if the infant is hypoxemic with a normal or low PaCOif the infant is hypoxemic with a normal or low PaCOif the infant is hypoxemic with a normal or low PaCOif the infant is hypoxemic with a normal or low PaCOif the infant is hypoxemic with a normal or low PaCOif the infant is hypoxemic with a norma...
The physician orders a 35% aerosol mask to be set up for a patient who requires an
inspiratory flow of 42L/min. What is the minimum flow rate to which the flowmeter
must be set to meet this patient's inspiratory flow demands?
a. 6L/min
b. 8L/min
c. 10L/min
d. 12L/min
✓ ~~~ b. 8L/min
A premature infant is receiving O2 via a 50% O2 hood and has a PaO2 of 43 torr
and a PaCO2 of 40 torr. The RT should recommend which of the following?
a. Increase the O2 to 70%
b. Intubate and institute mech. ventilation
c. Initiate CPAP of 4cm H2O and 50% O2
d. Increase the O2 to 100%
✓ ~~~ c. Initiate CPAP of 4cm H2O and 50% O2
As with adults, if the infant is hypoxemic with a normal or low PaCO2, increase the
PaO2 by increasing oxygen to no more than 60%. Studies show that oxygen levels
exceeding 60% increase damage to the lungs. If 60% doesn't reverse the
hypoxemia, place the infant on CPAP
A patient arrives in the ED after being pulled from a burning house. The RT should
recommend obtaining which of the following measurements to best determine the
severity of the patient's smoke inhalation?
a. SpO2
b. HbCO
c. PaO2
d. Hb
✓ ~~~ b. HbCO
To best determine the severity of smoke inhalation, an HbCO level should be
determined with a co-oximeter.
The physician has ordered O2 to be administered to an active 3 year old with an
SpO2 of 86%. Which of the following delivery devices would you recommend for this
patient?
a. 1 to 2 L NC
b. Air Entrainment Mask
,c. Simple O2 Mask
d. O2 Hood
✓ ~~~ a. 1 to 2 L NC
An active 3-year-old generally tolerates a cannula much better than any kind of mask
and is too large for an O2 hood.
The ability of the patient to follow instructions would be indicated by which of the
following?
a. Orientation to person
b. Performance of task when asked.
c. Ability to feed himself
d. Awareness of time
✓ ~~~ b. Performance of task when asked
If the patient is able to perform simple tasks when asked, this best determines his or
her ability to follow instructions. This is important before administering an incentive
spirometry or IPPB treatment, which requires the patient to be able to follow
instructions well or the treatment will not be effective
You suspect a patient may have a pulmonary embolism. Which of the following
would be the most appropriate recommendation for diagnosis of this condition?
a. Bronchoscopy
b. V/Q Lung Scan
c. Coagulation Studies
d. Shunt Study
✓ ~~~ b. V/Q Lung Scan
The best diagnostic test to determine whether a pulmonary embolism is present is
the V/Q lung scan.
To most effectively increase a sedated, paralyzed patient's alveolar minute
ventilation while the patient is on volume controlled ventilation in the assist-control
mode, you would recommend increasing which of the following?
a. PEEP
b. Insp. Flow
c. Vt
d. Ventilator Rate
✓ ~~~ c. Vt
Alveolar minute ventilation = (VT - VD) × respiratory rate
It represents the volume actually reaching the alveoli per minute. It takes into
account anatomic dead space (VD), which is approximately 1 mL/lb of body weight.
Anatomic VD is that portion of the airway where no gas exchange occurs. If a
patient's alveolar minute ventilation is to be increased, the VT must be increased. If
,only the ventilator rate is increased, the same VT is delivered, even though the
minute ventilation (VT × RR) increases.
Failure to hyperoxygenate a patient on a ventilator before ET suctioning may result
in
a. 2 only
b. 1 and 2
c. 2 and 3
d. 2 and 4
✓ ~~~ a. 2 only
It is important during ET suctioning that the PaO2 be maintained within a normal
range. This requires increasing the oxygen percentage during the procedure. Failure
to hyperoxygenate may cause hypoxemia, resulting in cardiac arrhythmias.
The most reliable method of determining whether the lungs of a patient receiving
mechanical ventilation are getting stiffer and harder to ventilate is by measuring the
a. Static Lung Compliance
b. Dynamic Lung Compliance
c. Spont. Vt
d. PaO2
✓ ~~~ a. Static Lung Compliance
When lungs get stiffer and harder to ventilate, greater pressure is required to move
the same volume of air. (peak inspiratory pressure increases when RAW increases)
This pressure does not reflect how stiff the lungs actually are. We determine the
plateau or static pressure by holding the volume in the patient's lungs for 1 to 2
seconds. This pressure closely relates to alveolar pressure. PEEP (if used) is
subtracted from the plateau pressure and this number is divided into the VT. The
results determine how compliant the lungs are.
A 60kg (132lb) 52 year old man is admitted to the ICU for treatment of refractory
hypoxemia. He is currently on volume controlled ventilation and pressure support of
10cmH2O with an FiO2 of 60%. Other pertinent data are below:
pH = 7.49
CO2 = 30
PaO2 = 59
HR = 120
RR = 26
Spont Vt = 400mL
, Which of the following should the RT recommend at this time?
a. Increase the pressure support level to 15cmH2O
b. Institute 5cmH2O of PEEP
c. Increase the FiO2 to 75%
d. Initiate SIMV 60% FiO2, with a Vt of 600mL on a Rate of 10.
✓ ~~~ b. Institue 5cmH2O PEEP
Refractory hypoxemia typically results from atelectasis, pneumonia, or pulmonary
edema, whereby increasing oxygen levels do not correct the hypoxemia. This
patient's lungs are well ventilated; therefore, mechanical ventilation is not indicated.
We should not exceed 60% oxygen to try and correct hypoxemia, so PEEP should
be instituted.
If not cleaned properly, which of the following devices is most likely to contaminate a
patient's airway with bacteria?
a. Bubble Humidifier
b. Heated Wick Humidifier
c. Vibrating Mesh Nebulizer
d. Heated Jet Nebulizer
✓ ~~~ d. Heated Jet Nebulizer
A warm moist environment is a breeding ground for bacteria. A heated nebulizer and
heated humidifier both have an increased potential for growing bacteria. However,
nebulizers produce particles in approximately the same size range as bacteria and
therefore have a greater chance of transporting the bacteria to the patient.
Humidifiers produce a vapor and are less likely to serve as a transport medium
a 70kg (154lb) male patient is receiving mechanical ventilation. The RT notes the
patient's SpO2 drops from 97% to 86%. The right lung is expanding more than the
left, with clear breath sounds on the right but diminished sounds on the left. The
patient's ETT is taped at the 29cm mark at the lip. Which of the following should the
RT do at this time?
a. Withdraw the tube to the 24cm mark.
b. Recommend an immediate chest xray film.
c. Advance the ETT 2cm
d. Obtain immediate ABG levels
✓ ~~~ a. Withdraw the tube to the 24cm mark.
The ET tube should be positioned 2 to 6 cm above the level of the carina. That
means the ET tube should be at the 21- to 25-cm mark at the teeth. In this question,
the tube is at the 29-cm mark and the patient has decreased breath sounds in the
left lung, which indicates the tube is in the right mainstem bronchus and must be
withdrawn.
Which one of the following sets of ABG measurements would indicate Compensate
Respiratory Acidosis?
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