TMC EXAM 4 question and correct answers 100% 2023

TMC EXAM 4 question and correct answers 100% 2023Which of the following equipment is most helpful at measuring FRC in a patient who has significant non-ventilated lung spaces? A. nitrogen analyzer for a nitrogen washout test B. helium analyzer for a helium dilution test C. plethysmograph D. peak flow meter The correct answer is : C Explanation : You can determine FRC in three different ways - body box, nitrogen washout, or helium dilution. If someone has non-ventilated lung space, nitrogen washout and helium dilution are not helpful and may be inaccurate. FRC determined by body box will be higher because it can access non-ventilated lung space and therefore is more accurate. The respiratory therapist is making a home visit to evaluate an oxygen-dependent patient. The patient has 3+ pitting peripheral edema and has not followed the physician's orders to limit fluid intake. You would expect which of the following hemodynamic values? A. elevated PCWP with a low cardiac output B. low mean arterial pressure C. elevated right sided preload with a normal to low right ventricular after load D. reduced cardiac index The correct answer is : C Explanation : Right-sided preload is another name for CVP (central venous pressure). Peripheral edema is one of the signs associated with right heart failure, which results in an elevated CVP with a normal or low pulmonary artery pressure (PAP), a.k.a. right ventricular afterload. A ventilator-dependent patient is scheduled for an MRI, which will require a transport of 90 minutes. The patient is receiving humidification with a heated- humidification system. A transport ventilator is available. How should a respiratory therapist assure that humidification will be provided to the patient during the MRI procedure? A. Provide a pass-over humidifier B. Provide an HME C. Provide ventilation with a manual resuscitator D. Use the same humidification system in use on the primary ventilator The correct answer is : B Explanation : A heat moisture exchanger (HME) is appropriate for a transport of only 90 min. Furthermore, the scenario does not suggest that the patient has thick, retained secretions, therefore an HME may be applied. Which of the following conditions would benefit most from polysomnography? A. COPD B. congestive heart failure C. suspected increased airway resistance D. obesity with increased day-time sleepiness The correct answer is : D Explanation : Polysomnography is another word for sleep study. An obese patient who has daytime sleepiness would benefit most from polysomnography. Keep in mind that Polysomnography is the study of the problem - not the solution. But it must be done for diagnostic purposes and in order to find the adequate CPAP setting. Which of the following can accurately be stated about a widening alveolar-arterial oxygen gradient? A. decreased venous admixture B. onset of oxygen toxicity C. increased intrapulmonary shunting D. improving V/Q mismatch The correct answer is : C Explanation : A normal alveolar arterial oxygen gradient is below 65 mmHg. When that gradient rises to 200, 300, 400, or more, then you have what is called shunting. If the A-a gradient is less than 300 it's technically called a ventilation perfusion (VQ) mismatch. But generally speaking, as the gradient widens it can properly be said that there is an increase in pulmonary shunting. How many hours will an H cylinder with 1400 psi last for a patient receiving oxygen at 7 lpm? A. 6 hours B. less than 1 hour C. 10 hours D. 4 hours The correct answer is : C Explanation : And H cylinder has a tank factor of 3.14. 3.14x1400 PSI = 4396 L. 4396 L / 7 L per minute = 628 min. 628 min./ 60 min.= 10.4 hours, or about 10 hours. When you get an answer that is not exact, pick the closest number possible. It is common on the exam not see the exact answer from your calculation. This is because the NBRC knows that you're estimating. The respiratory therapist notes a fall in pulse from 80/min to 60/min with a proportional drop in blood pressure during a suction procedure. Which of the following would be the most likely cause of these observations? A. Copious secretions B. Vagal reflex C. Transient hypoxemia D. Suction pressure is too high The correct answer is : B Explanation : During suctioning, a patient's heart rate may fall. This is a normal physiological response associated with the vagal reflex, or the vagal nerve response. This response will also lower blood pressure. A bronchopleural fistula on a patient receiving mechanical ventilation with a chest tube drainage system in place would be most likely be indicated by which of the following observations? A. occasional low-exhaled volume alarm B. high pressure ventilator alarm C. excess bubbling in the water seal chamber D. I:E ratio alarms The correct answer is : C Explanation : A bronchopleural fistula is essentially a leak from the airway in the lungs to the pleural space. This condition can result in two things - one) a low-pressure or low-volume alarm, 2) excess bubbling in the water seal chamber of the chest tube drainage system. When you look at the answers, a leak would not cause a high pressure alarm. The best test determination for a forced vital capacity maneuver is done by which of the following calculations? A. FEV1 + FVC B. SVC + FVC C. TLC - FVC D. FEV1/FVC The correct answer is : A Explanation : To determine the best trial or best patient effort for a forced vital capacity maneuver, the trial with the highest sum of the FEV1 and FVC is considered to be the patient's best effort. Which of the following medications would be helpful at reversing the affect of a benzodiazepine medication? A. Narcan B. Romazicon C. Versed D. Norcuron The correct answer is : B Explanation : Romazicon is the only medication on the list that can reverse the effects of benzodiazepines. A mechanically ventilated patient who with an 8.0 mm trachestomy tube in place has a strong cough, but is unable to expectorate thick, dry secretions. During an attempt to suction the patient, the tube becomes dislodged, but promptly placed back to its proper position. Following the procedure, the respiratory therapist notes dry crackles in the right upper lobe and neck upon auscultation. These breath sounds would most likely be associated with A. retained secretions in the airway B. pneumothorax C. subcutaneous emphysema D. bleb emphysema The correct answer is : C Explanation : In this scenario the respiratory therapist should assume that while the tube was dislodged, breaths delivered by the ventilator caused air to be forced into soft tissue areas under the skin outside of the trachea. This condition is known as subcutaneous emphysema. Auscultation reveals dry crackles and crepitus upon palpation. An emergency room physician orders an arterial blood gas with Carboxyhemoglobin level. This exam will help the physician determine which of the following? A. CO poisoning B. Presence of sickle cell anemia C. Carbon dioxide serum levels D. Presence of fetal hemoglobin The correct answer is : A Explanation : Carboxyhemoglobin (COHb) levels are determined with an instrument called a co-oximeter, which directly measures arterial blood COHb. Both carbon monoxide poisoning and evidence of smoking, or exposure to cigarette smoke can be determined with the COHb level. What is the relative humidity of the inspired gas of a patient who is intubated if the humidity deficit is 33 mg/L? A. 50% B. 75% C. 100% D. 25% The correct answer is : D Explanation : There are 44 mg of water per liter of gas if the gas is at 100% relative humidity. If you have only 11 mg/L of gas (deficit of 33 mg) then you have only 25% relative humidity because 11 mg is 25% of 44. A COPD patient who has bilateral expiratory wheezing would benefit most immediately from which of the following medications? A. Tilade (Nedocromil) B. Budesonide (Pulmicort) C. Albuterol D. Acetylcysteine (Mucomyst) The correct answer is : C Explanation : A COPD patient would benefit most from short-term bronchodilation because the patient is currently wheezing. Of the options listed, only albuterol is considered to be a bronchodilator. A patient with acute epiglottitis is awaiting transport to surgery for a tracheotomy under anesthesia. SpO2 is 88% on room air. While waiting the patient would benefit most from which of the following? A. heliox therapy with 60%/40% mixture B. high flow Venturi mask set at 50% C. simple mask at 6 L/min D. nasal cannula at 2 L/min The correct answer is : A Explanation : The patient has an arterial oxygen saturation of 88% on room air. This is consistent with hypoxemia and indicates a need for supplemental oxygen. Because the patient has acute epiglottitis, Heliox therapy is appropriate to reduce airway resistance. Additionally, the patient would benefit from an adult therapeutic dose of oxygen, which starts at 40%. Therefore, 60-40% Heliox mixture is most appropriate. An MVA victim with severe facial trauma has been trached in the emergency room. The respiratory therapist should now provide A. heated/humidified aerosol at FIO2 1.0 B. cool aerosol at FIO2 0.50 C. heated/humidified aerosol at FIO2 0.50 D. cool aerosol at FIO2 1.0 The correct answer is : A Explanation : In this example, the patient's natural upper airway has been by-passed and the respiratory therapist should be concerned about delivery of cold dry gas. Heat and humidification are the therapist's primary concern. 100% oxygen is also necessary due to the emergent nature of the patient's condition having suffered a motor vehicle accident. A patient is receiving a positive pressure treatment through a fenestrated tracheostomy tube. To prepare the patient to be able to speak, the respiratory therapist should FIRST A. inflate the cuff B. insert the inner cannula C. deflate the cuff D. cap the tube The correct answer is : C Explanation : When a patient has a fenestrated tracheostomy tube and requires transitioning from a positive pressure ventilation configuration to a speaking configuration, the first step is to deflate the cuff. The respiratory therapist should discontinue beta sympathomimetic aerosol therapy in which of the following scenarios? A. A pediatric patient does not cooperate with the therapy B. An asthmatic patient has a peak flow rate that is 75% of predicted or better C. The patient experiences nausea and tingling in their extremities D. A COPD patient is smoking cigarettes between therapy The correct answer is : C Explanation : Beta sympathomimetic medications such as albuterol, Alupent, Xopenex, etc., should be discontinued if the patient does not tolerate them well. Tingling in the extremities, nausea, & increased heart rate greater than 20 bpm, are all examples of poor tolerance. Prior to obtaining an MIP value with a pressure manometer, the respiratory therapist notes the needle is pointing at a positive pressure of 7 cm H2O prior to the maneuver. During the MIP maneuver, the needle reaches -20 cmH2O. The therapist should A. record an MIP of -27 cmH2O B. repeat the maneuver five more times C. record an MIP of -13 cmH2O D. record and MIP of -20 cmH2O The correct answer is : A Explanation : Although -20 cmH2O is observed on the pressure manometer, the real pressure being produced is -27 cmH2O. This is because the manometer is not properly calibrated to zero. Therefore, an adjustment must be accounted for when taking a measurement. You must add the number that the needle is pointing to prior to the maneuver to the number achieved by the patient during the maneuver to get an accurate measurement. A patient who is receiving mechanical ventilation in the assist/control mode with a PEEP of 10 cmH2O is being manually ventilated during a transport to CT scan. During the transport, the respiratory therapist notices desaturation and feels the PEEP should be increased. To do this, the therapist should A. increase oxygen flow rate to the bag B. cover the exhalation port C. squeeze the bag at a higher rate D. increase the tension on the PEEP spring The correct answer is : D Explanation : To increase the PEEP of the patient receiving positive pressure ventilation by manual resuscitation bag, one must tighten or increase the tension of the PEEP spring. To do this, the PEEP valve should be turned clockwise. A patient with diabetes has significant respiratory distress. Arterial blood gases reveal a pH of 7.10, PaCO2 of 29 torr, and a PaO2 of 81 torr. The patient has a spontaneous tidal volume of 700 mL and a respiratory rate of 30/min. The patient is receiving 100% oxygen by an air entrainment device with the flow at 15 L/min. Which of the following will help the patient and is the most appropriate action? A. sedate the patient B. employ a tandem air-entrainment device C. increase flow rate to 25 L/min D. switch to a Venturi mask at FIO2 0.5 with a flow set at 12 L/min The correct answer is : B Explanation : Although this patient is showing obvious signs of ventilatory failure the options given do not allow us to address that problem. The options given relate to a correction of the oxygenation status of the patient. If you look closely you will see that the total gas flow to the patient at 100% at 15 L per minute is insufficient to keep up with the patient's inspiratory demand. Some simple math, multiplying 600 mL times a rate of 30 per minute is equal to a minute ventilation of 18 L/min. But, the patient is receiving only 15 L/min. To correct this problem and meet or exceed the patient's inspiratory demand, the best option is to utilize a tandem device, or a side-by-side large volume nebulizer. This will double the total flow to the patient to be 30 L/min, which will exceed the patient's inspiratory demand. If a pressure-cycled mechanical ventilator had a leak in the circuit, what would the respiratory therapist expect to see? A. Peak pressures would decrease B. The flowrate would automatically increase to compensate C. The pressure monometer would have a negative deflection during each breath D. The mechanical breaths would not cycle off as expected The correct answer is : D Explanation : In pressure-cycled mechanical ventilation the positive pressure breaths stop once the preset pressure is reached. If the circuit has a leak the preset pressure cannot be reached, and therefore the machine will fail to cycle into exhalation. What would occur on a time-cycled ventilator with a fixed rate if the inspiratory flow rate were reduced? A. decrease in tidal volume B. increase in tidal volume C. increase in inspiratory time D. decrease in inspiratory time The correct answer is : A Explanation : On a time cycle ventilator, with a fixed rate and a fixed inspiratory time, if inspiratory flow rate is decreased, the result would be a decrease in tidal volume. Which of the following indicate a patient is ready to wean from mechanical ventilation? A. RSBI 138 B. VT of 6 mL/kg C. MIP of -12 cmH2O D. A-aDO2 of 380 mmHg The correct answer is : B Explanation : In order to wean from the ventilator the MIP must be more than -28 cmH2O. Tidal volume must be at least 5 mL per kilogram and RSBI must be less than 106. The alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this case only the tidal volume of 6 mL per kilogram and the RSBI of 90 indicate the patient is ready to wean from mechanical ventilatory support. Which of the following classes of medication is most helpful in treating an adult who has moderate stridor following endotracheal extubation? A. corticosteroid B. decongestant C. aminoglycocide D. vasoactive The correct answer is : B Explanation : Mild stridor can be treated with a cool mist or racemic epinephrine. Moderate stridor should be treated with racemic epinephrine. Severe or marked stridor should be managed as an emergency and treated through intubation or an emergency tracheotomy. Which of the following would be helpful during a bronchoscopy procedure to ensure adequate continuous ventilatory support for a patient who is receiving mechanical ventilation and is dependent on high levels of PEEP? A. high frequency jet ventilation B. resuscitation bag with a PEEP valve C. Halcinon D. closed in-line suction catheter The correct answer is : A Explanation : High-frequency jet ventilation may be helpful when a patient is undergoing a bronchoscopy. This sort of ventilation keeps mean airway pressures down while the bronchoscope is in place. The physician has asked the respiratory therapist to help determine oxygen consumption by the tissues. The therapist should suggest evaluation of which of the following? A. PaO2 B. CaO2 C. C(a-v)O2 D. CvO2 The correct answer is : C Explanation : Oxygen available at the tissue level is best determined by examining the arterial oxygen content or CaO2. However, to determine how much oxygen the tissue is consuming we must look at both the CaO2 and the CVO2. This allows us to determine how much oxygen existed before the tissues and how much oxygen exists after the tissues. When we subtract one from the other we get the C(a-v)O2. This value is most closely related with oxygen consumption at the tissue level. Arterial blood gases on a patient in the cardiac intensive care unit are as follows: pH 7.31 PaCO2 35 mm Hg PaO2 100 mm Hg HCO3- 18 mEq/L BE -6 mEq/L Which of the following is an appropriate action? A. increase FIO2 B. administer sodium bicarbonate C. decrease FIO2 D. increase minute volume The correct answer is : B Explanation : When we look at a patient's blood gas we usually start by looking at the ventilation aspect. In this case the PaCO2, which is 35 mmHg, shows normal ventilation and therefore should have normal acid-base relationship. However, when we observe the acid-base relationship we see that the pH is 7.31 and therefore is acidodic. If the source of the acidosis is not respiratory, then it must be metabolic. A quick glance at the rest of the blood gas shows the HCO3- is low. Therefore, the administration of sodium bicarbonate is most appropriate to treat metabolic acidosis.