(RRT) Registered Respiratory - Kettering (Multiple Choice) Exam 100% Correct

(RRT) Registered Respiratory - Kettering (Multiple Choice) Exam 100% Correct The Pulmonologist Determines A Patient Has Dyspnea, Diminished Breath Sounds With A Dull Percussion Note On The Left. The Chest Radiograph Indicates A Tracheal Shift To The Right. Which Of The Following Disease States Should The Therapist Suspect Is Affecting The Patient? 1) Tension Pneumothorax 2) Lung Abscess 3) Atelectasis 4) Pleural Effusion ANS: 4 Rationale: A Pleural Effusion Causes Fluid To Accumulate In The Pleural Space, Leading To Dullness On Percussion And Diminished Breath Sounds Due To Lung Compression. The Trachea Shifts Away From The Side Of The Effusion, Consistent With The Rightward Shift Noted In The Chest Radiograph. A Patient Has An Infected Mucopurulent Abscess In The Right Lung. The Left Lung Is Clear Of Secretions And Infection. The Patient Requires Intubation And Mechanical Ventilation. Which Of The Following Would Be Necessary To Ventilate This Patient Appropriately? 1) Laryngeal Mask Airway 2) Esophageal Tracheal Combitube 3) Carlens Tube 4) Kamen-Wilkinson Tube ANS: 4 Rationale: A Kamen-Wilkinson Tube (Also Known As A Double-Lumen Tube) Is Used For Selective Lung Ventilation. In Cases Of Unilateral Lung Infection Or Abscess, It Allows For Ventilation Of The Unaffected Lung While Excluding The Infected Lung. A Post-Operative Patient Has A Fenestrated Tracheostomy Tube In Place. The Therapist Is Monitoring The Cuff Pressure And Notes That The Pressure Is 32 Cmh2o With A Minimal Leak. The Most Likely Explanation For This Is The... 1) Cuff Is Overinflated. 2) Obturator Is In Place. 3) Tube Is Too Small. 4) Tube Is In The Left Mainstem Bronchus. ANS: 3 Rationale: A Cuff Pressure Of 32 Cmh2o Suggests That The Cuff May Not Be Sealing Effectively, Indicating That The Tube Might Be Too Small For The Patient's Airway, Allowing A Leak. A 24 Year Old Female Has Been Admitted To The Hospital After Being Involved In A Sky Diving Accident. She Is 163 Cm Tall (5 Ft 4 In) And Weighs 55 Kg (120 Lbs). The Patient Has Been Orally Intubated With A Size 7.5 Mm Endotracheal Tube. A Chest Radiograph Reveals Bilateral Opacification Of All Lung Fields. Mechanical Ventilation Has Been Established With A Volume Ventilator At The Following Settings: Mode - Simv, Vt - 650 Ml, Rr - 12/Mm, Fio2 - 65%, Peep - 10 Cmh2o, Pip - 58 Cmh2o, Plateau Press - 50 Cmh2o. Abg: Ph: 7.3, Paco2: 43 Torr, Pao2: 45 Torr, Hco3: 21 Meq/L, Sao: 82% The Patient's Condition Is Most Likely Related To: 1) Respiratory Acidosis 2) Ventilation Perfusion Mismatch 3) Venous Admixture 4) Alveolar Hypoventilation ANS: 3 Rationale: The Severely Low Pao2 And High Pip With Bilateral Opacification Suggest Significant Ventilation-Perfusion Mismatch And Venous Admixture, Possibly Due To Shunting From Lung Injuries After The Accident. A 54 Year Old Post-Appendectomy Patient Has An Order For Sustained Maximal Inspiration Q2h While Awake. The Patient's Pre-Op Inspiratory Capacity Was 3600 Ml. An Appropriate Post-Operative Goal For This Patient Would Be... 1) 1200 Ml 2) 1800 Ml 3) 2000 Ml 4) 2400 Ml ANS: 2 Rationale: A Common Post-Operative Goal Is To Achieve At Least 50% Of Pre-Operative Inspiratory Capacity. Thus, 1800 Ml Is A Reasonable Target Based On The Pre-Operative Inspiratory Capacity Of 3600 Ml. A Patient In The Icu Is Being Mechanically Ventilated Following An Automobile Accident. The Recent Chest Radiograph Reveals Ards. Which Of The Following Guidelines Should Be Included In The Management Of This Patient? 1) Tidal Volume Of 6 Ml/Kg 2) High Levels Of Peep Therapy 3) Maintain Plateau Pressure < 30 Cm H2o ANS: 1 & 3 (Tidal Volume Of 6 Ml/Kg And Maintain Plateau Pressure < 30 Cm H2o) Rationale: In Ards Management, Low Tidal Volumes (6 Ml/Kg) Help Reduce Ventilator-Induced Lung Injury. Maintaining Plateau Pressure Under 30 Cm H2o Minimizes Barotrauma. The Respiratory Therapist Reviews The Ventilator Flow Sheet For A Post-Op Patient. The Ventilator Settings Have Not Been Changed During The Past 24 Hours. The Peak And Plateau Pressure Were Recorded As Follows: 7 Am - Peak Press: 28, Plat. Press: 23 9 Am - Peak Press: 35, Plat. Press: 25 11 Am - Peak Press: 50, Plat. Press: 26 This Information Would Indicate That 1) Airway Resistance Is Decreasing 2) Lung Compliance Is Increasing 3) The Patient Needs Suctioning 4) The Patient Can Begin Weaning ANS: 3 Rationale: The Increasing Peak Pressure Suggests That There Is Likely An Increase In Airway Resistance, Which Could Indicate The Presence Of Secretions In The Airway, Warranting Suctioning.