While performing routine oxygen rounds, the respiratory therapist notes a COPD
patient who is receiving supplemental oxygen at 2 L/min is markedly cyanotic
and has a heart rate of 30/min. The therapist should FIRST
A. switch to FIO2 1.0
B. increase flow to 4 L/min by nasal cannula
C. obtain an arterial blood gas
D. go get help - ANS ✓The correct answer is : A
Explanation : Even though a COPD patient should rarely receive more than 2
L/min oxygen, there are emergency circumstances that would dictate more
supplemental oxygen. The use of the word "markedly" is an indication of an
emergency. In this case the patient is markedly cyanotic and therefore has an
oxygenation emergency. Switching to 100% oxygen is appropriate.
A respiratory therapist notices the cuff pressure on an endotracheal tube is 10
cm H2O. After introducing 10.0 mL of air, the cuff pressure is 5 cm H2O. The
patient is receiving positive pressure ventilation. The therapist should
recommend
A. replacing the ET tube
B. clamping the pilot tube
C. monitoring the patient
D. initiating high frequency jet ventilation - ANS ✓The correct answer is : A
TMC EXAM
, 2
TMC
Explanation : The ET tube cuff that fails to increase in pressure after introducing
additional air is most likely damaged. When a part of an ET tube is damaged, the
only acceptable option is to replace it.
Which of the following laboratory examinations would be helpful in further
assessing a patient with diabetic ketoacidosis?
A. creatinine
B. PD50
C. glucose level
D. P50 - ANS ✓The correct answer is : C
Explanation : A patient with diabetic ketoacidosis primarily has a problem with
the blood glucose level. Further assessment therefore can be done by examining
the glucose level.
What would most likely be indicated by an elevated CVP?
A. pulmonary embolism
B. fluid overload
C. left heart failure
D. increased pulmonary vascular resistance - ANS ✓The correct answer is : B
Explanation : Hypervolemia (fluid overload) is shown hemodynamically by an
increase in all hemodynamic values including CVP, PAP, PCWP, and cardiac
output. Among these values CVP is the first and most significant indicator when
fluid levels in the body are high or low. Remember, CVP may be known by other
names such as, right atrial pressure, right side preload, right ventricular filling
pressure, and right ventricular end-diastolic pressure.
For which of the following conditions is PEP therapy most beneficial?
TMC EXAM
, 3
TMC
A. Postoperative recovery
B. ARDS
C. pneumonia
D. myasthenia gravis - ANS ✓The correct answer is : C
Explanation : PEP therapy is beneficial at removing secretions. Of the options
given, only pneumonia is a disease where secretions are a primary concern.
Which of the following would be most helpful in determining if a patient
regularly smokes tobacco products?
A. COHb
B. end-tidal carbon dioxide
C. DLCO
D. pulse oximetery - ANS ✓The correct answer is : A
Explanation : The most reliable data that indicates the degree to which the
patient has recently been smoking comes from a COHb analysis.
A 32-year-old 81-kg (178-lb) adult male is receiving mechanical ventilatory
support. Settings are as follows:
Mode Assist/control
Mandatory rate 10
Total rate 18
Tidal volume 450 mL
FIO2 0.6
PEEP 5 cm H2O
TMC EXAM
, 4
TMC
The patient is cyanotic and anxious. The respiratory therapist will recommend
which of the following?
A. decrease mandatory rate
B. increase tidal volume
C. increase inspiratory flow rate
D. increase FIO2 - ANS ✓The correct answer is : B
Explanation : All of the answers offered indicate a change in the ventilator
settings. However, the question shows no evidence of arterial blood gas analysis.
This is because a close examination of the ventilator settings will show that there
is something wrong. The patient weighs 81 kg which would suggest a minimum
tidal volume of 500 mL. (6 x 81 kg = 486 mL). The patient's set tidal volume is
only 450 mL. This should be corrected.
The following graphic (shows fluttering expiratory flow) from an orally intubated
patient receiving mechanical ventilation is most likely caused by
A. vocal cord paralysis
B. condensate in the tubing
C. fixed upper airway obstruction
D. PEP therapy - ANS ✓The correct answer is : B
Explanation : Condensate in the tubing will show up as a fluttering expiratory
flow.
Which of the following patients would benefit most from an inverse I:E ratio
ventilation?
A. ARDS
B. chronic bronchitis
TMC EXAM
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller DoctorKen. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.99. You're not tied to anything after your purchase.
