and PaO2 is increased from 45 to 60mmHg, what is done next? - -Continue current O2 therapy VC ventilation, suddenly pressure limit sounds with every breath. Vital signs deteriorating, SpO2 dropping. Physical exam reveals tracheal shift to the right with absent breath sounds on the left. What should be done next? - -Perform needle compression An end-expiratory PA chest radiograph is most often useful in the detection of what? - -Small pleural effusion Difference between PADP and PCWP? - -3 During sleep, which of the following is characterized by cessation of airflow for 10seconds associated with paradoxical movement of the chest and abdomen? - -Obstructive apnea Which of the following ECG leads should be placed in the 5th intercostal space? - -V4 In order to initiate weaning, you change the patient from volume control A/C ventilation to pressure support. After 30 minutes on pressure support, the high respiratory rate alarm sounds, with the patient breathing at a rate of 25 to 30 per minute. What change should you make to the ventilator settings? - -Increase the high rate alarm to 30-35 A male patient with a smaller than normal trach tube is placed on volume control SIMV at a rate of 8/min. Over the last hour, you note the patient increasing use of his accessory muscles during spontaneous breaths, accompanied by some abdominal paradox. Which of the following would be the best way to overcome this problem? - -Add or increase pressure support Of the following patients undergoing a cardiopulmonary exercise test, for which would you recommend extra precautions? - -A patient with a resting systolic BP 200 mm Hg An unconscious apneic patient with a full stomach cannot be orally intubated in the emergency room. Which of the following would your recommend be? - -Inserting an esophageal-tracheal Combitube® The physician calls you over to examine the ABG results of a 52 kg female patient who is receiving volume control A/C ventilation. Currently the patient has a tidal volume of 400 mL, rate of 10/min, and 35% O2. Her blood gas results are as follows: pH 7.31 PaCO2 49 torr HCO3 24 mEq/L BE -2 mEq/L PaO2 74 torr SaO2 95% Based on these values, which of the following changes is appropriate? - -Increase the set rate While reviewing the flow sheet of a patient receiving artificial ventilatory support, you note a progressive rise in heart rate over the last two hours. Which of the following actions would you recommend to help identify the cause of this problem? - -Draw and analyze an arterial blood gas A 54 year-old patient is on a ventilator in the volume control mode. After you perform endotracheal suctioning, which of the following would indicate effective clearance of retained secretions? - -Lower peak pressure Which of the following valves in a typical high frequency oscillation ventilator is used to regulate the mean airway pressure? - -Control valve Which of the following is the most common problem encountered when applying assist-control mode during ventilation? - -Hyperventilation/hypocapnia Which of the following would you recommend to provide graphic data useful in evaluating the ventilator-patient interface? - -Capnography A patient with a normal cardiac output and PaO2 is exhibiting signs and symptoms of tissue hypoxia. Which of the following is the most likely cause? - -A hemoglobin deficiency While doing a normal patient assessment, you note that the arterial pressure monitor of a conscious patient in no apparent distress that the pressure waveform is absent and the alarm is sounding. What should your first action be? - -Check the A-line stopcock position