NBRC TMC/CRT/RRT Exam Questions and Answers, Exams of Nursing

Download NBRC TMC/CRT/RRT Exam Questions and Answers and more Exams Nursing in PDF only on Docsity! NBRC TMC/CRT/RRT EXAM LATEST 2023- 2024 QUESTIONS AND CORRECT ANSWERS |A GRADE After a patient undergoes a thoracentesis, the respiratory therapist notes that the obtained pleural fluid is clear with a slight straw color. This fluid is most likely the result of A. empyema. B. congestive heart failure. C. lung carcinoma. D. hemothorax. - ANSWER- B. congestive heart failure. Which of the following would be most important to evaluate for a patient who is entering a smoking cessation program? A. Height B. Smoking history C. Weight D. Diet - ANSWER- B. Smoking history The respiratory therapist is calibrating a spirometer and checking the volume with a 3.0 liter super syringe. The volumes recorded are: 2.85 L, 2.8 L, and 2.8 L. Based upon the information obtained which of the following is a correct statement? A. Another syringe needs to be used B. Spirometer is accurate C. The plunger was advanced too slowly D. Spirometer may have a leak - ANSWER- D. Spirometer may have a leak Which of the following is an indication for high frequency jet ventilation? A. Bronchopleural fistula B. Wilson Mikity syndrome C. Necrotizing lesion of right lung D. Centrilobular emphysema - ANSWER- A. Bronchopleural fistula A 43-year-old female patient has just undergone a total abdominal hysterectomy. The patient arrives in the post anesthesia care unit obtunded with minimal response to painful stimulus. What treatment should the respiratory therapist recommend for this patient? A. Initiate assisted ventilation B. Insert oropharyngeal airway C. Obtain positron emission tomography D. Initiate noninvasive capnography - ANSWER- B. Insert oropharyngeal airway A 44 week gestational age infant has just been delivered via C-section and is gasping, grunting, and has tachycardia and tachypnea. At one minute his Apgar score is 4 and at 5 minutes the score is 5. The infant is most likely suffering from A. transient tachypnea of the newborn. B. meconium aspiration. C. bronchopulmonary dysplasia. D. apnea of prematurity. - ANSWER- B. meconium aspiration. What is the normal VD/VT ratio for a patient breathing room air? A. 5 - 15% B. 20 - 40% C. 45 - 55% D. 65 - 75% - ANSWER- B. 20 - 40% A heat moisture exchanger is indicated for humidification in which of the following situations? A. Mechanical ventilation in a long-term care facility. B. Transport to a tertiary care center. C. Patient with tenacious secretions. D. Delivery of aerosolized bronchodilators. - ANSWER- B. Transport to a tertiary care center. All of the following could cause a patient's right-hemidiaphragm to be elevated, EXCEPT A. right lower lobe atelectasis. B. right side hyperlucency, absent vascular markings. C. hepatomegaly. D. right lower lobe consolidation with air bronchograms. - ANSWER- B. right side hyperlucency, absent vascular markings D. Cell hydration level - ANSWER- B. Serum electrolytes While instructing a patient prior to a vital capacity maneuver, the respiratory therapist should direct the patient to A. exhale to residual volume and inhale to inspiratory capacity. B. inhale to total lung capacity then exhale to residual volume. C. exhale normally then inhale to total lung capacity. D. inhale normally then exhale to functional residual capacity. - ANSWER- B. inhale to total lung capacity then exhale to residual volume. A patient involved in an automobile accident is brought to the ED with tachypnea, tracheal deviation to the right, splinting, asymmetrical chest movement, and decreased breath sounds on the left side. The respiratory therapist should initially A. insert a chest tube. B. administer 100% oxygen via mask. C. perform endotracheal intubation. D. initiate non-invasive positive pressure ventilation. - ANSWER- B. administer 100% oxygen via mask. A 77-year-old male patient is admitted to the emergency room with shortness of breath, fine basilar crackles, +2 pitting edema and a chest radiogram with a butterfly pattern. These results are most consistent with which of the following? A. Pulmonary edema B. Pulmonary interstitial emphysema C. Pneumothorax D. Emphysema - ANSWER- A. Pulmonary edema Which of the following formulas will determine the total flow being delivered to a patient with a 28% venturi mask running at 6 L/min? A. total flow = 6 x 2 B. total flow = 6 x 4 C. total flow = 6 x 5 D. total flow = 6 x 11 - ANSWER- D. total flow = 6 x 11 Fine crepitant crackles are most commonly associated with which of the following conditions? A. Bronchitis B. Pulmonary edema C. Pneumonia D. Foreign body aspiration - ANSWER- B. Pulmonary edema A patient with end-stage pulmonary fibrosis is receiving oxygen at 2 L/min via a transtracheal oxygen catheter. The patient experiences an increased work of breathing and shortness of breath. The respiratory therapist should A. manually ventilate the patient with a resuscitation bag. B. increase the flow to the transtracheal catheter to 6 L/min. C. evaluate the SpO2 with a pulse oximeter. D. flush the transtracheal device with isotonic saline. - ANSWER- D. flush the transtracheal device with isotonic saline. During bedside monitoring the respiratory therapist notices a dampened waveform on the arterial line graphic. To restore the graphic to normal, the therapist should first A. verify the position of the transducer. B. check the transducer dome for air bubbles. C. flush the catheter with heparin solution. D. attempt to draw blood from the arterial line. - ANSWER- B. check the transducer dome for air bubbles. An optimal PEEP study is initiated on a patient receiving mechanical ventilation. The respiratory therapist first places the patient on a PEEP of 10 cm H2O for 20 minutes with no adverse effects. The PEEP is increased to 15 cm H2O and the patient's heart rate rises significantly with a severe fall in the blood pressure. Based upon the above information, the therapist should conclude that the patient is suffering from A. peripheral vasoconstriction. B. hypovolemia. C. increased venous return. D. increased SVR - ANSWER- B. hypovolemia. A post-operative thoracotomy patient is receiving incentive spirometry therapy Q2H. Breath sounds are diminished in the bases of the lungs with scattered crackles. The patient's inspiratory capacity has decreased over the past 2 days. A chest radiograph indicates thin-layered basilar densities. Which of the following has most likely occurred? A. Atelectasis B. Pneumonia C. Pulmonary edema D. Consolidation - ANSWER- A. Atelectasis A patient is in full cardiopulmonary arrest and after several attempts, the Mode VC, SIMV Mandatory rate 12 b/min Total rate 18 b/min VT 800 mL 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 PECO2 30 torr Hb 15 g/dL What should the respiratory therapist report as the VD/VT ratio? A. 15% B. 25% C. 40% D. 50% - ANSWER- B. 25% What is the air-to-oxygen ratio for an air entrainment device delivering 60% oxygen? A. 1:1 B. 3:1 C. 4:1 D. 10:1 - ANSWER- A. 1:1 Following surgery to correct an abdominal aortic aneurysm, a 54-year-old female patient suddenly develops intense substernal chest pain with severe dyspnea. The pain does not appear to be aggravated by her respirations. Auscultation reveals bilateral, basilar, moist, crepitant rales. The patient appears pale, cold and clammy. Which of the following should the respiratory therapist recommend for initial assessment of this patient? A. Serum electrolytes B. Chest x-ray C. Complete blood cell count D. Electrocardiograph - ANSWER- D. Electrocardiograph An adult patient is intubated with a 7.0 mm ID endotracheal tube. What size suction catheter should be used to suction this patient? A. 8 French B. 10 French While suctioning a patient who is being mechanically ventilated, the respiratory therapist notes the following ECG pattern on the monitor: Suctioning is stopped and the patient is returned to the ventilator. Which of the following drugs should the respiratory therapist recommend FIRST? A. 100% oxygen B. atropine C. lidocaine D. epinephrine - ANSWER- A. 100% oxygen Adjusting the inspiratory flow during an IPPB treatment will result in a change in A. respiratory rate. B. peak pressure. C. tidal volume. D. inspiratory time - ANSWER- D. inspiratory time A patient in the intensive care unit has the following hemodynamic measurements: CVP 4 mm Hg PAP 48/16 mm Hg PCWP 8 mm Hg MAP 92 mm Hg Cardiac Output 5 L/min. Cardiac Index 2.5 L/min/m2 These results are most consistent with A. normal cardiac function B. pulmonary hypertension C. left heart failure D. hypovolemia - ANSWER- B. pulmonary hypertension A patient who is suspected of having a flail chest has been intubated and mechanically ventilated with PEEP therapy. The patient has just received pancuronium bromide. Which of the following ventilator alarms would be most important to set correctly for this patient? A. Peak pressure alarm B. Low PEEP pressure alarm C. I:E ratio alarm D. Low exhaled volume alarm - ANSWER- B. Low PEEP pressure alarm 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 distal lumen? A. CVP B. PAP C. PCWP D. MAP - ANSWER- B. PAP A pre-op patient who is at high risk for post-operative complications should be evaluated by obtaining the results of A. VD/VT study. B. diffusion studies. C. basic spirometry. D. indirect calorimetry. - ANSWER- C. basic spirometry. A patient is receiving noninvasive positive pressure ventilation by mask. Current settings and arterial blood gas results are as follows: IPAP 10 cm H2O EPAP 5 cm H2O Respiratory rate 12 /min pH 7.31 PaCO2 56 torr PaO2 63 torr HCO3 25 mEq/L BE +1 mEq/L Which of the following should the respiratory therapist recommend? A. Increase the EPAP to 10 cm H2O B. Decrease the EPAP to 3 cm H2O C. Increase the IPAP to 20 cm H2O D. Decrease the IPAP to 5 cm H2O - ANSWER- C. Increase the IPAP to 20 cm H2O During recovery from resection of an aortic aneurysm, a 65-year-old female patient suddenly develops severe substernal chest pain with grave dyspnea. The physician describes the bilateral breath sounds as basilar moist crepitant crackles. The patient appears pale, cool and diaphoretic. Which of the following should the respiratory therapist recommend as part of the initial assessment of this patient? A. ECG B. CBC C. Serum electrolytes D. Lateral decubitus radiograph - ANSWER- A. ECG A. select a metered dose inhaler. B. utilize a dry powder inhaler. C. replace the small volume nebulizer every 24 hours. D. wipe the surface of the nebulizer with alcohol every evening. - ANSWER- A. select a metered dose inhaler. Which of the following is a FALSE statement about self-inflating resuscitation devices? A. A reservoir is utilized to increase the delivered oxygen concentration. B. The therapist can sense changes in the patient's lung compliance and airway resistance. C. A compressed gas source is necessary for the device to operate. D. Excessive gas flow may cause the valve to malfunction. - ANSWER- C. A compressed gas source is necessary for the device to operate. A 72-year-old male patient who is 5' 10" tall and weighs 75 kg (165 lb) is receiving mechanical ventilation. The respiratory therapist notes diminished breath sounds in the bases of both lungs. The patient is on the following ventilator settings: Mode VC, A/C VT 600 mL Set rate 10 br/min PEEP 10 cm H2O FIO2 0.50 Sigh volume 0.6 L Arterial blood gases show: pH 7.42 PaO2 82 torr PaCO2 38 torr SaO2 93% Based on this information, the respiratory therapist should A. maintain the current settings. B. increase the set rate to 12 br/min. C. decrease the tidal volume to 500 mL. D. increase the sigh volume to 1.0 L. - ANSWER- D. increase the sigh volume to 1.0 L. A patient in the intensive care unit has the following hemodynamic measurements: CVP: 12 mm Hg PAP: 48/16 mm Hg PCWP: 15 mm Hg MAP: 99 mm Hg Cardiac Output: 8.0 L/min. Cardiac Index: 4.7 L/min/m2 Which of the following should the respiratory therapist recommend? A. Oxygen B. Dopamine C. Lidocaine D. Furosemide - ANSWER- D. Furosemide The following pulmonary function data was reported for a 45 year old pre-op patient: TLC - 5.4 L RV - 1.0 L IRV - 2.6 L VC - 4.2 L ERV - 1.0 L VT - 0.6 L FRC - 2.0 L IC - 3.2 L Which of the above capacities is incorrect? A. TLC B. VC C. FRC D. IC - ANSWER- A. TLC A 16-year-old patient involved in a motorcycle accident has been admitted to the emergency department. The paramedic indicates that the patient was not wearing a helmet. To assess the patient's neurologic status the respiratory therapist would assess the patient's A. vital capacity. B. pupillary response. C. herring bruer reflex . D. moro reflexes. - ANSWER- B. pupillary response. The peak inspiratory pressure on a pressure-cycled ventilator is 30 cm H2O. The respiratory therapist decreases the inspiratory flow. This change would affect the A. rate. B. PEEP. C. expiratory time. D. I:E ratio. - ANSWER- D. I:E ratio. A patient recently underwent a coronary artery bypass and is now receiving Incentive Spirometry QID. The patient's inspiratory capacity has diminished over the past several days and the patient is becoming increasingly short of chamber. C. increase the amount of suction. D. advance the chest tube 2 cm. - ANSWER- A. check for a leak in the system. For a patient enrolled in a smoking cessation program, which of the following would indicate that the patient is non-compliant? A. COHb level of 7% B. Regular attendance at counseling sessions C. Increased exercise tolerance D. Decreased use of accessory muscles - ANSWER- A. COHb level of 7% A patient receiving a loop diuretic such as furosemide (Lasix) would most likely need what type of electrolyte replacement? A. Potassium B. Sodium C. Chloride D. Bicarbonate - ANSWER- A. Potassium The FRC measured by body plethysmography is 30% larger than that measured by helium dilution. This difference is best explained by A. maldistribution of ventilation. B. increased diffusing capacity. C. trapped thoracic gas. D. reduced lung compliance. - ANSWER- C. trapped thoracic gas. While performing a 12-lead electrocardiograph on a 68-year-old male patient, the respiratory therapist notices a sudden increase in artifact on the ECG paper. Upon further investigation, the therapist discovers that the V2 electrode has fallen off the chest. Where on the patient should the therapist place this electrode? A. 4th intercostal space on the left side of the sternum. B. 5th intercostal space, left mid- clavicular line. C. 6th intercostal space, left mid-axillary line. D. 7th intercostal space, right mid-clavicular line. - ANSWER- A. 4th intercostal space on the left side of the sternum. Which of the following devices would produce the greatest humidity output for a patient? A. Bubble humidifier B. Wick- type humidifier C. Large reservoir nebulizer D. Ultrasonic nebulizer - ANSWER- D. Ultrasonic nebulizer A 7 year old child suspected of having epiglottitis would exhibit which of the following signs? 1. Drooling A. Change to a nasal endotracheal tube B. Add air to the cuff C. Add water to the humidifier D. Insert an oral pharyngeal airway - ANSWER- D. Insert an oral pharyngeal airway The most common complication associated with fiberoptic bronchoscopy via the nasal route is A. nosocomial infection. B. hypoxemia. C. uncontrolled coughing. D. mild epistaxis. - ANSWER- D. mild epistaxis. The respiratory therapist is reviewing a patient's chart prior to performing a bedside assessment to determine readiness for weaning from ventilatory assistance. The patient weighs 60 kg (132 lb). The therapist would expect the patient to be able to achieve a spontaneous tidal volume of A. 200 - 355 mL B. 300 - 480 mL C. 400 - 620 mL D. 600 - 720 mL - ANSWER- B. 300 - 480 mL The physician informs the patient that the results of his polysomnogram indicate obstructive sleep apnea. Treatment for this disorder might include A. bronchial hygiene therapy. B. respiratory stimulants. C. tracheostomy. D. negative pressure ventilation. - ANSWER- C. tracheostomy. After completing oxygen rounds, the respiratory therapist must clean flowmeters that were removed from rooms where no patients were receiving oxygen therapy. Which of the following methods is most appropriate for disinfection of the flowmeters? A. Steam autoclave B. Soak in acid gluteraldehyde C. Wash in Pasteurmatic D. Wipe with alcohol - ANSWER- D. Wipe with alcohol A 4-year-old girl is admitted to the emergency department with persistent dry coughing. Chest radiograph results reveal normal inspiration with the right lung remaining expanded on expiration. Which of the following should the respiratory therapist recommend at this time? A. Endobronchial intubation B. Arterial blood gas analysis C. Bronchoscopic examination D. Lateral neck radiograph - ANSWER- C. Bronchoscopic examination Which of the following would indicate that the lung compliance of a patient on a volume- cycled ventilator is increasing? A. Plateau pressure begins to decrease B. Peak pressure begins to increase C. Blood pressure decreases D. Arterial PCO2 decreases - ANSWER- A. Plateau pressure begins to decrease Heliox therapy is indicated for treatment of patients with post extubation stridor because of the A. ability to effectively deliver humidity. B. low density of the gas mixture. C. high molecular weight of the gas mixture. D. low risk of bronchospasm. - ANSWER- B. low density of the gas mixture. A 17 year-old patient is receiving 40% oxygen via a Venturi mask following a motor vehicle accident. He suddenly develops acute shortness of breath, is diaphoretic and SpO2 is 85%. Breath sounds are vesicular on the right and extremely diminished on the left. The respiratory therapist should evaluate the patient for the presence of A. atelectasis. B. a pneumothorax. C. arterial hypertension. D. a myocardial infarction. - ANSWER- B. a pneumothorax. Which of the following would NOT be required to perform a nasal intubation? A. Magill forceps B. Stylet C. Laryngoscope D. Endotracheal tube - ANSWER- B. Stylet Which of the following formulas will determine the amount of physiologic deadspace for a patient? A. PAO2 - PaO2 B. CaO2 - CvO2 C. (PaCO2 - PECO2) / PaCO2 D. CcO2 - CaO2 / CcO2 - CvO2 - ANSWER- C. (PaCO2 - PECO2) / PaCO2 A balloon-tipped, flow-directed catheter is positioned in the pulmonary artery with the balloon inflated. Which of the following pressures will be measured by the distal lumen? A. A venous blood sample was drawn. B. The blood gas sample was not cooled prior to analysis. C. The blood gas sample had an air bubble in it. D. The patient's blood gas sample was mixed up with another sample. - ANSWER- C. The blood gas sample had an air bubble in it. Over the last hour a patient being ventilated with a volume cycled ventilator has had a decrease in urine output from 35 mL/hour to 10 mL/hour. The most likely cause of this change would be an increase in the A. respiratory rate. B. delivered FIO2 . C. peak airway pressure. D. inspiratory flow. - ANSWER- C. peak airway pressure. Following administration of oxygen, what additional therapy should the respiratory therapist recommend for a patient with decompression sickness? A. Non-invasive ventilation B. Inhaled nitric oxide C. Hyperbaric oxygen therapy D. Extracorporeal membrane oxygenation - ANSWER- C. Hyperbaric oxygen therapy A patient has been participating in Pulmonary Rehabilitation for the past 5 weeks. The patient has recorded the results of his 6 minute walk test each week. The results indicate a steady increase in distance over the 5 week period. These results are consistent with A. need to wear supplemental oxygen while walking. B. need for an additional 6 weeks of rehabilitation. C. improvement in exercise ability. D. early discharge from rehabilitation. - ANSWER- C. improvement in exercise ability. The following measurements were obtained from a patient being monitored with a balloon tipped, flow directed catheter: CVP 2 cmH2O PAP 12 torr (mean) PCWP 3 torr CI 1.2 L/min/m2 BP 110/90 mm Hg Based on the above information, all of the following parameters would be decreased EXCEPT A. right ventricular end diastolic pressure. B. left atrial filling pressure. A. lidocaine. B. nitroglyceri n. C. atropine. D. amiodarone. - ANSWER- C. atropine. A patient with a size 8.5 mm ID oral endotracheal tube is transported from the Emergency Department to the Intensive Care Unit. The respiratory therapist suspects the tube has changed position during transport. Which of the following is the first step to assess the tube position? A. Chest radiograph B. Bilateral chest auscultation C. Verify symmetrical chest movement D. Diagnostic chest percussion - ANSWER- C. Verify symmetrical chest movement A newborn infant has an APGAR score of 8 one minute after delivery. The most appropriate action at this time would be to A. intubate and ventilate the infant. B. dry and monitor the infant. C. initiate oxygen therapy. D. begin chest compressions immediately. - ANSWER- B. dry and monitor the infant. Which of the following statements is TRUE concerning positive expiratory pressure (PEP) therapy? A. It applies expiratory positive airway pressure (EPAP) using a one-way expiratory valve and a one-way inspiratory flow resistor. B. It is used for 5 - 10 minute intervals every hour. C. The inspiratory flow resistor prevents end-inspiratory pressures from rising above zero. D. It may help improve secretion expectoration, decrease hyperinflation and improve airway maintenance - ANSWER- D. It may help improve secretion expectoration, decrease hyperinflation and improve airway maintenance A 10-year-old patient with asthma is asked to monitor his airflow improvement following each Beta-2 agonist treatment taken at home. Which of the following should the therapist provide for the patient? A. Turbine pneumotachometer B. Peak flow meter C. Pulse oximeter D. Volume displacement spirometer - ANSWER- B. Peak flow meter All of the following could cause the high pressure alarm on a volume cycled ventilator to sound EXCEPT A tracheostomy tube has just been changed on a patient receiving continuous volume- cycled ventilation. The patient suddenly becomes dyspneic and develops crepitus around the tracheostomy stoma. The respiratory therapist should A. suction the patient. B. insert a larger tracheostomy tube. C. reposition the tracheostomy tube. D. recommend an antihistamine. - ANSWER- C. reposition the tracheostomy tube. A patient's cardiac output is increased and his QS/QT is calculated to be 20%. Based upon this information, the respiratory therapist would inform the physician this patient has A. an elevated shunt. B. a reduced cardiac index. C. increased pulmonary vascular resistance. D. normal lung mechanics. - ANSWER- A. an elevated shunt. How long will a full E cylinder of oxygen last if run until empty with a flowrate of 10 L/min? A. 1 hour B. 10 hours C. 33 hours D. 66 hours - ANSWER- A. 1 hour The most common hazard associated with insertion of a central venous catheter is A. pulmonary embolus. B. hypoxemia. C. rupture of the right atrium. D. pneumothorax. - ANSWER- D. pneumothorax. During oral endotracheal intubation, the tip of the Macintosh laryngoscope blade should be placed A. between the soft palate and tongue. B. in the vallecula. C. under the epiglottis. D. between the vocal cords. - ANSWER- B. in the vallecula. While suctioning an adult patient, the respiratory therapist observes evidence of hypoxemia on the bedside heart monitor. Which of the following are acceptable forms of treatment for the therapist to recommend? A. Perform cardioversion B. Administer lidocaine C. Administer 100% oxygen D. Recommend nitroglycerin - ANSWER- C. Administer 100% oxygen A patient with chronic bronchitis is to receive therapy to help remove a large amount of thick purulent secretions. Which of the following would be most helpful? A. Incentive Spirometry B. IPPB C. Postural drainage and percussion D. Small volume nebulizer with normal saline - ANSWER- C. Postural drainage and percussion A patient is suspected of having developed a pulmonary embolus. Which of the following tests should the therapist recommend to confirm the diagnosis? A. (A-a)DO2 B. C(a- v)O2 C. VD/VT D. P50 - ANSWER- C. VD/VT During mechanical ventilation, a patient initiates the breath and then the ventilator controls the remaining variables for that breath. This describes a/an A. spontaneous breath. B. assisted breath. C. mandatory breath. D. supported breath. - ANSWER- B. assisted breath. A 150 kg (330 lb) patient has been referred to a sleep center for evaluation of sleep apnea and daytime drowsiness. Which of the following is the most appropriate diagnostic procedure? A. Spirometry B. Pulse oximetry C. Polysomnography D. Body plethysmography - ANSWER- C. Polysomnography A 2100 g neonate is in the NICU and is being monitored with a TcPO2 monitor. The TcPO2 is reading 53 torr with the temperature set at 40oC. The arterial PO2 is 73 torr. Which of the following would best explain the difference in TcPO2 levels? A. There was an error in the arterial blood gas analysis. pH 7.36 PaCO2 45 torr PaO2 89 torr HCO3- 22 mEq/L The respiratory therapist should A. decrease PEEP. B. increase set rate to 14 br/min. C. add pressure support. D. initiate pressure control mode. - ANSWER- C. add pressure support. A patient is receiving 60% oxygen at a flow of 8 LPM via a large volume nebulizer and aerosol mask. The patient's inspiratory flowrate is 35 LPM. Which of the following should the respiratory therapist recommend? A. Decrease the flow setting to 5 LPM B. Maintain the current flow setting C. Increase the flow setting to 15 LPM D. Use two nebulizers at a flow of 10 LPM each - ANSWER- D. Use two nebulizers at a flow of 10 LPM each A patient with chronic hypercapnia is brought into the ED. The history of the present illness revealed that the patient passed out at home. A pulmonary artery catheter has been placed with the following measurements obtained: PAP 25/10 mm Hg BP 76/50 mm Hg PCWP 4 mm Hg SVR 1360 dynes CVP 0 mm Hg CI 1.8 L/min/m2 Which of the following is the most likely cause for his condition? A. Hypovolemia B. Drug overdose C. Cor pulmonale D. High FIO2 vasodilation - ANSWER- A. Hypovolemia The physician requests assistance in establishing a patent airway for a conscious patient who requires frequent suctioning. The respiratory therapist should recommend insertion of a/an A. nasopharyngeal airway. B. endobronchial airway. C. oropharyngeal airway. D. nasal oxygen catheter. - ANSWER- A. nasopharyngeal airway. determines that the ventilator is self-cycling between the patient-initiated breaths. The therapist should adjust the A. sensitivity. B. expiratory time. C. flow. D. inspiratory pressure. - ANSWER- A. sensitivity. The following results are obtained from the pulmonary artery catheter of a patient who collapsed during a visit with a friend in the hospital: CVP 10 cmH2O PAP 33/27 mm Hg PCWP 20 mm Hg BP 108/72 mm Hg Which of the following conditions could be associated with these results? A. Tricuspid valve stenosis B. Right ventricular failure C. Cardiogenic pulmonary edema D. Fluid overload - ANSWER- C. Cardiogenic pulmonary edema During inline suctioning of a patient's endotracheal tube, 100% oxygen is being supplied via the ventilator. The respiratory therapist observes several premature ventricular contractions on the ECG monitor. The therapist should A. decrease the suctioning time per pass. B. use a smaller suction catheter. C. increase oxygenation time. D. decrease the suction pressure. - ANSWER- A. decrease the suctioning time per pass. A 25-year-old, 58 kg (130 lb) female is admitted to ICU after an emergency C-section. The patient is receiving mechanical ventilation via volume control ventilator. The current ventilator settings are: Mode VC, SIMV VT 500 mL f 12 bpm FIO2 0.50 PEEP 5 cm H2O The following laboratory data are available: pH 7.36 PaCO2 44 torr PaO2 50 torr A. maintain the present therapy and re-evaluate the patient in thirty minutes. B. decrease the PEEP to 15 cm H2O and increase the FIO2 to 0.70. C. decrease the PEEP to 12 cm H2O and maintain the FIO2 at 0.60. D. discontinue the PEEP and increase the FIO2 to 0.80. - ANSWER- B. decrease the PEEP to 15 cm H2O and increase the FIO2 to 0.70. A patient with bilateral pneumonia is receiving mechanical ventilation in the intensive care unit. The following data is obtained: Mode PC Set 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 PAO2 370 torr C(a-v)O2 3.5 vol% The respiratory therapist should report the A-aDO2 as A. 275 torr. B. 300 torr. C. 345 torr. D. 370 torr. - ANSWER- A. 275 torr. A 32-week gestational age infant is receiving mechanical ventilation for pulmonary interstitial emphysema. The respiratory therapist suspects that a pneumothorax has developed. Which of the following diagnostic procedures should the therapist recommend to confirm this diagnosis? A. Upper airway x- ray B. Capillary blood gas C. Chest radiograph D. Pre- & post-ductal blood gases - ANSWER- C. Chest radiograph A patient is receiving mechanical ventilation at the following settings: Mode SIMV Mandatory rate 12 Total rate 12 FIO2 0.50 VT 700 mL Peak flow 50 L/min PEEP 5 cm H2O The following volume-pressure loop is observed. Which of the following should the respiratory therapist recommend? A. Increase the PEEP B. Change to assist-control mode C. Increase the VT D. Increase the peak flow - ANSWER- A. Increase the PEEP A nasally intubated patient is receiving mechanical ventilation via volume- cycled ventilator. While performing a patient-ventilator system check, the respiratory therapist notices that the high pressure alarm is sounding. The patient appears cyanotic and his heart rate is 48 beats per minute. The therapist is unable to pass a suction catheter through the nasotracheal tube. The therapist should A. increase the FIO2 to 1.00. B. call the patient's physician. C. obtain a stat arterial blood gas. D. remove the tube and manually ventilate the patient. - ANSWER- D. remove the tube and manually ventilate the patient. A fireman is brought to the Emergency Department after being knocked unconscious in a burning office building. What is the best way to improve the oxygenation status of this patient? A. Non-rebreather mask at FIO2 0.75 B. Blood transfusion C. Monitor Co-oximetry every hour D. Hyperbaric oxygen therapy - ANSWER- D. Hyperbaric oxygen therapy What is the correct formula to calculate the static lung compliance of a patient receiving mechanical ventilation? A. Peak pressure ÷ tidal volume B. Tidal volume ÷ (plateau pressure - PEEP) C. Tidal volume ÷ (peak pressure + PEEP) D. (Plateau pressure - PEEP) ÷ tidal volume - ANSWER- B. Tidal volume ÷ (plateau pressure - PEEP) A 2-year-old child recently diagnosed with laryngotracheobronchitis requires the administration of 40% oxygen. What is the most appropriate method for delivering the oxygen? A. Oxyhood connected to a blender set at 40% and 10 L/min B. Cool aerosol mask set at 15 L/min and 40% C. Venturi mask set at 40% D. Croup tent at 40% - ANSWER- B. Cool aerosol mask set at 15 L/min and 40% A 2000 g neonate is breathing spontaneously on 28% oxygen via an oxyhood with the following arterial blood gas results: pH 7.37 PaCO2 37 torr PaO2 46 torr HCO3- 22 mEq/L Based upon the above information, the respiratory therapist should recommend which of the following? A. Intubate and initiate mechanical ventilation with an FIO2 0.55 B. Intubate and initiate 5 cmH2O CPAP with an FIO2 0.60 C. Increase the FIO2 to 0.35 D. Increase the FIO2 to 0.60 - ANSWER- C. Increase the FIO2 to 0.35 Indirect calorimetry is performed on a 65-year-old patient to evaluate his nutritional status. It is determined that the patient's RQ is 1.00. This would indicate that the patient's diet consists mostly of A. fats. B. protein s. C. sugars. D. carbohydrates. - ANSWER- D. carbohydrates. All of the following could be recommended to treat a patient with severely decreased static lung compliance, EXCEPT A. inverse ratio ventilation. B. appropriate PEEP therapy. C. airway pressure release ventilation. D. aerosolized beta agonist therapy. - ANSWER- D. aerosolized beta agonist therapy. B. Inspiratory flow C. Rate control D. Volume control - ANSWER- A. Expiratory resistance valve A respiratory therapist enters a patient's room during oxygen rounds. The patient has end-stage emphysema and appears to be sleeping. The patient doesn't respond to questions and his pulse is 20 bpm. The therapist should immediately A. confirm DNR status. B. go get help. C. begin rescue ventilation. D. begin chest compressions. - ANSWER- A. confirm DNR status. A 55 year old patient admitted to the emergency department has a history of hypertension. The patient is conscious, diaphoretic and complaining of chest pain. The respiratory therapist's first response should be to A. administer 100% oxygen. B. place the patient on a cardiac monitor. C. administer nitroglycerin sublingual. D. insert a peripheral intravenous line. - ANSWER- A. administer 100% oxygen. While attempting to calibrate a polarographic oxygen analyzer, the respiratory therapist notices that the analyzer reads 21% when exposed to room air but only reads 64% when exposed to 100% oxygen. The most appropriate action at this time would be to A. reset the zero point. B. replace the battery. C. replace the fuel cell. D. add electrolyte solution. - ANSWER- B. replace the battery. A patient in the intensive care area has the following laboratory data: pH 7.54 PaCO2 48 torr PaO2 78 torr CaO2 18.9 vol% K+ 2.1 mEq/L Cl- 82 mEq/L Na+ 142 mEq/L Based on these results, the respiratory therapist should recommend administration of A. KCl. B. NaHCO3 . C. NaCl. D. O2. - ANSWER- A. KCl. While weaning a patient from inhaled nitric oxide therapy, the respiratory therapist notes an increase in pulmonary artery pressure following a recent decrease in dosage. The therapist should A. discontinue the nitric oxide. B. call the physician for guidance. C. continue to monitor the patient. D. return the iNO dose to the previous level. - ANSWER- D. return the iNO dose to the previous level.