The National Board for Respiratory Care, Inc. Therapist Multiple-Choice SAE (Form 2020 B) INDIVIDUAL FEEDBACK REPORT

The National Board for Respiratory Care, Inc. Therapist Multiple-Choice SAE (Form 2020 B) INDIVIDUAL FEEDBACK REPORT Finish date: 9/12/2019 6:35 PM Central Daylight Time Points: 102 of 140 Percent: 73% √ 1. A patient with a PBW of 55 kg (121 lb) is receiving VC, A/C ventilation. Ventilator settings and blood gas analysis results are: FIO2 0.70 Mandatory rate 14 VT 350 mL PEEP 5 cm H2O pH 7.35 PaCO2 35 mm Hg PaO2 40 mm Hg HCO3 - 19 mEq/L BE -6 mEq/L SO2 (calc) 74% A respiratory therapist should recommend A. changing to SIMV mode. increasing to 10 cm H2O PEEP. C. changing to 5 cm H2O CPAP. D. increasing to 400 mL VT. EXPLANATIONS (h) A. Changing to SIMV will not treat the hypoxemia. It may also cause a decrease in minute ventilation and adverse changes in the acid-base status. (c) B. The increase in PEEP will increase FRC, decrease the intrapulmonary shunt, and address the hypoxemia. (h) C. Changing to CPAP may decrease minute ventilation causing adverse changes in the acid-base status. (u) D. Increasing the tidal volume will further decrease the PaCO2. It will not significantly improve oxygenation. √ 2. When instructing a patient on the administration of umeclidinium/vilanterol (Anoro Ellipta), which of the following is most important to emphasize? A. Gargle immediately after use. B. Inhale slowly with a breath hold. Breathe in fast and deep. D. Shake medication vigorously before use. EXPLANATIONS: B.√ C.√ (u) A. Umeclidinium/vilanterol (Anoro Ellipta) is not an inhaled steroid and, thus, does not require gargling after use. (u) B. Umeclidinium/vilanterol (Anoro Ellipta) is a DPI that requires rapid inhalation. (c) C. Breathing in fast and deep is the proper method of administration for umeclidinium/vilanterol (Anoro Ellipta). (u) D. Umeclidinium/vilanterol (Anoro Ellipta) is a DPI and does not require shaking before use. √ 3. Following placement of a tracheostomy tube for long-term mechanical ventilation, which of the following patient positions best prevents ventilator-associated pneumonia? A. prone B. Trendelenburg C. supine semi-Fowler EXPLANATIONS: (h) A. Prone positioning is contraindicated following tracheostomy placement. (h) B. Use of Trendelenburg positioning may increase the risk of aspiration. (u) C. A decreased incidence of ventilator-associated pneumonia has been observed with an elevated head of bed as compared to supine. (c) D. Routine use of semi-Fowler positioning with the head of the bed elevated at an angle of 30-45 degrees has been shown to decrease rates of ventilator-associated pneumonia. √ 4. Which of the following is used to monitor the partial pressure of transcutaneous carbon dioxide? A. red-light absorption sensor B. electromechanical transducer C. infrared analyzer Stow-Severinghaus electrode EXPLANATIONS: (u) A. A red-light absorption sensor is used in a pulse oximeter. (u) B. An electromechanical transducer measures airway pressure. (u) C. An infrared analyzer is used in a capnometer. (c) D. A Stow-Severinghaus blood gas electrode is used in transcutaneous monitors. √ 5. An adult patient requires frequent blood sampling and medication administrations through an IV for 1 month. The preferred vascular access is a peripherally inserted central catheter. B. subclavian central vascular line. D.√ D.√ A.√ C. standard peripheral IV line. D. internal jugular catheter. EXPLANATIONS: (c) A. A PICC is the best choice for long-term IV access and allows for blood sampling. (u) B. A subclavian central vascular line is recommended for short-term use and should be removed as soon as feasible to avoid infection. (u) C. A standard peripheral IV line is not meant for long-term use. (u) D. An internal jugular catheter is recommended for short-term use and should be removed as soon as feasible to avoid infection. √ 6. A 170-cm (5-ft 7-in), 69-kg (152-lb) male with ARDS has the following ABG analysis results: pH 7.37 PCO2 43 mm Hg PO2 95 mm Hg HCO3 - 25 mEq/L BE -1 mEq/L SO2 (calc) 97% The patient is receiving VC, A/C ventilation with the following settings: FIO2 0.70 Mandatory rate 12 VT 450 mL PEEP 8 cm H2O Which of the following is most appropriate? Decrease the FIO2 to 0.60. B. Change the PEEP to 5 cm H2O. C. Increase the minute ventilation. D. Maintain the current settings. EXPLANATIONS: (c) A. Since the PaO2 is adequate, it is now appropriate to decrease the FIO2. (u) B. The PEEP needs to be maintained to prevent derecruitment of alveoli. (u) C. There is no indication for changing the minute ventilation. The patient's ventilation is appropriate. (u) D. The FIO2 needs to be decreased to minimize oxygen-induced lung injury. √ 7. Following an emergent C-section, a 35 year old is receiving VC, A/C ventilation. The following pressure-volume loop is observed: