Lindsey Jones Practice Exam with correct answers graded A+.

1. A patient has undergone overnight oximetry. Data shows several episodes of O2 desaturation throughout the night. The RTT would expect orders for which of the following kinds of testing: a. V/Q scan b. pulmonary function testing c. polysomnography d. 24-hour Holter monitoring - correct answer Your answer: C Correct answer: C The use of overnight oximetery is often used to detect O2 desaturation during the night that may be associated with central or obstructive sleep apnea. Because data indicates some periodic desaturation, the practitioner should suspect possible sleep apnea and should order diagnostic testing that will confirm or rule out the suspicion. A routine screening blood gas performed on an asymptomatic patient prior to surgery shows the following: pH: 7.38 PaCO2: 42 PaO2: 80 HCO3: 26 SaO2: 96% COHb: 24% What should the RRT do? a. place the patient on a NRB mask b. report the findings and emphasize that the patient is likely a smoker c. evaluate saturation using a single wave-length spectrophotometer d. run quality control material and evaluate the accuracy of the co-oximeter - correct answer your answer: D correct answer: D In this case the patient is presented as asyptomatic. A patient with a COHb level of 24% would feel dyspnea and present with tachypnea. Therefore, the RRT should evaluate the accuracy of the lab results, specifically the COHb. When checking accuracy of lab results, one would use quality control measures. The infection control department of a small hospital informs the RRT supervisor that the biological control accompanying some durable autoclaved equipment shows viable spores. The supervisor should do which of the following with the equipment: a. incinerate b. record date and place into service c. wipe with isopropyl alcohol before use d. resterilize - correct answer your answer: D correct answer: D The presence of viable spores indicates the possibility of living organisms developing in the sterilized package or on the sterilized equipment. Sterilization suggest the absence of living organisms, therefore the presence of viable spores indicates the need to resterilize. A post-op patient is not progressing with sustained maximal inspiratory therapy and refuses to cough because of pain along the incision site. The RRT should instruct the patient to: a. pause at the top of each inspiration b. press a pillow against the incision site when coughing c. attempt coughing 1 hour after pain medication has been administered d. avoid coughing until the pain subsides - correct answer your answer: B correct answer: B Explosive coughing by a post-op patient can inadvertently open incision sites. To prevent this, splinting the site with a pillow is an appropriate option. Several hours after oral endotracheal extubation of an 8.0-mm tube, and adult patient begins to demonstrate inspiratory stridor. Which of the following would be most helpful to the patient: a. racemic epinephrine b. albuterol c. atropine sulfate d. heated aerosol by mask - correct answer your answer: A correct answer: A When a patient is extubated and has swelling of the upper airway tissues as demonstrated by stridor, racemic epinephrine is an appropriate medication to reduce swelling quickly. Another, less effective option, is to provide a cool mist. In extreme cases, such as marked stridor, reintubation, or an emergency tracheotomy may be indicated. An adult patient is receiving mechanical ventilatory support and is being suctioned through the endotracheal tube at a pressure of -90 mmHg. Secretions have been difficult to remove. What can be done FIRST to increase suctioning efficiency: a. increase suction time b. decrease suction to 80 mmHg c. increase suction pressure to 100 mmHg d. increase suction catheter size - correct answer your answer: C Correct answer: C An increase in suctioning effectiveness is done through three different ways - increasing suction catheter diameter, increasing suction pressure, and increasing suction time. Before increasing catheter size, the first thing that should be done is to ensure the appropriate range of suction pressure is being used. In this case, the appropriate suction pressure for an adult is 100-120 mmHg. A pressure of 90 mmHg is being used, which is insufficient suction pressure. This should be corrected before doing anything else to increase suction effectiveness. A chemical indicator tape found inside the sealed, packeaged disposable mask helps determine which of the following: a. if the equipment is sterile b. if the equipment has been properly sterilized c. if microorganisms remain viable on the equipment d. if the package has remained closed - correct answer your answer: A correct answer: B A chemical indicator tape inside a sterilized package does not actually indicated the presence or absence of viable spores. It does, however, indicate if the equipment has been through the sterilization process. A 23-year old female patient in active child labor is receiving O2 by partial-rebreathing mask at 9/L/min. The reservoir bag collapses completely during contractions due to the patient's deep rapid breaths. The RRT should recommend: a. increasing the flow to the mask b. changing to a nasal cannula c. changing to 100% NRB d. coaching the patient to take smaller breaths - correct answer your answer: C correct answer: A When the reservoir bag on a non-rebreather mask collapses completely with each breath, the problem is most likely due to insufficient flow to the mask. A radiology report of a chest x-ray indicates the end of the radio-opaque line on an oral endotracheal tube is resting 1 cm above the carina. The RRT should suggest: a. advance the ET tube 1 cm b. withdraw the ET tube 2 cm c. withdraw the ET tube 5 cm d. advance the ET tube 2 cm - correct answer your answer: B correct answer: B The ET tube is properly positioned when the end is 2-5 cm above the carina. In this case, the tube is only 1 cm above the carina. Withdrawing the ET tube by 2-4 cm is appropriate. Peak flow measurements are indicated in which of the following conditions, if present? a. ARDS b. airway obstruction c. myasthenia gravis d. Guillain-Barre - correct answer your answer: A correct answer: B Peak flow measurements are especially helpful in patients with asthma or patients who are suspected to have airway obstruction, mostly due to bronchoconstriction. A female patient is intubated with a 7.0 mm ET tube. The tube is noted to be positioned at 26 cm at the teeth. Breath sounds are not bilateral. Which of the following will best confirm placement of the artificial airway: a. capnography b. chest radiograph c. chest rise d. breath sounds - correct answer your answer: B correct answer: B There are several ways to assess proper ET tube placement, such as auscultation of breathsounds, observance of symmetric chest rise, or end-tidal CO2 evaluation. However, this scenario asks for confirmation of proper placement, which is accomplished with a chest x-ray. A blood gas analyzer fails again to produce acceptable results on the pH value when running quality control material for the second time. The RRT should: a. remove the machine from service b. perform a one-point calibration c. perform proficiency testing d. monitor future results - correct answer your answer: A correct answer: A When a blood gas machine fails to produce accurate results on one of its analytes the RRT may respond by removing the machine from service, notifying the supervisor, or rerunning the control. In this case, removing the machine from service is the only suitable answer offered. Following a full cardiopulmonary arrest and successful resuscitation, the patient has received dopamine to raise blood pressure, The RRT is having difficulty obtaining arterial blood from the radial artery due to hypotension. From which of the following sites should the therapist attempt to perform an arterial puncture: a. pedal artery b. femoral artery c. umbilical artery d. carotid artery - correct answer your answer: B correct answer: B During CPR, blood pressure exists because of cardiac compressions and is usually low. Palpation of pulse, therefore, is difficult in the usual locations such as the radial or brachial arteries. When blood gases are needed during a code with a patient who has very low blood pressure, the femoral artery is the location of choice. While coaching a patient with CF on the use of a PEP therapy device, the patient suddenly becomes short of breath and cyanotic above the waist. The most appropriate action is to: a. schedule a V/Q scan after completion of the Tx b. discontinue the Tx c. perform NT suctioning d. switch to IPV - correct answer your answer: D correct answer: B This patient is exhibiting an adverse reaction to the therapy. The first reaction of the therapist should be to stop the therapy and ensure the patient's vital stability. Subsequently, alternative therapies may be considered to accomplish the same objective without causing a similar adverse reaction. The low ventilator alarm is sounding on a 28-year old patient with myasthenia gravis. The respiratory therapist notes the oral endotracheal tube cuff is failing to hold pressure. The ET tube is positioned at 22 cm at the teeth. The RRT should: a. increase the tidal volume b. decrease the low tidal volume alarm c. replace the ET tube d. send to surgery for placement of a tracheostomy - correct answer your answer: C correct answer: C An ET tube whose cuff is failing to retain air is considered defective and should be replaced. The following ECG tracing suddenly presents on a patient in the emergency department (ED) who was admitted for chest pain. The tracing is confirmed in two leads. The therapist should immediately: [asystole tracing] A. administer Lidocaine B. defibrillate at 360 joules with synchronization set to OFF C. administer sublingual nitroglycerin (Isordil) D. begin chest compressions - correct answer Your answer was : D The correct answer is : D Explanation : After confirming this rhythm (asystole) in 2 leads, the primary treatment is chest compressions. The expired air over one minute that participates in active gas exchange is one's A. anatomical gas exchange. B. alveolar ventilation. C. respiratory quotient. D. minute ventilation. Your answer was : B The correct answer is : B - correct answer Explanation : The total expired air over 1 minute is known as minute ventilation. Not all of this air participates in gas exchange due to anatomical dead space. Once anatomical deadspace is removed, the remaining ventilation is known as alveolar minute ventilation or simply alveolar ventilation. An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the oxygen coming from the end of the tubing and finds it is 60%. Which of the following most likely explains this finding? A. excess water in the tubing B. leak in the tubing C. low flow through the jet orifice D. poorly calibrated analyzer - correct answer Explanation : When administering oxygen by any device that has a venturi mechanism, back pressure on the venturi will slow the speed of gas, decrease room air entrainment, and result in an increase in FIO2. Of the options offered, only excess water in the tubing would cause this type of back pressure. A patient has been diagnosed with central sleep apnea. Which of the following would be helpful and most appropriate in the further treatment of the patient? A. full nocturnal ventilatory support B. weight loss C. surgical remove of soft tissue D. bi-level therapy with a rate - correct answer Your answer was : D The correct answer is : D Explanation : A patient with central sleep apnea either needs mechanical ventilatory support or medication that stimulates ventilation. Dopram is such a medication. Mechanical ventilatory support can be achieved with bilevel therapy in conjunction with a rate. Immediately after oral intubation of an apneic patient, the respiratory therapist begins manual ventilation with a bag-valve assembly. The patient is simultaneously connected to an end-tidal carbon dioxide monitor. Which of the following should the respiratory therapist expect to observe when looking at the capnographic waveform? A. stair-step shifts in the CO2 tracing B. steady CO2 reading C. fall in CO2 followed by a subtle rise D. first a rise, then a fall in CO2 - correct answer Your answer was : A The correct answer is : D Explanation : Initial ventilation attempts after a patient has been apneic will show reduced end-tidal CO2 followed by a steady rise as ventilation is provided. Ultimately, as ventilation continues the end-tidal CO2 will begin to decrease. At patient is receiving heliox therapy at a mixture of 70% / 30%. The gas mixture is flowing through an oxygen flow meter at 10 L/min. The actual flow to the patient is A. 18 L B. 16 L C. 10 L D. 12 L - correct answer Your answer was : B The correct answer is : B Explanation : Helium-oxygen mixtures that are run through an oxygen flowmeter are less viscous than oxygen. This causes an error in the indicated flow rate on the oxygen flow meter. Essentially, the total flow is higher than is indicated. Each helium-oxygen mixture has a correction factor. A 70%/30% helium-oxygen mixture has a correction factor of 1.6. This means the 10 L/min indicated flow should be multiplied by 1.6 to determine the total gas flow. In this case, the total gas flow is 16 L/min. Which of the following equations would determine cardiac index? A. C.O. / BSA B. C.O. x BSA C. stroke volume x heart rate D. C.O. / ejection fraction - correct answer Your answer was : A The correct answer is : A Explanation : Cardiac index can be calculated by dividing the cardiac output by the body surface area. The body surface area is given in units of millimeters squared. Body surface area rarely deviates from about 2 m², regardless of the size of the patient. So essentially, we could take cardiac output and divide it by two to get cardiac index. This can be done even if the body surface area of the patient is unknown. For example, if the cardiac output is 4 L/min, the cardiac index is about 2. Conversely, if cardiac index is 1.8, cardiac output could be estimated to be 3.6 L/min. A couple is found drowsy while driving on a long car trip. The highway patrol officer reports both the driver and the passenger were confused. The emergency room physician suspects carbon monoxide poisoning. Which of the following recommendations is most helpful at this time? A. IV injection of solu-mederol B. administration of Narcan C. high-flow oxygen D. administration of Dopram (doxapram) - correct answer Your answer was : D The correct answer is : C Explanation : The treatment for suspected carbon monoxide poisoning is to drastically increase alveolar oxygen tension. This can best be accomplished by administering high-flow supplemental oxygen, preferably at 100%. Additional therapy that may be helpful is hyperbaric oxygen therapy. A respiratory therapist is suctioning a patient who is receiving positive pressure ventilation through a non-fenestrated tracheostomy tube when it is discovered that the suction catheter will not pass beyond the end of the tracheostomy tube. The patient is cyanotic and in obvious respiratory distress. After the therapist evacuates the cuff, the catheter passes easily. The therapist should first do which of the following? A. extubate the patient B. increase the pressure limit on the ventilator, monitor exhaled volumes C. remove the inner cannula and cap the tube D. inflate the cuff and resume positive pressure ventilation - correct answer Your answer was : C The correct answer is : A Explanation : Because the catheter passes easily after the tracheostomy tube cuff is deflated, the most likely problem is that the tracheostomy tube cuff has become damaged and has herniated over the end of the tracheostomy tube. This means the tracheostomy tube should be changed to one that is not damaged. This starts with extubating the patient and providing ventilation and oxygenation, and generally ensuring the stability of the patient. A patient with significant pulmonary shunting is receiving volume-controlled ventilation on the following settings and has the following arterial blood gas results: Mode: assist/control Mandatory Rate: 18 VT: 500 mL FiO2: 0.70 PEEP: 25 cm H2O C.O.: 3.2 L/min HR: 118 pH: 7.36 PaCO2: 45 torr PaO2: 54 torr HCO3: 26 mEq/L BE: +2 mEq/L The therapist should decrease which of the following? a. FiO2 b. PEEP c. rate d. flow - correct answer your answer: D correct answer: B This patient is hypoxic. To correct this either PEEP of FiO2 should be increased. However, closer examination of hemodynamic data, namely cardiac output, shows instability. Normal cardiac output is 4-8 L/min. This patient has low cardiac output most likely brought on by excessive levels of PEEP. The most appropriate action, in spite of hypoxemia, is to decrease PEEP. Which of the following parameters is NOT consistent with weaning from mechanical ventilation? A. VT to 500 mL B. RSBI of 86 C. A-aDO2 of 320 mmHg D. VD/VT of 0.50 - correct answer Your answer was : C The correct answer is : C Explanation : In order to wean from a ventilator, the patient's dead space-tidal volume ratio must be below 60% or .60. The rapid shallow breathing index must be below 106. Spontaneous tidal volume must be greater than 5 mL per kilogram. The alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this case, the dead space-tidal volume ratio is too high and the alveoli-arterial oxygen difference is too wide. These are the two criteria that indicate the patient is not ready to wean from the ventilator. A chest radiograph reveals excess fluid in the lower left chest, causing a partial hemothorax and considerable dyspnea for the patient. The respiratory therapist should recommend? A. Thoracentesis of the left chest cavity B. Administration of Lasix (furosemide) C. Palpate the trachea to check for deviation D. Chest tubes in the left chest between 2nd and 3rd intercostal space - correct answer Your answer was : A The correct answer is : A Explanation : Excess fluid in the lower left chest may be removed by performing a thoracentesis of the left chest cavity. Upon entering a patient's room, the respiratory therapist finds the patient is unresponsive. The first action should be to A. call for help B. page the physician C. look, listen and feel for breathing D. check for a pulse - correct answer Your answer was : A The correct answer is : A Explanation : Normally, calling for help is not the best option. When taking care of a patient in an emergency situation, YOU are the help. However, calling for help is a formal step in the basic life support procedure and therefore is appropriate in this case. A patient with ARDS receiving volume-controlled ventilation has the following arterial blood results on the settings below: Mode: assist/control Mandatory Rate: 22 VT: 350 mL FiO2: 0.70 PEEP: 22 cm H2O C.I.: 2.2 L/min/m2 HR: 102 pH: 7.35 PaCO2: 45 torr PaO2: 58 torr HCO3: 25 mEq/L BE: +1 mEq/L Which of the following changes is most appropriate? A. increase FIO2 to 0.8 B. decrease FIO2 to 0.6 C. increase PEEP to 25 cm H2O D. decrease PEEP to 20 cm H2O - correct answer Your answer was : C The correct answer is : C Explanation : This patient is hypoxic. To correct this problem either PEEP or FIO2 must be increased. Because the patient is already on 70% the next logical step is to increase PEEP. Hemodynamic data, namely a normal cardiac output, supports this change. A patient with a history of hyper-reactive airway disease is having difficulty expectorating because the sputum is thick and tenacious. Which of the following medications should the respiratory therapist recommend? A. Solu-Mederol B. Beclamethasone (Beclovent) C. Spiriva (tiotropium bromide) D. Acetylcysteine (mucomyst) - correct answer Your answer was : D The correct answer is : D Explanation : Hyperactive airway disease is associated with diseases such as asthma and consist of bronchoconstriction and inflammation. This patient appears to have difficulty with bronchoconstriction and thick secretions. Therefore, a mucolytic, such as acetylcysteine, and Solu-Medrol are appropriate. A COPD patient is brought to the emergency room on a non-rebreathing mask. The respiratory therapist notes the bag collapses minimally even though it appears to have a good seal. Pulse oximetry reveals an SPO2 of 100%. The therapist should A. insert an oral pharyngeal airway B. increase flow to the NRB mask C. place the patient on a nasal cannula D. intubate and mechanically ventilate - correct answer Your answer was : C The correct answer is : C Explanation : The reservoir bag on the non-rereading mask is collapsing minimally. This means the patient's respiratory depth is insufficient. Because pulse oximetry shows an oxygen saturation of 100% and the patient is a COPD patient, it is likely that the patient is receiving too much oxygen and that his or her respiratory drive has been suppressed. The best solution would be to reduce oxygen percentage by placing the patient on a nasal cannula. Although this detail is not offered in this question, it would also be appropriate to utilize only 1 or 2 Lmin. It would also be suitable to place the patient on a Venturi mask at 24% or 28%. A patient has been on mechanical ventilator support for 5 days. The physician would like to consider weaning the patient. The following clinical data is available: MIP -34 cmH2O VT (spont) 450 mL A-aDO2 220 mmHg VD/VT 0.70 VC 1.6 L RR 18/min Based on this data, the therapist should recommend A. obtain arterial blood gas analysis B. perform pulmonary function testing C. avoid weaning at this time D. begin weaning with pressure support - correct answer Your answer was : C The correct answer is : C Explanation : All data suggests that the patient is ready to wean except for one piece of data. That is the VD/VT ratio which is above 60%. It must be below 60% for weaning to be considered. While performing postural drainage and percussion to the basal segments with the head of the bed down 30 degrees, the respiratory therapist notes frequent PVCs on the monitor. The therapist should do which of the following? A. elevate the head of bed and continue percussion over the basal segments B. administer Lidocaine C. switch to PEP therapy D. switch to aerosolized Albuterol treatments - correct answer Your answer was : B The correct answer is : C Explanation : When a patient has an adverse reaction to a particular therapy the first step is to stop the therapy and the next step is to modify the therapy to another method that has the same objective. In this case, the patient has PVCs because the head of bed is down 30°. Because we are draining the basal segments, bringing the head of bed up and continuing therapy is not appropriate because you are no longer draining the basal segments. Thus, a change in modality that is more significant is required. In this case PEP therapy is most appropriate. 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. bleb emphysema C. pneumothorax D. subcutaneous emphysema - correct answer Your answer was : D The correct answer is : D 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. A respiratory therapist notes during a ventilator/patient check that the RAW is lower than in previous assessments. One explanation for this change is a reduced A. I:E. B. fever. C. waveform. D. flowrate. - correct answer Your answer was : D The correct answer is : D Explanation : As flow rate increases airway resistance also increases due to the turbulence of air movement. Therefore, reductions in flow rate will likewise reduce airway resistance. For a patient with severe mitral-valve stenosis, a balloon-tipped flow-directed pulmonary artery catheter would be associated with which of the following clinical data? A. PAP 19 mm Hg and PCWP 7 mmHg B. PCWP 14 mm Hg and C.O. 4 L/M C. CVP 9 mm Hg and PAP 9 mmHg D. PAP 25/8 mmHg - correct answer Your answer was : B The correct answer is : B Explanation : Mitral valve stenosis is a problem resulting from left heart failure. Problems in the left heart are manifested hemodynamically with high pulmonary capillary wedge pressure (PCWP) and low or normal cardiac output. Which of the following is optimal for home oxygen to be delivered through ventilation assistance equipment? A. molecular sieve device B. liquid oxygen C. pulse dose oxygen device D. E-cylinders - correct answer Your answer was : D The correct answer is : A Explanation : The best device for home oxygen therapy is a molecular sieve device, commonly known as an oxygen concentrator. This device is powered with electricity, which makes it appropriate for home use. A respiratory therapist notes a pressure-volume loop on a patient receiving mechanical ventilation has a pronounced beak. What strategy is useful in this case? A. increasing flow B. increasing PEEP C. decreasing tidal volume D. decreasing flow - correct answer Your answer was : C The correct answer is : C Explanation : A pressure volume loop on a ventilator that shows a significant beak indicates inappropriate ventilation. It indicates that a massive increase in pressure is required to deliver the final part of a tidal volume. This is undesirable because an increase in mean airway pressure has many negative affects on the patient, including decreased venous return, among other things. The solution is to sacrifice some of the tidal volume and therefore reduce pressure. A proper pressure volume loop will show a very tiny beak. This beak indicates the point of over distention of the lung and is a good indicator that we are filling the lung properly. Achieving this small beak will help to increase alveolar recruitment, aerate distal parts of the lungs, and help mobilize and remove secretions. Which of the following best describes the function of digitalis? A. lowers blood pressure B. increases blood pressure C. increases strength of cardiac contractility D. increases heart rate - correct answer Your answer was : C The correct answer is : C Explanation : Digitalis is a drug that is used to treat left heart failure or conditions related to a decreased ejection fraction of the left ventricle. Digitalis works by increasing the strength of the contraction of the left ventricle. Which of the following devices is most appropriate to use when suctioning a patient with an effective, productive cough? A. Coude tip suction catheter B. Nasal trumpet C. Tonsil suction device D. Closed system suction catheter - correct answer Your answer was : C The correct answer is : C Explanation : A patient with a strong, productive cough should not require a catheter to be inserted into the trachea. However, it may be appropriate to use an oral tip suction catheter to clear secretions from the oropharynx, or the mouth. The general rule is to apply the least amount of invasiveness necessary to clear the airway. Immediately after placing a sterile tracheostomy tube in a patient who has maintained a stoma for 4 years, the patient coughs vigorously and expectorates the tube out onto the sterile napkin resting on the chest of the patient. The therapist should A. obtain a new, sterile trach tube B. re-insert the expectorated trach tube C. obtain a larger tracheostomy tube D. immediately insert an obdurator into the stoma - correct answer Your answer was : D The correct answer is : C Explanation : For a patient who has maintained an open stoma for several years and easily expectorates a new tracheostomy tube, the patient is most likely in need of a larger airway. A 62-year-old male, six hours post CABG, experiences a sudden onset of tachypnea 3 hours after extubation. Breath sounds are markedly decreased over the right lung field. Respiratory rate is 24/min, HR 110/min, BP 160/85 mm Hg, and SpO2 is 89% on 35% oxygen via air-entrainment mask. Which of the following should the respiratory therapist recommend NEXT? A. radiological examination of the chest B. deliver oxygen via HHF C. V/Q scan with Xenon gas D. begin CPAP by mask at 8 cm H2O - correct answer Your answer was : A The correct answer is : A Explanation : The superficial evidence in this question indicates some sort of respiratory/ventilatory problem. However, the source of the problem is not evident and additional information is required. In this case, radiological examination of the chest may provide the additional information needed to determine the source of the problem. A 65-kg (143-lb), 5-ft, 5-in male patient with pneumonia is receiving mechanical ventilator support by a Servo adult ventilator on the following settings with corresponding arterial blood gas values: Mode Assist/control Mandatory rate 14/min VT 450 mL FIO2 0.6 PEEP 5 cmH2O pH 7.35 PaCO2 45 mmHg PaO2 74 mmHg HCO3- 24 mEq/L BE 0 mEq/L Which of the following actions is most appropriate? A. increase rate B. increase tidal volume C. increase PEEP D. increase FIO2 - correct answer Your answer was : C The correct answer is : C Explanation : An examination of the arterial blood gas data reveals that ventilation is appropriate but oxygenation is a problem. To correct oxygenation the FIO2 or PEEP must be adjusted. In this case, the patient is already at 60% oxygen. So, the PEEP must be increased. What would most likely be indicated by an elevated CVP? A. fluid overload B. left heart failure C. pulmonary embolism D. increased pulmonary vascular resistance - correct answer Your answer was : B The correct answer is : A 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. The respiratory therapist notes an order in a patient's record for 3 mg of a drug. The normal stock concentration of the drug is 0.15%. How many mL will be required to meet the ordered dosage? A. 2.0 B. 20.0 C. 4.5 D. 1.6 - correct answer Your answer was : A The correct answer is : A Explanation : To determine the number of mL needed, one must first determine how many mg per mL exists in that drug at a specific concentration. This can be done by taking the concentration (strength) and multiplying it by 10. ie, 0.15% x 10 = 1.5 mg/mL. In this case, 3 mg is needed. Thus 3 mg/1.5 mg/mL = 2.0 mL. A patient in the intensive care unit has the following clinical and laboratory data: PB 747 mm Hg PH2O 47 mm Hg pH 7.28 PaCO2 52 mm Hg PaO2 70 mm Hg HCO3- 27 mEq/L BE +2 mEq/L FIO2 0.6 SaO2 1.0 CvO2 12 vol% CaO2 17 vol% Hb 15 gm/dL Which of the following represents the C(a-v)O2? A. 2 vol% B. 5 vol% C. 200 vol% D. 25 vol% - correct answer Your answer was : B The correct answer is : B Explanation : To answer this question, one must complete two calculations. First, CaO2 and CvO2 must be determined. Once CvO2 is subtracted from CaO2, 5 vol% is the closest answer. Pulmonary function is done on a 68-year old male with a 20-pack-year history of smoking. The following pulmonary function data is recorded: A. chronic bronchitis B. asbestosis C. emphysema D. sarcoidosis - correct answer Your answer was : C The correct answer is : A Explanation : Pulmonary function test data indicates the patient has an obstructed defect. This is manifest by a reduced FEV1/FVC%. Anything less than 75% is considered abnormal. The SVC is normal and therefore indicates the patient has no restrictive defect. So, we must pick an answer that is an obstructive disease. When we look at the answers we see there are two options - emphysema and chronic bronchitis. To know which one it is we must look back at the pulmonary function testing data and observe the DLCO. Only emphysema shows a poor DLCO. In this case the DLCO is greater than 20 CO/min/mmHg and is therefore normal. This means that emphysema can not be the correct option leaving only chronic bronchitis as the only possible correct choice. Which of the following is an important action when drawing an arterial blood gas sample? A. run the sample within 15 minutes B. Compress the site prior to puncture C. Choose a radial site with adequate ulnar circulation D. Use an 16 gauge needle - correct answer Your answer was : C The correct answer is : C Explanation : One must perform the Allen's test in order to determine the presence of collateral circulation prior to an arterial puncture. The radial site with the best collateral circulation is the optimal location for an arterial puncture for an adult for reasons primarily related to patient safety. Essential basic recall information includes the proper needle size for an adult, which is a 22 gauge. The sample should be run as quickly as possible, usually within 5 minutes. A patient has a systolic blood pressure of 180 mm Hg. Diastolic pressure is 120 mm Hg. CVP is 5 mm Hg with a PCWP of 6 mm Hg. What is the patient's MAP? A. 160/90 mm Hg B. 140 mm Hg C. 125/70 mm Hg D. 140/100 mm Hg - correct answer Your answer was : B The correctanswer is : B Explanation : MAP is calcuated by adding the sysotic pressure to twice the diastolic pressure, then divide the sum by three. (180 + 120 + 120) = 420. 420/3 = 140 mm Hg. A firefighter is brought to the emergency room with a red face, singed nasal hairs and a slight inspiratory stridor. The patient is not alert. Which of the following is the most appropriate initial action the respiratory therapist should take? A. perform an emergency tracheotomy B. place the patient on a nonrebreathing mask C. schedule the patient for hyperbaric oxygen therapy D. obtain a blood gas with COHb evaluation - correct answer Your answer was : B The correct answer is : B Explanation : The presence of a red face, singed nasal hairs, and slight inspiratory stridor, in addition to the profession of firefighter, are all indications that the patient has likely inhaled smoke, heated gas, and carbon monoxide. To treat this condition, the most appropriate action is to place the patient on a non-rebreathing mask and achieve an oxygen percentage as close as possible to 100%. Hyperbaric oxygen therapy would also be appropriate but simply scheduling the patient for hyperbaric oxygen therapy would delay therapy. Therefore, immediate use of a non-rebreathing mask is most appropriate. After a gastric bypass surgery, which of the following positions should the patient be placed in to facilitate effective ventilation? A. 1/4 turn to either side B. supine C. prone D. semi-Fowler's position - correct answer Your answer was : B The correct answer is : D Explanation : The lungs are most effectively ventilated when patients are in semi-Fowler's position. This, of course, only applies to patients who are in bed. Standing always provides the best gas distribution and ventilation of the lungs. A patient receiving oxygen by non-rebreathing mask is breathing rapidly and deeply. The reservoir bag collapses completely with each inspiration. The therapist should A. check for adequate mask seal B. switch to a Venturi mask at 50% C. increase flow D. continue current therapy - correct answer Your answer was : B The correct answer is : C Explanation : When a patient is receiving oxygen by non-rebreathing mask, they are drawing most of their breath from the reservoir bag. If the bag collapses completely during each breath, the flow to the bag is inadequate. The solution is to increase flow so that the reservoir bag collapses only partially with each breath. If the bag does not collapse at all it most likely means there is a poor seal between the patient and the mask. Another cause, however, could be that the flow is set too high. Which of the following would provide continuous pressure in the oropharynx to help minimize soft tissue occlusion? A. APRV B. CPAP C. IPPB D. PRVC - correct answer Your answer was : B The correct answer is : B Explanation : CPAP is used, especially in cases of obstructive sleep apnea, to put pressure on oral soft tissues and keep them from relaxing and collapsing over the airway, causing obstruction. Which of the following patient conditions would CONTRAINDICATE the use of Trendelenburg's position? A. Massive blood loss B. Increased intracranial pressures C. Lobectomy D. Independent lung ventilation - correct answer Your answer was : B The correct answer is : B Explanation : Placing the patient's head-of-bed down would be harmful to the patient, who has increased intracranial pressures. This could cause further increase which could result in herniation of the brainstem and permanent neurological damage. A patient has been diagnosed with central sleep apnea. Which of the following would be helpful and most appropriate in the further treatment of the patient? A. surgical remove of soft tissue B. weight loss C. bi-level therapy with a rate D. full nocturnal ventilatory support - correct answer Your answer was : C The correct answer is : C Explanation : A patient with central sleep apnea either needs mechanical ventilatory support or medication that stimulates ventilation. Dopram is such a medication. Mechanical ventilatory support can be achieved with bilevel therapy in conjunction with a rate. In order for a patient with a fenestrated tracheostomy tube to feel the least amount of airway resistance while breathing spontaneously, what should the respiratory therapist recommend? A. deflate cuff, remove inner cannula, remove cap B. inflate cuff, remove inner cannula, cap tube C. inflate cuff, insert inner cannula, remove cap D. deflate cuff, remove inner cannula, cap tube - correct answer Your answer was : B The correct answer is : A Explanation : A fenestrated tracheostomy tube has an inner cannula with a hole to facilitate talking and weaning. It also has an inner cannula for resuscitation, or mechanical ventilation. The cuff is like that of an endotracheal tube, low-pressure, high-volume. And finally, a cap is used to close the tube for speech therapy. When the cap is used, the inner cannula should be removed and the cuff should be deflated. Which of the following will result in an increase in mean airway pressure for a patient receiving volume-controlled ventilation? A. increase in tidal volume B. decreased I:E ratio C. increase inspiratory flow rate D. decrease in mandatory rate - correct answer Your answer was : A The correct answer is : A Explanation : Mean airway pressure increases most significantly with an increase in mandatory rate on a ventilator. The second most significant cause of increased mean airway pressure is an increase in tidal volume. Increasing inspiratory flow rate, decreasing mandatory rate, and decreasing inspiratory time will all cause a decrease in mean airway pressure. Which of the following would NOT be an indication for implementing mechanical ventilatory support? A. acute ventilatory failure B. VC of 8 mL/kg C. VT of 6 mL/kg D. impending ventilatory failure - correct answer Your answer was : C The correct answer is : C Explanation : A patient with a tidal volume of less than 5 mL per kilogram or a vital capacity of less than 10 mL per kilogram requires mechanical ventilatory support. Additionally, if blood gases are consistent with acute ventilatory failure or impending ventilatory failure, mechanical ventilation is indicated. This question is asking which of the following is NOT an indication for mechanical ventilation. Because the patient's tidal volume is 5 mL per kilogram and this is sufficient, this is the correct answer. A 14-year old patient with asthma is in the emergency department (ED) with shortness of breath. Two treatments with Albuterol have been given, but the patient is still wheezing and peak flow measurements have not changed. The respiratory therapist should recommend? A. administering ipratropium bromide (Atrovent) B. drawing arterial blood for gas analysis C. administering cromolyn sodium (Intal) D. ordering a chest radiograph - correct answer Your answer was : A The correct answer is : A Explanation : When a patient is not responsive to a particular bronchodilator medication, it is appropriate to attempt bronchodilation with a different medication. In this case, Atrovent is a good alternative medication because it is also a short term rescue medication, like albuterol, but with a different mode of action. The following chest CT image is being observed by the respiratory therapist. The therapist should recommend A. Oblique chest radiograph B. Postural draining and percussion of the right chest C. Thoracentesis D. Needle decompression of the left chest - correct answer Your answer was : C The correct answer is : C Explanation : Close observation of this radiological image reveals the lung is partially collapsed. Because of the partial collapse, is not likely that air has entered that space and therefore this is not a pneumothorax. Rather, this exam shows an increase in fluid in the pleural area, decompressing the lung tissue. This is known as a hemothorax. The most appropriate action is a thoracentesis. Which of the following patient instructions is appropriate for a 12-year-old male patient who is about to have an appendectomy? A. "After surgery, you will need to take several deep breaths every hour." B. "When you cough you must splint your incision." C. "During surgery, we will be monitoring your end tidal CO2." D. "Once your anesthesia wears off we will start you on incentive spirometry." - correct answer Your answer was : A The correct answer is : A Explanation : Lung expansion following abdominal surgery is important in order to avoid pulmonary complications such as atelectasis. Also, in this example, several answers contain the use of terminology that would not be understood by a 12-year old patient. The best test determination for a forced vital capacity maneuver is done by which of the following calculations? A. FEV1 + FVC B. FEV1/FVC C. SVC + FVC D. TLC - FVC - correct answer Your answer was : D 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. A patient admitted to the hospital for pneumonia is receiving oxygen therapy by transtracheal catheter. Twenty minutes after the completion of a meal, the patient complains of shortness of breath and expresses the device is not working properly. The respiratory therapist should first A. increase the oxygen flow rate to the catheter B. apply suction to the catheter C. initiate oxygen by air-entrainment mask D. remove the catheter - correct answer Your answer was : B The correct answer is : C Explanation : When a problem is encountered with one oxygen delivery modality, the first best response is to initiate oxygen therapy with a different modality and then troubleshoot the problem. The results of a V/Q scan is inconclusive following what appears to be the development of a pulmonary embolus. What further testing should the therapist recommend? A. echocardiogram B. modified barium swallow test C. pulmonary angiography D. transesophageal echo (TE) - correct answer Your answer was : D The correct answer is : C Explanation : Sometimes a ventilation perfusion scan is inconclusive when looking for a pulmonary embolus. When this occurs, pulmonary angiography may be used to obtain more accurate and confirming results. Pulmonary angiography is more expensive and therefore is used only when a VQ scan is inconclusive. At patient is receiving heliox therapy at a mixture of 70% / 30%. The gas mixture is flowing through an oxygen flow meter at 10 L/min. The actual flow to the patient is A. 18 L B. 10 L C. 12 L D. 16 L - correct answer Your answer was : D The correct answer is : D Explanation : Helium-oxygen mixtures that are run through an oxygen flowmeter are less viscous than oxygen. This causes an error in the indicated flow rate on the oxygen flow meter. Essentially, the total flow is higher than is indicated. Each helium-oxygen mixture has a correction factor. A 70%/30% helium-oxygen mixture has a correction factor of 1.6. This means the 10 L/min indicated flow should be multiplied by 1.6 to determine the total gas flow. In this case, the total gas flow is 16 L/min. What is the minute alveolar ventilation (L/min) of a 68-kg (150-lb) IBW patient who has a tidal volume of 500 mL and a respiratory rate of 14? A. 2.1 B. 4.9 C. 6.0 D. 7.0 - correct answer Your answer was : D The correct answer is : B Explanation : To determine the minute ventilation of the patient, one should multiply the tidal volume by the rate. In this case, tidal volume is expressed in milliliters. Because minute ventilation should be expressed as L/min, tidal volume must be translated to liters. To subtract deadspace from the tidal volume, one must estimate deadspace by looking at the ideal body weight in lbs. In this case, 150 lbs is about 150 mL of deadspace. Thus alveolar tidal volume (the amount of volume that reaches the alveoli) is 350 mL, or 0.35 L. This number should then be multiplied by the RR (14) to get the minute alveolar ventilation. (0.35 x 14 = 4.9) An expiratory hold initiated just prior to the next inspiratory phase facilitates the measurement of which of the following? A. P(plat) B. P50 C. PIP D. auto-PEEP - correct answer Your answer was : B The correct answer is : D Explanation : AutoPEEP is measured by initiating an expiratory hold just prior to the next breath. This gives time for the system to measure the residual total positive pressure. The amount that this pressure is above the set PEEP is considered excessive accumulated auto PEEP. While transporting at patient from the emergency department (ED) to the intensive care unit (ICU), the respiratory therapist suspects the oral endotracheal tube has changed position. The quickest way to assess the ET tube position would be to A. visualize diaphragmatic excursion B. obtain a chest radiograph C. analyze end-tidal CO2 D. auscultate breath sounds - correct answer Your answer was : D The correct answer is : D Explanation : There are many ways to determine the location or position of the ET tube. The question is asking for the quickest way. Of the options offered, auscultation of breath sounds would provide the most immediate pertinent data. If an option such as examination of equal and bilateral chest rise were offered, that option would be even better because it is visual in nature and therefore quicker. Which of the following would be a good goal to be included in a pulmonary rehabilitation program for a COPD patient? A. reduce infections B. omit ALDs C. return to normal life D. restore normal ABG values - correct answer Your answer was : A The correct answer is : A Explanation : The purpose of a pulmonary rehabilitation program for a patient with COPD relates to improving their life from their point of view. Legitimate goals include recognizing signs of infection, reducing hospitalizations, increasing their ability to perform activities of daily living, and generally increasing exercise tolerance. Because lung disease cannot be reversed it is unreasonable to think that we can return the patient to normal life or reduce their need for oxygen. It is also unreasonable to acheive normal blood gas or pulmonary function values. The head of 41-gestational week infant has just been delivered through the birth canal. The respiratory therapist notices meconium staining about the infant's face. Which of the following actions should the therapist recommend next A. begin chest compressions B. provide vigorous manual resuscitation C. perform deep tracheal suctioning D. place the infant on mechanical ventilation - correct answer Your answer was : C The correct answer is : C Explanation : When the head of an infant is delivered, the first action should be to suction the mouth and the upper airway prior to complete delivery. This is because it is believed that compression of the chest by the vaginal wall during delivery promotes initial ventilation attempts. It is important to clear the airway of fluid and other debris prior to any ventilation attempt. Which of the following may NOT be used with a face mask? A. Wright's respirometer B. NPPV C. peak flow meter D. CPAP - correct answer Your answer was : C The correct answer is : C Explanation : A respiratory therapist can achieve the goals of CPAP, NPPV, and even a Wright's respirometer with the use of a facemask. However a peak flow meter must be positioned between the teeth of the patient with the lips sealed, and nose plugged in order to achieve accurate peak-flow measurements. A respiratory therapist should open the airway by using the jaw-thrust maneuver for a patient experiencing A. vomiting B. a difficult intubation requiring application of cricoid pressure C. a carotid massage D. a serious motor vehicle accident - correct answer Your answer was : D The correct answer is : D Explanation : Trauma caused by motor vehicle accidents may result in injury to the spinal cord, or vertebrae. Additional movement or manipulation of the neck or upper back may result in additional damage, which could result in permanent paralysis. The jaw-thrust maneuver will prevent further damage to the spine. Using the formula for calculation of cardiac index, how would a morbidly obese patient's C.I. compare to that of a person at ideal body weight? A. cardiac index would remained unchanged B. cardiac index would be lower C. cardiac index would be unpredictable D. cardiac index would be higher - correct answer Your answer was : B The correct answer is : B Explanation : Cardiac index is determined by dividing cardiac output by body surface area. As body surface area is increased (from obesity) the cardiac index calculation will be less than a patient at ideal body weight. If a pressure-cycled mechanical ventilator had a leak in the circuit, what would the respiratory therapist expect to see? A. The pressure monometer would have a negative deflection during each breath B. Peak pressures would decrease C. The flowrate would automatically increase to compensate D. The mechanical breaths would not cycle off as expected - correct answer Your answer was : B 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. Which of the following is most likely to increase nosocomial infection in a hospital? A. use of an HME for 48 hours B. poor hand washing among staff C. frequent disconnection in the ventilator circuit D. use of alcohol-based hand cleaners - correct answer Your answer was : B The correct answer is : B Explanation : The most common nosocomial infection source is from poor hand washing. Although frequent disconnection of a ventilator circuit will also increase incidence of infection, poor hand washing is by far more common. While providing advanced cardiac life support to a victim of a motor vehicle accident, a patient suddenly becomes hypotensive. Pulse is 140/min, RR 30/min. Diagnostic percussion reveals hyperresonance on the left and breath sounds are present on the right and absent on the left. The therapist should FIRST recommend A. obtain a chest radiograph B. insert a chest tube in the left chest C. inserting a needle in between ribs in the left chest D. provide manual ventilation with larger volumes per squeeze - correct answer Your answer was : C The correct answer is : C Explanation : Clinical data suggests the presence of a tension pneumothorax. If this condition worsens the patient could become emergent and unstable and experience significant hemodynamic degradation. Therefore, the pressure must be relieved immediately by inserting a needle (usually 14-gauge) into the left chest. This will immediately vent any building pressures and will help stabilize the patient until further, long-term treatment can be provided. A respiratory therapist finds that an endotracheal tube cuff fails to hold pressure and air passage is detected around the cuff at the peak inspiratory phase of the ventilator. Close investigation reveals there is leak in the pilot valve. What action should the therapist take? A. Increase tidal volume to compensate for the leak B. Permanently clamp the tube between the cuff and pilot balloon C. Recommend replacing the airway D. Frequently add air to the cuff - correct answer Your answer was : C The correct answer is : C Explanation : When an endotracheal tube cuff fails to hold pressure because of either a blown cuff or a leaky pilot valve, It may be tempting to clamp the pilot tube and attempt to continue using the cuff. However, regardless of the location of the leak, the endotracheal tube is considered to be defective and should be replaced. A respiratory therapist suspects a 4-year-old child has aspirated a small plastic toy into the right lung. Which of the following would be most helpful in determining the nature of the object aspirated? A. transillumination B. echocardiogram C. bronchoscope D. chest radiograph - correct answer Your answer was : D The correct answer is : C Explanation : The preferred method for inspection and removal of any aspirated object would be bronchoscopy. A bronchoscope is both diagnostic and therapeutic. In other words, it can be used to diagnose the patient but it can also be used to remove the object if found. A chest x-ray would be insufficient because the gamma rays would penetrate the plastic material and possibly not expose the item on the x-ray. A patient is breathing spontaneously through an aerosol mask connected to a single large volume air-entrainment nebulizer set at 100%. The oxygen flow meter is set to 15 L/min. The patient's tidal volume is 600 mL and the respiratory rate is 34/min. Which of the following can the respiratory therapist conclude? A. The flow rate at the oxygen flow meter is set too high B. The patient should be instructed to breathe slower C. The inspiratory demand of the patient is not being met D. The patient should be sedated - correct answer Your answer was : B The correct answer is : C Explanation : To answer this question one must understand how to calculate the total inspiratory demand of the patient and compare it to the total flow being received. This patient is on a large-volume nebulizer set at 100% and therefore is not entraining any room air. This means whatever the flow meter is set at is the total flow of gas to the patient. Therefore, the patient is receiving 15 L per minute. However if we take the tidal volume and multiply it by the rate we get a minute ventilation of 20.4 L. This means the patient requires 5.4 L more than is being delivered by the nebulizer. The additional 5 L is being entrained through the aerosol mask, which means the patient is not receiving 100% oxygen and the inspiratory demand of the patient is not being met. When evaluating a patient's pulmonary condition, the therapist should include which of the following in the assessment? A. insurance and disease history B. occupation and smoking history C. marital status and disease history D. language skills and social status - correct answer Your answer was : B The correct answer is : B Explanation : When evaluating a patient's pulmonary condition, occupation may reveal long-term exposure to pulmonary irritants. Smoking history would also be helpful. Marital status and language skills do not directly relate to a patient's pulmonary condition. A patient is on 60%/40% heliox therapy by nonrebreathing mask. If flowing through an oxygen flow meter, what is the actual flow of the mixture if the flow meter indicates 10 L/min? A. 14 L/min B. 16 L/min C. 18 L/min D. 10 L/min - correct answer Your answer was : A The correct answer is : A Explanation : When helium-oxygen mixtures are run through flow meters that are intended for oxygen only, the indicated flow on the flow meter is inaccurate. This is because the helium-oxygen mixture is less viscous and does not push the indicator ball up as much as does oxygen. In this case, a correction factor must be used depending upon the mixture percentages. For an 80/20% mixture a correction factor of 1.8 must be used. A 70/30% mixture has a correction factor of 1.6 and a 60/40% mixture has a correction factor of 1.4. In this problem the 60/40% mixture factor of 1.4 must be multiplied by the indicated flow on the oxygen flow meter to calculate actual total gas flow. When we do this we get a total gas flow of 14 L/min. A patient vomits and aspirates during postural drainage and percussion while in the appropriate position to drain the left lower lobe. The respiratory therapist's immediate reaction should be to A. place the patient in the right lower lobe drainage position B. place the patient in the upper right lobe drainage position C. implement incentive spirometry D. suction the patient's oropharynx - correct answer Your answer was : D The correct answer is : A Explanation : When somebody vomits during postural drainage and percussion, when draining a specific side, the immediate response should be to drain the opposite side. A patient receives postural drainage and percussion. During the treatment, the patient develops rhonchi. The respiratory therapist should NEXT A. discontinue treatment B. switch to PEP therapy C. administer an IPPB treatment D. perform nasal tracheal suctioning - correct answer Your answer was : D The correct answer is : D Explanation : The development of rhonchi during postural drainage and percussion is an indication that the therapy is working - is mobilizing secretions effectively and moving them upward where they can be expectorated or suctioned. A respiratory therapist is providing education to a patient who will be self-administering nebulized albuterol at home. Which of the following instruction is critical to address infection control? A. utilizing cidex (alkaline gleuteraldehyde) once a week B. washing hands before and after therapy C. soaking non-disposable equipment in 100% alcohol solution D. utilizing an acetic acid soak for non-disposable equipment daily - correct answer Your answer was : B The correct answer is : B Explanation : For homecare patients, prevention of infections and general infection control should minimally be done by washing hands before and after therapy. Other options, including the use of alkaline gleuteraldehyde, is not appropriate for home use. A patient with asthma is receiving bi-level therapy to decrease work of breathing. Current settings and blood gas results are: IPAP 20 cm H2O EPAP 10 cm H2O FIO2 0.35 pH 7.35 PaCO2 45 torr PaO2 70 torr HCO3- 24 mEq/L BE 0 mEq/L The respiratory therapist should make which of the following changes? A. decrease both IPAP and EPAP B. decrease EPAP C. increase EPAP D. increase IPAP and EPAP Your answer was : D The correct answer is : D - correct answer Your answer was : D The correct answer is : D Explanation : The arterial blood gas shows the patient is hypoxic but ventilation appears to be adequate. When we want to correct oxygenation we must look to the expiratory positive airway pressure. We must be careful here, however, because raising EPAP by itself will also inadvertently lower ventilation by decreasing the distance between the expiratory pressure and the inspiratory pressure. Thus, when we raised EPAP by a specific amount we must raise IPAP by that same amount if we do not wish to decrease ventilation. A 90 kg (198 lb) adult male is receiving volume-controlled ventilation following abdominal surgery. Current ventilator settings and corresponding arterial blood gas results are: Mode: SIMV Mandatory Rate: 16 Total Rate: 17 Tidal Volume: 650mL PEEP: 5 cm H2O FiO2: 0.40 pH: 7.48 PaCO2: 33 torr PaO2: 128 torr HCO3: 25 mEq/L BE: +1 mEq/L The respiratory therapist should recommend A. decreasing FIO2 to 0.35 B. discontinuing PEEP C. decreasing mandatory rate D. switching to assist/control mode - correct answer Your answer was : B The correct answer is : B Explanation : This patient is both hyperventilating and hyper oxygenating. Of these two problems, the over-oxygenation should be addressed first. To correct over-oxygenation either FIO2 or PEEP should be decreased. Normally, FIO2 is decreased first until below 0.6. and then PEEP is lowered. In this case, however, oxygen percentage is already below 60% and therefore discontinuing PEEP is the best option. A 32-year-old male has a respiratory rate of 26/min and a tidal volume of 200 mL. Following sedation with a benzodiazepine medication, respiratory rate drops to 10/min and tidal volume increases to 520 mL. The respiratory therapist can accurately conclude that there was an increase in which of the following? A. dead space ventilation B. alveolar ventilation C. pulmonary perfusion D. minute ventilation - correct answer Your answer was : D The correct answer is : B Explanation : As this patient receives sedation is obvious that their work of breathing decreases as evidenced by an increasing tidal volume which results in a decreasing spontaneous respiratory rate. As tidal volume increases and respiratory rate decreases, the effect is an increase in alveolar ventilation. A 39-year-old unconscious male is brought to the emergency room after a suspected suicide attempt. He was found in his garage with the car running and the exhaust vented to the interior portion of the vehicle. Which of the following should be examined immediately? A. homocysteine level B. COHb C. MetHb D. SpO2 - correct answer Your answer was : B The correct answer is : B Explanation : When suspecting a patient has carbon monoxide poisoning, a COHb is the most appropriate data to rule in or rule out CO poisoning. You are called to the emergency room to provide ventilation with a manual resuscitator for a patient receiving CPR. The patient is intubated and the endotracheal tube position has been confirmed. It is difficult to squeeze the bag. A possible causes is A. right maintstem bronchus B. insufficient oxygen flow to the bag C. a deflated ET tube cuff D. low pulmonary compliance. -