TMC TEST BANK FINAL EXAM QUESTIONS
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QUESTIONS
A physician orders 2 L/min O2 via simple mask to a 33 year-old post-op female patient with moderate
hypoxemia breathing room air (PaO2 = 52 mm Hg). The correct action at this time would be to:
Select one:
A. carry out the physician's prescription exactly as written
B. recommend a flow of at least 5 L/min to wash out CO2
C. recommend that the mask be changed to a cannula at 2 L/min
D. not apply the oxygen until contacting the medical director
- ANSWER B. recommend a flow of at least 5 L/min to wash out CO2
After PEEP was changed from 5 cm H2O to 10 cm H2O, a patient's blood pressure dropped from 120/80
mm Hg to 100/70 mm Hg, and the SpO2 increased from 87% to 91% with an FIO2 of 0.60. Which of the
following should you do?
Select one:
A. Increase the FIO2 to 1.00
B. Return the PEEP to 5 cm H2O
C. Decrease the PEEP to 0 cm H2O
D. Maintain PEEP at 10 cm H2O
- ANSWER D. Maintain PEEP at 10 cm H2O
,A 59-year-old postoperative man who weighs 77 kg (169 lb) is receiving volume control A/C ventilation at
a rate of 14/min with a tidal volume of 650 mL and an FIO2 of 0.4. Results of arterial blood gas analysis
are as follows:
Blood Gases
pH = 7.51
PaCO2 = 30 torr
HCO3 = 23 mEq/L
BE = -1
PaO2 = 117 torr
SaO2 = 99%
Based on this information, you should recommend which of the following?
Select one:
A. decrease the minute ventilation
B. discontinue mechanical ventilation
C. increase the peak flow setting
D. administer IV bicarbonate
- ANSWER A. decrease the minute ventilation
After weaning and extubation, a patient on a cool aerosol mask at 40% O2 develops moderate
hypoxemia and hypercapnia, with a falling pH. Which of the following actions would you recommend at
this time?
Select one:
A. increase the nebulizer oxygen concentration to 60%
B. apply bi-level positive airway pressure via mask
C. administer 50 mEq IV sodium bicarbonate
D. re-intubate and apply volume control ventilation
,- ANSWER B. apply bi-level positive airway pressure via mask
A neonate born 10 weeks premature is developing signs of respiratory distress syndrome (RDS). On
standard volume controlled SIMV with 90% O2, he is still severely hypoxemic, exhibits sternal retractions,
and has bilateral infiltrates and air bronchograms on his chest X-ray. What should you recommend?
Select one:
A. Instill surfactant through the endotracheal tube
B. Nebulize albuterol (Proventil) through a SVN
C. Change to a high-frequency ventilator
D. Add 10 cm H2O PEEP
- ANSWER A. Instill surfactant through the endotracheal tube
Prior to beginning an adrenergic aerosol bronchodilator treatment on an adult patient, you record a
resting heart rate of 132/min. Which of the following would be the correct action in this case?
Select one:
A. double the drug diluent and prolong the administration time
B. have the patient self-administer the aerosol treatment
C. postpone therapy until able to contact the ordering physician
D. use half the standard dosage listed in the package insert
- ANSWER C. postpone therapy until able to contact the ordering physician
The intracranial pressure (ICP) of a patient with closed head trauma receiving volume control A/C
ventilation has risen from 18 mm Hg to 26 mm Hg despite aggressive treatment with osmotic diuresis,
CSF fluid drainage, sedation and neuromuscular blockade. Which of the following short-term ventilatory
strategies would you recommend to help manage this patient?
Select one:
A. decelerating flows
B. inspiratory hold
, C. hyperventilation
D. high PEEP
- ANSWER C. hyperventilation
When treating a patient with active tuberculosis, you note large amounts of bloody secretions. You
should notify the:
Select one:
A. nearest relative
B. attending physician
C. department medical director
D. respiratory supervisor
- ANSWER B. attending physician
A doctor asks you to assess if a 65 kg (143 lb) patient with a neuromuscular disorder receiving volume
control SIMV is ready for weaning. You obtain the following data during a bedside ventilatory
assessment:
Spontaneous tidal volume: 250 mL
Minute ventilation: 8.5 L/min
Vital capacity: 700 mL
Max inspiratory pressure: -28 cm H2O
Based on this information, which of the following would you recommend?
Select one:
A. begin a spontaneous breathing T-piece trial
B. postpone weaning and re-evaluate the patient
C. begin weaning using a pressure support protocol
D. begin weaning by decreasing the SIMV rate
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