NBRC Exam Part I: Patient Assessment and Mechanical Ventilation, Exams of Nursing

Download NBRC Exam Part I: Patient Assessment and Mechanical Ventilation and more Exams Nursing in PDF only on Docsity! NBRC EXAM, Part I 154 Question and correct Answers 2023 PATIENT ASSESSMENT: All the following could cause capnography to go from 3 6 to 30 EXCEPT: A. Endotracheal tube positioned in the right mainstream bronchus B. Hyperventilation C. pulmonary emboli D. Hypovolemia - Endotracheal tube positioned in right mainstem bronchus is a problem but the co2 reading would not change, so ANSWER is A. What is the target Vt for individual on mechanical ventilation - 6-8 ml/kg (of ideal body weight) This is new strategy as of January 2015 Is the following Static OR Dynamic Compliance: Means flow throughout the respiratory system has stopped and all ventilatory muscle activity is absent. _______ conditions can be imposed with an inspiratory pause when a patient is sedated and mechanically ventilated. - Static Compliance Is the following Static OR Dynamic Compliance: Flow at airway opening is zero. Mechanics are evaluated under ______ conditions, when non-intubated patient breathes spontaneously. - Dynamic Compliance A balloon tipped flow directed catheter is positioned in the pulmonary artery with the balloon deflated. Which of the following pressures will be measured by the proximal lumen: a. Cvp b. Pap c. Pwp d. Map - ANSWER is A. Cvp = deflated/proximal lumen Pap = deflated/distal Pwp = inflated/wedged All of the following will affect the accuracy of a capnography EXCEPT a. Long sampling line b. Low sampling flow c. Condensation in the tubing d. Use of desiccant - Gas will pass through and out of a long sampling line before reaching analyzer so, low sampling flow will not give you enough information for a good reading, and condensation as a rule is always a problem especially in analyzers. Dessicant removes moisture from the gas, which is a good thing, so ANSWER is D A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following should the respiratory therapist use to monitor the neonates overall cardiopulmonary status. a. TcPCO2 and TcPO2 monitor b. Arterial blood gas analysis Q4 c. SpO2 monitor d. Capillary gas analysis Q8 - Since the baby is stable, go less invasive, also go continuous monitoring (not 4 hour or 8 hour), Transcutaneous (Tc) continuous monitoring of CO2 and O2 is the best. Answer is A A unilateral wheeze would most likely indicate which of the following. a. Asthma b. Atelectasis c. Foreign body aspiration d. Epiglottitis - You wouldn't have asthma on just one side (unilateral), atelectasis would cause diminished breath sounds, with epiglottitis you would get stridor, since you are only hearing wheezing on one side, you are hearing it on the side where you aspirated something, so ANSWER is C All of the following would be associated with the presence of a pneumothorax EXCEPT a. Tracheal deviation b. Dull percussion c. Absent breath sounds d. Respiratory distress - With pneumothorax you would hear a high pitch hyperresonnance, breath sounds would be absent, and respiratory distress could be present. Dull percussion would NOT be present, so ANSWER is B. What should you recommend FIRST for a patient with multifocal pvc's a. Administration of lidocaine b. Administration of 100% oxygen c. Administration of atropine d. Administration of epinephrine - Multiple pvc's coming from multiple locations (multifocal) is a real problem and you should administer oxygen FIRST, so ANSWER is B. lidocaine will help reduce irritability of heart and help with pvc's but would not be first option, atropine is used for bradycardia and cardiac irregularities but not pvc's, epinephrine is emergency drug not for pvc's but more for pulseless ventricular tachycardia or ventricular fibrilation where heart is not responding . A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease. The patient required a chest tube for a persistent pneumothorax. Two days later the chest radiograph reveals bilateral radiolucency, midline mediastinum, and the right hemidiaphragm slightly elevated. This would indicate A. atelectasis. B. bronchopulmonary dysplasia. C. fluid overload. D. resolution of a pneumothorax. - bilateral means both sides, radiolucency refers to dark, midline mediastinum is right where is should be, the right hemidiaphragm slightly elevated is normal; so this actually indicates everything is normal. With atelectasis we would see patchy infiltrates, loss of volume, with bronchopulmonary dysplasia it would look similar to ARDS, with fluid overload you would see pattern similar to butterfly or batwing similar to pulmonary edema, so the best ANSWER is D and the pneumothorax has resolved. A chest X-ray shows increased retro-sternal air, flat hemidiaphram, decreased movement, and no vascular markings on the right side. These signs would be most likely associated with: A. pneumothorax B. pleural effusion C. pneumonia D. flail chest - The flat hemidiaphram indicates pneumothorax, so the ANSWER is A. What is the normal range for the pulmonary artery systolic pressure in an adult? A. 2-6 mm Hg B. 4-12 mm Hg C. 9-18 mm Hg D. 21-28 mm Hg - The normal pressure is 25 mm Hg, so the ANSWER is D 21-28 mm Hg While assessing a patient's breath sounds the respiratory therapist notes that when the patient is instructed to say the letter "E", it comes through the stethescope sounding like "aaaahhh". This change in the sound is associated with which of the following conditions? A. Pleuritic inflammation B. Pneumonia C. Bronchospasm D. Epiglotitis - The sound aaaaahhhhh is egotheny and is associated with consolidation in the lung, so the ANSWER is B pneumonia. Pleural inflammation would be a crackling crunching sound, bronchospasm would sound like wheezing, and epiglottitis would be stridor. An 1800 g neonate in the NICU is being monitored with a TcPO2 electrode. The TcPO2 electrode is reading 42 torr with the temperature set at 38oC. The PO2 from an umbilical artery sample is 72 torr. Which of the following would best explain the difference in these readings? A. There was an error in the arterial blood gas results. B. The TcPO2 electrode needs to be repositioned. C. The TcPO2 electrode temperature setting is too low. D. The TcPO2 electrode has been dislodged. - TcPO2 should be set at 43-45 C so the electrode is not hot enough to make the device work. There is not enough profusion with the electrode so you need to raise the temperature on the electrode, so the ANSWER is C, TcPO2 electrode temperature setting is too low. A multiple trauma victim with internal hemorrhage is being monitored via pulse oximetry. Which of the following conditions would affect the accuracy of her SpO2 readings? A. hypotension B. hyperoxia C. hypocarbia D. hyperthermia - Since the SpO2 measures the color of the blood and the ability to shine a light through the blood, the only answer that would affect the accuracy of the SpO2 reading would be ANSWER A hypotension because hypotension causes less profusion (needed for the SpO2 reading) A patient with COPD has been admitted for possible pneumonia. The patient is producing moderate amounts of thick yellow sputum and breath sounds are decreased in the right middle lobe. Sputum culture indicates a staphylococcal infection. Which of the following therapies should the respiratory therapist recommend? A. chest physical therapy B. antibiotic therapy C. incentive spirometry D. IPPB - The priority in this case is the infection and only the antibiotic treatment can get rid of the infection, so the ANSWER is B, Antibiotic treatment. A premature baby is receiving an FIO2 of .40 and CPAP at 5 cmH2O. As the respiratory therapist increases the CPAP to 7 cmH2O, the baby's respiratory rate increases to 58 per minute and the TcPCO2 reading increases with a stable SpO2 monitor reading. The respiratory therapist should recommend which of the following? A. Discontinue the CPAP B. Draw an arterial blood gas sample C. Increase the CPAP to 10 cmH2O D. Place the baby in an oxyhood at an FIO2 0.45 - Drawing an ABG would give us more information and since this is not an emergency that is the best ANSWER B, arterial blood gas. A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the patient has the following laboratory findings: K+: 3 mEq/L Na+: 115 mEq/L Cl-: 80 mEq/L HCO3-: 24 mEq/L Urine output: 60 mL/hour BP: 125/95 mm Hg Based upon this information the respiratory therapist would conclude A. the patient is hyperkalemic B. the patient requires decreased fluid intake C. the patient is polycythemic D. the patient has a metabolic alkalosis - Hyperkalemic is high potassium, polycythemic has extra red blood cells, and we do not have Hb measurement, metabolic alkalosis is associated with low potassium but the bicarb is normal (and it would be high with low potassium), the urine output is high so the best ANSWER is B, patient requires reduced fluid intake. A 55-year-old patient is admitted to CCU with chest pain. While assembling an oxygen mask, the respiratory therapist notes the following ECG pattern: Ventricular fibrillation The patient is now unconscious, unresponsive and has no palpable pulse. The therapist's first response should be to: A. administer oxygen by non-rebreather mask. B. deliver a pre-cordial thump. C. recommend intravenous amiodarone. D. perform synchronized cardioversion. - Since you are actually witnessing a ventricular fibrillation, the very first thing you can do is try to get their heart started again by doing ANSWER B, deliver a pre-cordial thump which is a good thump right in the center of their sternum. The respiratory therapist notices a dampened waveform on a pulmonary arterial line. The therapist's first action should be to A. attempt to draw blood from the line. B. check the transducer dome for air bubbles. C. flush the catheter with heparin solution. D. check the position of the transducer. - Dampened wave form is when you aren't getting a nice sharp reading, you should get a clear systolic and diastolic pattern; the most common cause is a blood clot, flushing the catheter with heparin might push the blood clot into the lung at this point (not a good idea), another common cause of a dampened wave form is air bubbles in the transducer dome, so the ANSWER is B. A patient in the intensive care unit is suffering left heart failure. Which of the following drugs will increase the strength of contraction and improve cardiac output? A. digitalis B. atropine C. isuprel D. lidocaine - Atropine is used for bradycardia and increases output but not strength, Isuprel treats bradycardia and output but not strength, Lidocaine reduces irritability of heart, but Digitalis is a cardiac glycoside that increases cardiac output and strengthens cardiac contraction, so ANSWER is A The results of a patient's chest radiograph reveal the presence of a left basilar free fluid accumulation with a meniscus formation. Physical examination of the chest D. PAO2 - CaO2 IS best measurement of oxy delivered to the tissues, normal is 18-20%, this patient's is 12.5% which is low so patient is suffering from anemia (not enough oxy rich hemoglobin). So ANSWER is C. The tip of a catheter used to measure the wedge pressure should be positioned in the: A. superior vena cava B. right atrium C. pulmonary artery D. pulmonary vein - Tip of catheter used to measure the wedge pressure should be positioned in the... Answer C pulmonary artery A 64-year-old patient is being resuscitated for full cardiopulmonary arrest. After several unsuccessful attempts, the patient is orally intubated with a size 7.0 mm endotracheal tube. The physician is unable to establish a peripheral or central intravenous line. The ECG monitor now shows the following rhythm (sinus rhythm with regular positive p-wave, bradycardia). The respiratory therapist should recommend administration of: A. lidocaine by small volume nebulizer. B. atropine through the endotracheal tube. C. epinephrine by intra-cardiac injection. D. amiodarone by intraosseous injection. - Graph shows sinus rhythm with regular positive p-wave, bradycardia (slow heart rate, heart beat more than 5 boxes wide is bradycardia; boxes less than 3 wide is tachycardia). Since no IV can be inserted, we will administer drugs through endotracheal tube.... but what drug...lidocaine would be for gag reflex or coughing, epinephrine very powerful used for emergencies, for flat line, amiodarone might be used for ventricular disrythmias, pvc's; atropine is for Bradycardia so ANSWER is Atropine. A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. To determine the cause of the problem the respiratory therapist should recommend A. administering 100% oxygen. B. a V/Q scan. C. streptokinase. D. a STAT chest x-ray. - long bone fracture combined with patient just lying around makes them very susceptible for pulmonary emboli; so which of these 4 would best find pulmonary emboli. A V/Q scan will show areas of ventilation and profusion and pulmonary emboli could cause area of deadspace, so ANSWER is B (streptokinase is an effective clot buster, STAT chest x-ray would be helpful but not be the best for diagnosing emboli). The respiratory therapist is called to the emergency department to evaluate a patient who was brought in via an ambulance due to a motor vehicle accident. The patient is cold and clammy with a blood pressure of 82/46 mm Hg. The ECG monitor shows sinus tachycardia with occasional PVC. Which of the following should the therapist evaluate at this time? A. Serum electrolytes B. Cardiac enzymes C. Hb and Hct levels D. 12 lead ECG - Patient seems to be experiencing shock, serum electrolytes would be a good choice, cardiac enzymes would be good but very expensive, 12 lead ECG is another good test but more appropriate if we were mainly concerned with the heart; Hb and Hct most closely corresponds to shock because you know the patient was in an accident and probably had a lot of blood loss, so ANSWER is C Hb and Hct Viral infections cause WBC to (INCREASE OR DECREASE) Bacterial infections cause WBC to (INCREASE OR DECREASE) - Viral WBC Decrease Bacterial WBC Increase Which of the following drugs should the respiratory therapist recommend to lower a patient's blood pressure as well as decrease his ventricular afterload? A. Norepinephrine B. Propranolol C. Procainamide D. Sodium nitroprusside - Norepinephrine will increase blood pressure and afterload; Propranolol will slow the heart down but doesn't do anything for the afterload; Procainamide is an antirhythmic agent; Sodium Nitroprusside is a vasodilator, which will reduce blood pressure and decrease the afterload. A pleural friction rub is associated with all of the following conditions EXCEPT A. pneumonia. B. tuberculosis. C. pleurisy. D. pulmonary edema. - Pulmonary edema has a lot of excess fluid in the lung so there would be no friction rub, so ANSWER is D pulmonary edema A 40-year-old patient who smokes 2 packs of cigarettes per day has a carboxyhemoglobin level of 6.4%. These results are most consistent with A. Severe COPD B. History of dyspnea on exertion C. Need for supplemental oxygen D. Expected level for this patient - Nothing about COPD will give you a carboxyhemoglobin level of 6.4%; 6.4% is a typical level for a heavy smoker so ANSWER is D, Expected level for this patient. The following data has been obtained from a 28-week gestational age infant who was born premature: Color: Cyanotic Chest x-ray: Cardiac enlargement Chest Sounds: Systolic murmur Respiratory rate: 55 Br/min. SpO2: 80% Which of the following diagnostic tests should the respiratory therapist recommend? A. Pre- and post-ductal blood gas studies B. L/S ratio C. New Ballard Score D. Capillary blood gas - L/S ratio is done prior to birth to measure ability to produce surfactant; Ballard Score measures gestational age, Capillary blood gas is not going to determine the heart problems we are seeing, so ANSWER is A, Pre and Post-ductal blood gas studies; AIRWAY CARE: A nasopharyngeal airway is indicated for which of the following patients? A. unconscious patient with a closed head injury B. conscious patient with an ineffective cough C. alert patient who is expectorating a large amount of secretions D. uncooperative patient - Nasopharyngeal airway is not for unconscious or uncooperative patients. Patients conscious and expectorating large amounts of secretions on their own does not indicate need for nasopharyngeal airway. So, ANSWER is B, conscious patient with an ineffective cough is the answer and best use of this airway. A 43-week gestational age infant has just been delivered and is stained with meconium. The physician has asked that the baby be intubated and suctioned immediately. The respiratory therapist should recommend intubating the baby with which of the following size endotracheal tubes? A. 2.0 mm B. 2.5 mm C. 3.0 mm D. 4.0 mm - This baby is post-term (by 3 weeks) so the baby probably weighs about 3,000 grams at full term so you can go a full-size airway at 3.0mm ANSWER is C, 3.0 mm. You wouldn't use a 4.0mm until the baby is about 1 year old. A patient being mechanically ventilated requires endotracheal suctioning. The patient is on high levels of PEEP therapy and has periods of hypotension. The respiratory therapist hyperoxygenates the patient before beginning the procedure. As the therapist disconnects the patient from the ventilator circuit, the following pattern is seen on the ECG monitor: Which of the following could be the cause of this patient's ECG pattern? Bradycardia rythm A. loss of PEEP B. inadequate hyperoxygenation time C. vagus nerve stimulation D. normal response to suctioning - Answer is A, Loss of PEEP Which of the following describes the proper technique when using a stylet? A. The distal end should be recessed at least 1 cm from the tip of the endotracheal tube Retract stylet immediately...this answer just stops. But ANSWER B, stop procedure, manually ventilate the patient, and reposition the sytlet is the best "complete" answer. Which of the following is the best method to minimize damage to the tracheal wall caused by an endotracheal tube cuff? A. Measuring the volume used to inflate the cuff B. Palpating the inflation of the pilot balloon C. Utilizing a cuff pressure manometer D. Using minimal occluding volume to seal the airway - Using minimal occluding volume to seal the airway is an older standard (may be used in practice but not for this test), so, ANSWER is C, Utilizing a cuff pressure manometer. THERAPEUTIC PROCEDURES: A patient is on a continuous flow CPAP system. The respiratory therapist notes that the pressure drops to zero during inspiration. The therapist should: A. Initiate mechanical ventilation B. Change to an IPAP/EPAP system C. Increase the flow D. Decrease the threshold resistor - Anytime there is a loss of pressure it is due to 1) a leak, or 2) not enough flow, so look for one of these answers; so the ANSWER is C, increase the flow. A chronic hypercapnic patient enters the emergency room complaining of shortness of breath. The patient is coughing up inspissated, pale, yellow secretions. Which of the following would you recommend at this time? A. Sputum culture and sensitivity B. Oxygen at 2 LPM via nasal cannula C. A-P and lateral chest x-ray D. Arterial blood gases - This is a COPD patient (chronic hypercapnic). Since all four answers are good, look at the one you should do first, so ANSWER is B, oxygen at 2 lpm nasal cannula. A patient with known reversible airway disease takes two puffs of albuterol from his metered-dose inhaler. The respiratory therapist measures the patient's peak flow following the administration of the medication and determines that the peak flow has increased only minimally. The therapist should A. add a spacer to the metered-dose inhaler. B. change the medication to levalbuterol C. administer the medication by small volume nebulizer. D. contact the physician concerning the care of this patient. - ANSWER is A, add a spacer to the metered-dose inhaler. This will give you a better result with the metered-dose inhaler and since the question does "not" say the med was administered with the spacer in place, you can assume it was not since this option is one of the answers. An H cylinder of oxygen has 1200 psi remaining in the tank. How long will it take to decrease to 200 psi if the flow is 5 LPM? A. 1 hour B. 10 hours C. 60 hours D. 600 hours - An "H" cylinder has 1200 psi minus 200 psi = how long to use 1000 psi at 5 lpm. Take 1000 x 3.14 (tank factor) = 3000 liters / 5 lpm = 600 min. / 60 min. = 10 hours, so ANSWER is B, 10 hours While receiving postural drainage and percussion to her right lower lobe, a 44-year- old patient suddenly vomits and aspirates. The respiratory therapist should immediately A. place the patient in Fowlers position. B. encourage the patient to take deep breaths. C. suction the patient. D. administer acetylcysteine by SVN. - placing patient in Fowlers position is good... but not until you have cleared away the vomit so they do not aspirate anything further, so ANSWER is C, suction the patient. An air flowmeter and an oxygen flowmeter are being used to deliver 40% oxygen to a patient via a non-rebreathing mask. A total flow of 12 LPM is required to prevent the non-rebreathing bag from deflating. How many liters of air and how many liters of oxygen should the therapist use? A. 2 LPM air, 6 LPM oxygen B. 4 LPM air, 8 LPM oxygen C. 6 LPM air, 6 LPM oxygen D. 9 LPM air, 3 LPM oxygen - air flowmeter and oxygen flowmeter must equal 12 lpm, with 40% oxygen, so air must be 60%; this is a ratio of 3 to 1 (this is a common ratio), so ANSWER is D 9 lpm air, 3 lpm oxygen (which is 3 to 1) A 26-week gestational age infant requires intensive monitoring and care in the NICU. Which device would be most appropriate for maintaining a neutral thermal environment for this infant? A. radiant warmer B. isolette C. croupette D. bassinet - Both the isolette and the radiant warmer can be neutral thermal environments. The key to this question, making one better than the other, is access to the patient since this baby requires continuous monitoring. Supposedly, the radiant warmer provides better access to the baby than the isolette. Which of the following formulas will calculate the number of hours an E cylinder will provide oxygen to a patient? A. tank pressure (PSI) x 0.3 / flowrate (LPM) B. flowrate (LPM) x 0.3 / tank pressure (PSI) C. [tank pressure (PSI) x 0.3 / flowrate (LPM)] / 60 D. [flowrate (LPM) x 0.3 / tank pressure (PSI)] / 60 - Question 2 of 15 - psi x 0.3 / flowrate / 60 (to give you the hours) A 26-year-old patient with shortness of breath is admitted to the emergency room. The patient states that he was running in Central Park with a friend and could not catch his breath. Bedside assessment reveals the following data: Pulse: 120 Respirations: 25 br/min Color: pale SpO2: 89% on room air Breath sounds: slightly diminished on the right The respiratory therapist should: A. request a STAT chest x-ray. B. administer 100% oxygen. C. insert a large bore needle into the 2nd intercostal space on the right side in the midclavicular line. D. insert a chest tube into the 2nd intercostal space on the right side in the midclavicular line. - Request a STAT x-ray is good but the patient currently has shortness of breath and is uncomfortable, so what would you do FIRST, ANSWER is B, administer 100% oxygen A patient is receiving CPAP therapy and the pressure is fluctuating between +5 and - 8 cmH2O. What should the therapist do to stabilize the CPAP therapy? A. increase the flowrate B. decrease the pressure C. check for system leaks D. check for sticking valves - Because the flow was 5+ and 8-, you don't check for leak, you want to maintain a positive pressure on both inspiration and expiration, so you should increase the flowrate to meet patient demand and maintain a positive pressure on both inspiration and expiration, so ANSWER is A increase flowrate. Which of the following supply pressures would be appropriate for an air/oxygen proportioner? A. 30 psi B. 50 psi C. 100 psi D. 760 psi - appropriate pressure at which a blender should operate (air/oxygen proportioner), just about all respiratory care equipment operates at 50 psi and the minimum would be 40 psi, so ANSWER is B, 50 psi. A patient is receiving IPPB by mouthpiece. The therapist notes that the machine fails to cycle into the expiratory phase. The respiratory therapist should A. increase the flow. B. decrease the sensitivity. C. adjust the apnea timer. D. increase the pressure. - IPPB machines are pressure cycled and have to reach a preset pressure to turn off inspiration and go into the expiratory phase. Two reasons a machine would not reach a preset pressure, 1) there is a leak, 2) not enough flow, so ANSWER is A, increase the flow. Decreasing sensitivity only controls the machine turning on; and Which of the following are true statements concerning an automated medication dispensing system? 1. Maintains accurate information about when medication was dispensed. 2. Allows multiple practitioners to access patient medication. 3. Assists with management of medication inventory. A. 2 only B. 1 and 3 only C. 1 and 2 only D. 1, 2, and 3 - ALL three are good so D is the answer. In order to assist a patient with his efforts to quit smoking, the respiratory therapist could recommend Varenicline Naloxone Bupropion HCI A. Yes No Yes B. No No No C. Yes Yes Yes D. No Yes No - Answer is A. Varenicline is chantex which is help reduce erge of smoking. Naloxone is narcan which is used to flip the effects of narcotics. Bupropion HCI is a anti- depressant so would help while trying to quit smoking. The ICU director wishes to implement a protocol to reduce the risk of ventilator- associated pneumonia (VAP) for patients requiring mechanical ventilation. The respiratory therapist should recommend that the protocol include A. placing the patient in the prone position. B. changing the ventilator circuit each day. C. utilizing a closed-suction catheter system. D. intubating the patient with a Carlens tube. - Answer is C. Prone position is good which is what I picked but not the nest answer. The most important is making sure the suction catherter is enclosed. A 75-year-old patient with COPD is receiving oxygen at home by nasal cannula with a bubble humidifier. How should the respiratory therapist instruct the patient to clean his humidifier? A. Place it on the top shelf of the dishwasher. B. Soak it in an acetic acid solution for 20 minutes and rinse with water. C. Rinse it with distilled water and allow to air dry. D. Soak it in an alkaline glutaraldehyde solution for 30 minutes and rinse with water. - Answer is B. Dishwasher would ruin it by the heat. Answer d would sterilize it but to expensive and not practical for home setting. In order to monitor compliance of hospital employees in a smoking cessation program, the respiratory therapist should monitor the employees' A. PaO2. B. FECO. C. PETCO2. D. FENO. - Answer is B. FEC0 is high means they have been smoking shows the carbon monoxide levels. It's the exhaled c0 levels. A patient complains of shortness of breath while receiving oxygen via transtracheal catheter. Her pulse oximeter reading has decreased from 92% to 85%. The respiratory therapist should first A. increase the flow to the catheter. B. flush the catheter with saline. C. administer metaproterenol via small volume nebulizer. D. replace the transtracheal catheter with a nasal cannula. - Answer is B. Mucus plugging is a big problem. It's a common problem . C is a bronchodilator theres no need for one right now. And D would be a good second choice. But first try to clear the catheter we already have in place. A patient is being discharged from the hospital. The physician has ordered portable oxygen therapy at home. The patient has been instructed to use the oxygen at 1-2 L/min during the day and PRN at night. Which of the following should the respiratory therapist recommend? A. E cylinders B. Concentrator C. Liquid system D. Molecular sieve - Answer is C. E cylinders are portable but don't last last for regular use. Concentrator must be plugged in so not portable. Liquid system is going to last long and is very portable. Molecular sieve is a concentrator so obviously they are both wrong. An oxygen conservation cannula would be most appropriate for which of the following patients? A. A patient with pneumonia requiring low flow oxygen. B. A patient with emphysema who is experiencing increased shortness of breath. C. A patient with a severe exacerbation of asthma. D. A patient with pulmonary fibrosis requiring long term oxygen therapy. - Answer is D. conservation cannula is for long term patient can turn down the flow but get the same oxygen percent. D is the right answer because it point out LONG TERM OXYGEN THERAPY. SPECIAL PROCEDURES: A patient suffering from decompression sickness requires hyperbaric oxygen therapy. The respiratory therapist should initiate therapy at A. 2 ATA. B. 4 ATA. C. 6 ATA. D. 8 ATA. - Answer is A. ATA is Absolute this machine can go from 2-6 but you want to start the patient off at the lowest. A patient is breathing a mixture of 70% He / 30% O2 via non-rebreather mask. The oxygen flowmeter indicates a flow of 12 L/min. What is the actual flow of gas to the mask? A. 12 L/min B. 16 L/min C. 19 L/min D. 22 L/min - Answer is C. flow 12 x 1.6 =19.2 so round off 19 is closest. 1.6 is the factor for He at 70% Which of the following is a potential side effect of inhaled nitric oxide therapy? A. Systemic hypotension B. Formation of nitrous oxide C. Oxygen toxicity D. Methemoglobinemia - Answer is D. Nitric oxide is for pulmonary hypertension. Nitric oxide can alterate hemoglobin which is why D is the best answer. While assisting a pulmonologist performing thoracentesis on a 58-year-old man, the respiratory therapist observes that the pleural fluid is clear with a light straw color. This fluid would best be described as A. exudate. B. transudate. C. purulent. D. serosanguineous - Answer is B. exudate is blood puss. Purulent is fluid with puss. Serosanguineous is sero fluid and blood. The following pneumogram is obtained (this patient is showing signs of obstructive sleep apnea) while a 47-year-old woman undergoes polysomnography: The respiratory therapist should recommend that the patient receive: A. doxapram. B. oxygen therapy. C. non-invasive ventilation. D. nasal CPAP. - Answer is D. this patient is showing signs of obstructive sleep apnea because there is no air flow but the thoracic is showing. If there is no chest rise abdomen then it would be central sleep apnea but since it is obstructive sleep apnea CPAP is your best choice. In preparing to perform a cardiopulmonary stress test on a 60-year-old man, the respiratory therapist must determine the target heart rate range for the patient. What is the patient's maximum heart rate? A. 130 beats/minute B. 160 beats/minute C. 190 beats/minute D. 220 beats/minute - heart rate is 220, minus patients age so... 220-60. So answer is B. Following indirect calorimetry, a 66-year-old patient's RQ is calculated to be 1.01. What food group is being primarily metabolized by this patient? A. Proteins pH: 7.39 PvCO2: 46 torr PvO2: 50 torr SvO2: 80 % HCO3-: 25 mEq/L BE: +1 mEq/L What should the respiratory therapist report as the patient's C(a-v)O2? A. 1.8 vol% B. 3.3 vol% C. 5.2 vol% D. 7.3 vol% - Shortcut for figuring patients C(a-v)O2 Take the difference between SaO2 - SvO2 x 2 = 34, then place decimal between 3.4, so ANSWER is B 3.3 vol% A patient in the intensive care unit has the following data obtained: pH: 7.41 PaCO2: 40 torr PaO2: 235 torr SaO2: 99% HCO3-: 23 mEq/L BE: +1 mEq/L FIO2: 1.0 VD/VT: 0.35 Hb: 15 g/dL RER: 0.8 PB: 747 What should the respiratory therapist report as the P(A-a)O2? A. 210 torr B. 415 torr C. 535 torr D. 620 torr - This is common called the A-a gradient. P(A-a)O2, ANSWER is B, 415 torr. A patient is being ventilated with a Servo 300 ventilator in the intensive care unit. The following data is obtained: Mode: SIMV Mandatory rate: 12 b/min Total rate: 12 b/min VE: 8.6 L FIO2: 0.60 PIP: 31 cm H2O PEEP: 10 cm H2O pH: 7.41 PaCO2: 40 torr PaO2: 95 torr SaO2: 96% HCO3-: 23 mEq/L BE: +1 mEq/L A-aDO2: 300 torr C(a-v)O2: 3.6 vol% What should the therapist report as the QS/QT? A. 15% B. 18% C. 20% D. 25% - QS/QT is the shunt (5% is normal) Shortcut - Start with 5%, add another 5% for each 100 of A-a gradient, so 5% + 15% = 20, so the ANSWER is C, 20% The FRC (functional residual capacity) is measured on a patient using the helium dilution technique and the result is 3.0 liters. The same patient is then tested in a body box and the result is 4.5 liters. Which of the following would account for the difference? A. The patient has significant non-ventilated lung volume B. There was a leak during the helium dilution procedure C. The patient did not perform the maneuver properly D. Hysteresis is present - Question is asking why is there a difference in the FRC between helium test and body box test. A body box is more accurate, it measures ALL gases in the chest. Helium will not measure any "trapped" gases. So, the difference must be the trapped gases, so the ANSWER is A, the patient has significant non-ventilated lung volume (which is a fancy name for trapped gases). What is the PAO2 for a patient breathing 30% oxygen at sea level? A. 100 - 105 torr B. 120 - 140 torr C. 155 - 170 torr D. 210 - 220 torr - PAO2 of patient breathing 30% oxygen - ANSWER is C, 155 - 170 torr PAO2 Shortcut take FiO2 x 7 - 50 = 160 (30% x 7 = 210 - 50 = 160) Prior to performing spirometry on a pre-op patient, the respiratory therapist calibrates the spirometer using a 3.0 L super syringe. The three volumes achieved are: 2.80 L, 2.80 L, 2.79 L. Based upon the information obtained the therapist should conclude that the 1. spirometer is precise. 2. spirometer is accurate. 3. super syringe was advanced too slowly. 4. spirometer may have a leak. A. 1 and 3 only B. 1 and 4 only C. 2 and 3 only D. 2 and 4 only - When you use a 3.0 L syringe it should come out within .1, so 2.80, 2.79 are too low. Spirometer is "precise" means "consistent" it does not mean accurate of perfect. Spriometer is accurate means average (the average of the 3 numbers should come out to 3.0). Spirometer has a leak is why when you blow 3.0 L, you only get volumes of 2.80, 2.80 and 2.79, so ANSWER is B 1 and 4 A patient is observed to have an increased respiratory rate and depth of breathing. Their breath has a fruit-like aroma. This would most likely be associated with: A. head trauma B. metabolic acidosis C. drug overdose D. chronic obstructive lung disease - A patient breathing deep and fast is Kushmals breathing (body trying to push out CO2 to get rid of metabolic acidosis). The fruit-like breath is also associated with the metabolic acidosis, so ANSWER is B, metabolic acidosis. A patient is on a ventilator and is in the process of being weaned. What is the best way to continuously monitor the minute ventilation? A. Chest transducers B. Thermistors C. Water seal spirometer D. Pneumotachometer - Best way to continuously monitor minute ventilation. Chest transducers measure effort to breathe; thermistor is a temperature probe that will measure effort; water seal spirometer is very accurate in measuring volumes but it can't continuously measure minute ventilation because it will run out of room; Pneumotachometer will measure flow passing through it for as long as you want, so ANSWER is D, Pneumotachometer. The best way to check the accuracy of an air/oxygen proportioner is by using: A. polarographic electrode analyzer B. precision geisler tube analyzer C. infrared absorption analyzer D. teflon membrane analyzer - ANSWER is A, polarographic electrode analyzer Which of the following would equal the vital capacity (VC)? A. VT + IRV B. ERV + RV C. IRV + VT + ERV D. IRV + VT + ERV + RV - Question 13 of 15 - What equals vital capacity (look at Kevin's chart) A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. After administering 100% oxygen, the therapist should recommend A. a barium swallow. B. a CT of the chest. C. starting heparin therapy. PaCO2: 44 torr SpO2: 93% The patient is conscious and pulling on the IV lines and ventilator tubing. At this time, the respiratory therapist should recommend A. changing to assist/control mode. B. restraining the patient. C. increasing the set rate to 16 br/min. D. sedating the patient. - D, Sedate the patient (if nothing in their blood gas is causing their behavior and they are just agitated, just sedate them to calm them down); Changing to assist/control mode won't do anyting about patients agitation; Restraining patient won't help agitation and might cause them to become more violent; Increasing the set rate to 16/br min. won't do anything and this isn't a good time to change settings. Question 9 of 15 - A 60-year-old male patient weighs 80 kg (176 lb) and is on a volume-cycled ventilator at a set VT of 800 mL, a peak pressure reading of 65 cm H2O, exhaled VT measured at 760 mL, peak inspiratory flowrate is 60 L/min., a plateau pressure reading of 58 cm H2O and a PEEP of 5 cm H2O. Which of the following is most likely occurring at this time? A. Dynamic compliance is decreasing B. Static compliance is increasing C. Airway resistance is increasing D. Thoracic compliance is increasing - A, Dynamic compliance is decreasing (You have increasing pressure therefore you would have decreasing compliance; The other answers are decreasing compliance answers. An infant on a high frequency jet ventilator (rate of 150 b/m) has the following arterial blood gases: pH: 7.30 PaO2: 60 torr PaCO2: 50 torr HCO3-: 21 mEq/L Which of the following changes would best help to improve these results? A. Increase the inspiratory time B. Increase the drive pressure C. Increase the frequency to 190 br/min D. Increase the FIO2 - Question 12 of 15 - By looking at PaCO2 you can see that the patient is not being properly ventilated (and the PaO2 is a little low due to this also). All are good answers but the "best" is ANSWER B, Increase the drive pressure to deliver more volume and blow off more CO2. Think of this as any other machine (PEEP, etc.) and what would you do if the patient was not being properly ventilated? Forget that this is a baby on a fancy named machine... you would increase the pressure, so increase it here.; Increasing inspiratory time A premature neonate with respiratory distress syndrome is being mechanically ventilated with a pressure-limited, time-cycled ventilator at the following settings: PIP: 25 cm H2O Rate: 24/min Flow: 7 L/min I time: 0.6 sec. FIO2: 0.45 PEEP: 4 cm H2O Arterial blood gas results from an umbilical artery line are as follows: pH: 7.29 PaCO2: 62 torr PaO2: 68 torr HCO3-: 22 mEq/L The therapist should now recommend: A. Increase PEEP B. Increase the I time C. Increase the rate D. Decrease PIP - You are seeing inadequate ventilation; A, increasing PEEP would help the oxygenation not ventilation; ANSWER is C, increase the rate. Mechanical Ventilation - B The respiratory therapist reviews the ventilator parameter sheet for a patient receiving mechanical ventilation. The peak and plateau pressure readings are as follows: Based upon this information, the therapist should conclude that A. airway resistance is increasing. B. water is building up in the tubing. C. pulmonary compliance is decreasing. D. minute volume is increasing. - Peak pressure = how much pressure it takes to put air into the lungs and how much it takes to push air through the tubing; Plateau pressure = only pressure it takes to put air into the lungs. The difference between these two shows airway resistance. You'll notice by the difference between the two pressures that airway resistance is pretty much staying the same; If water was building up in tubing the airway resistance would also be increasing. You will notice on the Plateau pressure only, that it is gradually "increasing"... it is taking more pressure just to get air into the lungs, so the lungs are becoming stiffer (compliance is decreasing), so the ANSWER C, Pulmonary compliance is decreasing. Question 4 of 15 - A 48-year-old patient is receiving mechanical ventilation following a hernia repair. He is 6' tall and weighs 75 kg (165 lb). Prior to initiating a spontaneous breathing trial, the respiratory therapist notes the following information: FIO2: 0.35 SIMV mandatory rate: 6 /min. Total rate: 14 /min. VT: 600 mL MIP: -26 cm H2O Spont. VT: 400 mL Arterial blood gas results show: pH: 7.39 PaCO2: 42 torr PaO2: 88 torr HCO3-: 23 mEq/L The patient is to be placed on CPAP with an FIO2 of 0.40. Five minutes into the SBT, his respiratory rate increases to 28 /min., heart rate changes from 110 /min. to 135 /min. and blood pressure changes from 112/70 mm Hg to 140/88 mm Hg. At this time, the therapist should A. shorten the SBT by 5 minutes. B. continue the SBT. C. discontinue the SBT. D. increase the FIO2 to 0.45. - Didn't type answer A post-operative craniotomy patient was thrashing around while on a volume-cycled microprocessor ventilator. The physician has asked for your recommendation in the management of this patient to prevent him from harming himself and to also stabilize his ICP. Which of the following drugs would you recommend administering at this time? A. Anectine B. Versed C. Valium D. Morphine - Ideal drug would be one that sedates, relieves pain, and depresses ventilator drive. Anectine is a short acting paralyzing drug with no sedative and no pain killers; Versed is an anti-anxiety, it would sedate, but that is all; Valium sedates but does not control ventilation or kill pain. Morphine sedates, depresses ventilatory drive, and is a pain killer, so ANSWER is D, Morphine A 68 kg (150 lb) patient has a spontaneous tidal volume of 450 mL and is breathing at a rate of 12 breaths/min. What is their minute alveolar ventilation? A. 1.8 L/min B. 3.6 L/min C. 5.4 L/min D. 8.6 L/min - Alveolar ventilation = (Vt - deadspace) x RR = 3600 ml or 3.6 L (deadspace is = to patients weight in pounds), so ANSWER is B, 3.6 L/min A 6' 2" tall, 80 kg (176 lb) male patient with alpha 1 protease inhibitor deficiency is being mechanically ventilated at the following settings: Mode: VC, SIMV Set rate: 12 br/min. Total rate: 16 br/min. Tidal volume (set): 650 mL Tidal volume (spontaneous): 320 mL Peak flow: 55 L/min FIO2: 0.30 Set rate: 20 /min. Total rate: 20 /min. PEEP: 18 cm H2O Peak pressure: 35 cm H2O Arterial blood gas results show: pH: 7.35 PaCO2: 45 torr PaO2: 43 torr HCO3-: 22 mEq/L It would be appropriate for the respiratory therapist to A. increase the set rate to 25 /min. B. switch to inverse ratio ventilation. C. increase pressure to 40 cm H2O. D. increase PEEP to 25 cm H2O. - Because this patient is severely hypoxic while on high levels of oxygen and high levels of PEEP, you can tell that this patient has ARDS, so ANSWER is B, Switch to inverse ratio ventilation Mechanical Ventilation - C A 65 kg (150 lb) patient requires a minute alveolar ventilation of 10 L/min. Which of the following set of parameters would be most appropriate? A. VT 600 mL, RR 16 /min, VD mech 0 mL B. VT 650 mL, RR 18 /min, VD mech 50 mL C. VT 700 mL, RR 20 /min, VD mech 50 mL D. VT 900 mL, RR 12 /min, VD mech 100 Ml - Calculate minute alveolar ventilation. In this case, the patient is on a ventilator so we also have to subtract out not only the deadspace, but also the mechanical deadspace (listed in each answer) so, ANSWER is C, VT 700 mL, RR 20/min, VC mech 50 mL (700 - 150 - 50) x 20 Need Question - Question 6 of 15 - Patients airway pressures are decreasing, lungs are improving. Since it's the patients airway pressure that is decreasing, we should readjust the low pressure alarm, so ANSWER is B, low pressure alarm. Following mitral valve replacement surgery, a 29-year-old female patient is combative on a volume-control ventilator in the assist/control mode. The peak pressure alarm is sounding with each breath. The nurse practitioner has a STAT call in to the cardiovascular surgeon. She asks the respiratory therapist for an immediate recommendation. Which of the following should the therapist recommend? A. increase the peak pressure alarm limit B. Order a STAT chest x-ray C. Change to SIMV mode and evaluate the patient D. Order a STAT arterial blood gas - Combative post-op patient. You need to take some action to support the patient and evaluate further. Order a STAT chest x-ray is not going to help the immediate problem and will actually delay action. Change to SIMV mode and evaluate will help correct peak pressure alarm problem by allowing the patient to breathe spontaneously in between ventilator breaths. SIMV as a rule is more comfortable for most patients, so ANSWER is C. Need question - Question 10 of 15 - Vt is high at 500 mL. Good range would be weight in kg x 5 through weight in kg x 10 (40 x 5 = 200, and 40 x 10 = 400, So range would be 200- 400. ANSWER A, decrease tidal volume is correct A patient is receiving mechanical ventilation at the following settings: Mode: SIMV Mandatory rate: 12 Total rate: 12 FIO2: 0.50 VT: 750 ml Peak flow: 50 L/min. PEEP: 5 cmH2O The following volume-pressure loop is observed. Which of the following changes should the therapist recommend? A. Increase the PEEP B. Change to pressure support mode C. Decrease the VT D. Increase the peak flow - volume/pressure loop looks like a beak (overdistention). Get rid of the beak (up and down is pressure measurement; side to side measurement is volume). ANSWER is C, Decrease the Vt A 28-week gestational age infant with severe respiratory distress syndrome is being mechanically ventilated in the PC, SIMV mode at the following settings: Flow rate: 6 L/min Set rate: 32 br/min. PIP: 28 cmH2O FIO2: 0.70 PEEP: 5 cm H2O I time: 0.8 seconds Umbilical arterial blood gas results reveal: pH: 7.40 PCO2: 39 torr PO2: 42 torr HCO3-: 23 mEq/L Based on the above information, the respiratory therapist should change the A. I time to 1.0 second. B. PEEP to 7 cm H2O. C. FIO2 to 0.75. D. PIP to 30 cm H2O. - Ventilation is good on baby, PO2 is bad (less than 60), so we have an oxygenation problem. Baby is already on high level of oxygen and they are already on PEEP therapy, but they are still shunting (they are on 70% FiO2 and still bad oxygenation with good ventilation) so inch up the PEEP (never above 8), so ANSWER is B, PEEP to 7 cm H2O. Need question - Question 13 of 15 - Peak Pressure - Plateau Pressure = Airway Resistance. So, we can see that the airway resistance has been increasing steadily. Most common cause are secretions, or bronchospasm though bronchospasm is not as common. Lung compliance is indicated by the Plateau pressure, which has been maintaining. ANSWER C, the patient needs suctioning. A 70 kg (154 lb) male patient is being mechanically ventilated following a triple coronary artery bypass graft. The chest radiograph shows bilateral radiolucency. An arterial blood gas has been obtained. Ventilatory data and blood gas results are below: Mode: SIMV FIO2: 0.40 Mandatory rate: 8 Total rate: 16 VT: 650 mL Spontaneous VT: 175 mL PIP: 29 cm H2O Plateau Pressure: 21 cm H2O PEEP: 5 cm H2O pH: 7.31 PaCO2: 54 torr PaO2: 83 torr HCO3-: 23 mEq/L BE: 0 mEq/L Which of the following should the therapist recommend? A. Independent lung ventilation B. Pressure control ventilation C. Pressure support ventilation D. Inverse ratio ventilation - Bilateral radiolucency is a normal looking lungs. PaCO2 is high and the patient is on SIMV but there is no pressure support. Pressure support supports patients spontaneous breathing, Mode: PC, SIMV Arterial blood gas results show: pH: 7.36 PaCO2: 44 torr PaO2: 49 torr HCO3-: 24 mEq/L The respiratory therapist should adjust the A. PEEP to 8 cm H2O. B. FIO2 to 0.65. C. set rate to 24 /min. D. PIP to 36 cm H2O. - They are extremely hypoxic and shunting (since they have bad oxygen while on FiO2 of 60%), so raising FiO2 would not help. So ANSWER is A, Increase PEEP to 8 Question 10 of 15 - A patient is receiving mechanical ventilation at the following settings: Mode: VC, SIMV Mandatory rate: 12 /min Total rate: 12 /min FIO2: 0.50 VT: 700 mL Peak flow: 40 L/min. PEEP: 5 cm H2O The following scalar graphic is observed. Which of the following should the respiratory therapist recommend? A. Increase the PEEP B. Change to pressure control mode C. Decrease the VT D. Increase the peak flow - Need Answer Which of the following parameters are acceptable for weaning a patient from continuous mechanical ventilation? 1. VD/VT: 65% 2. MIP: -18 cm H2O 3. Qs/Qt: 10% 4. A-aDO2: 12 torr (21% oxygen) A. 3 & 4 only B. 1 & 2 only C. 1, 2 & 3 only D. 1, 2, 3 & 4 - Vd/Vt ratio should be less than 40%; MIP - 18 cm H2O should be -20; Qs/Qt ratio should be less than 20% so this is acceptable; A-aDO2 12 torr (21% oxygen) acceptable because the gradient (12) should be less than the oxygen (21). So ANSWER is A, 3 & 4 only A post-operative thoracotomy patient is receiving mechanical ventilation in the recovery room with a tidal volume of 750 mL, SIMV mandatory rate 8/min, FIO2 of 0.40. Arterial blood gas results show: pH: 7.36 PaO2: 89 torr PaCO2: 45 torr SaO2: 95% The patient is breathing fast and shallow. Based upon this information, the respiratory therapist should recommend A. repeating the arterial blood gas in 30 minutes. B. increase SIMV mandatory rate to 10/min. C. sedating the patient. D. paralyzing the patient with pancuronium bromide (Pavulon). - Any patient on any ventilator you must consider patient response. Blood gases are fine and don't warrant any changes to ventilator settings. Plus this patient is in the recovery room so we want to get them off the ventilator and wake them up. So the best ANSWER is A, check arterial blood gas in 30 min. (basically monitor the patient). A post-operative craniotomy patient is receiving mechanical ventilation and has an increased intracranial pressure reading. The goals of mechanical ventilation for this patient include all of the following EXCEPT A. increased PaCO2. B. keep airway pressure to a minimum. C. hyperoxygenate. D. use minimum PEEP levels. - You do not want increased PaCO2 with a patient who has increased cranial pressure