THERAPIST MULTIPLE-CHOICE EXAMINATION PRACTICE TEST EXAM QUESTIONSAND CORRECT ANSWERS WITH DETAILED EXPLANATIONS GRADED A+

THERAPIST MULTIPLE-CHOICE EXAMINATION PRACTICE TEST EXAM QUESTIONSAND CORRECT ANSWERS WITH DETAILED EXPLANATIONS GRADED A+ The physician orders a 35% aerosol mask to be set up for a patient who requires an inspiratory flow of 42 L/min. What is the minimum flow rate to which the flowmeter must be set to meet this patient's in- spiratory flow demands? A. 6 L/min B. 8 L/min C. 10 L/min D. 12 L/min - ANSWER-B, The air/O2ratio for a 35% oxygen mixture is 5 : 1. To calculate total flow output from this device, add the ratio parts together and multiply by the liter flow: 6 ×6 = 36 L/min, 6 ×8 = 48 L/min, 6 × 10 = 60 L/min, 6 ×12 = 72 L/min. Total flow needed: 42 L/min. The minimum flow necessary is 8, giving a total flow of 48 L/min. (Analysis) A premature 3-week-old infant is receiving 1 L/min of O via a nasal cannula and has a PaO of 43 torr22 and a PaCO2 of 40 torr. The respiratory therapist should recommend which of the following? A. Increase the cannula flow to 2 L/min. B. Intubate and institute mechanical ventilation C. Initiate CPAP of 4 cm H2O and 50% O2 D. Increase the cannula flow to 5 L/min. - ANSWER-A, A PaO2 of 43 torr represents hypoxemia. The normal PaO2 for an infant is 50-70 torr. Increasing the cannula flow by 1 L/min is the most appropriate choice to return the PaO2 to normal. With a normal PaCO2 of 40 torr, mechanical ventilation is not indicated. (Analysis) The following pulmonary function results are obtained on a patient: FEV1/FVC 90% of predicted FVC 55% of predicted These data indicate the patient could have which of the following? A. Emphysema B. Cystic fibrosis C. Chronic bronchitis D. Pulmonary fibrosis - ANSWER-D, Pulmonary fibrosis is an example of a restrictive lung disorder. Restrictive disorders are characterized by decreased volumes and capacities and normal flow studies on pulmonary function tests. Obstructive disorders are characterized by increased volumes and capacities due to air trapping and by decreased flow studies. When given a question on the exam where there are three obstructive disease selections and one restrictive disorder, you should select the one disorder not common to the other three. In other words, from these pulmonary function values you would not be able to determine emphysema from chronic bronchitis or cystic fibrosis (all obstructive disorders); therefore the answer must be the restrictive disorder. you are asked to deliver a low percentage of O2 to a patient whose respiratory rate is 30/min with an irregular breathing pattern. Which device would be the best choice? A. Nasal cannula at 2 L/min B. Air-entrainment mask at 28% C. Simple O2 mask at 5 L/min D. Partial rebreathing mask at 8 L/min - ANSWER-B, This question appears to not give adequate information to answer the question. However, the idea is that a low-flow O2device should not be set up for a patient who has an irregular breathing pattern or a respiratory rate of more than 25/min because of inconsistent O2concentrations. A highflow device (air-entrainment mask) is indicated in this situation because more consistent O2concentrations are delivered, regardless of the patient's ventilatory pattern. Which of the following ABG results would be considered normal in a patient with severe COPD? A. pH 7.50, PCO2 40 torr, PO2 56 torr, HCO330 mEq/L, BE 4 B. pH 7.29, PCO2 54 torr, PO2 70 torr, HCO323 mEq/L, BE 0 C. pH 7.36, PCO2 40 torr, PO2 85 torr, HCO324 mEq/L, BE 1 D. pH 7.38, PCO2 60 torr, PO2 57 torr, HCO333 mEq/L, BE 10 - ANSWER-D, Refer to the explanation for question 13 The respiratory therapist is called to the bedside of a patient who is receiving volumecontrolled ventilation. Upon entering the room you notice the high-pressure limit is alarming with every breath and the low-volume alarm is activated. The nurse informs you that the patient had a pulmonary artery catheter inserted in the right subclavian vein 34 minutes prior. Upon assessment the therapist notes unilateral expansion and diminished breath sounds in the right upper lobe. There is no tracheal deviation present. Heart rate is 102/min, RR 20/min, and BP 120/64. What is the most appropriate recommendation at this time? A)CXR and possible chest tube insertion B)Emergency needle decompression C)Monitor the patient for improvement in condition for the next 30 minutes. D)STAT ABG - ANSWER-. A, This scenario suggests a pneumothorax has most likely occurred during the insertion of the subclavian line. Since the question states there is no tracheal deviation, which would indicate a tension pneumothorax corrected with needle decompression, getting a CXR and possible chest tube insertion is the best choice. how do you treat tension pneumothorax ? - ANSWER-needle decompression A patient with a peak inspiratory flow of 40 L/min is to be given O2 with a 30% airentrainment mask. What is the minimum O2 flow required to meet the patient's inspiratory flow demands? A. 3 L/min B. 5 L/min C. 8 L/min D. 10 L/min - ANSWER-. B, The air/O2ratio for 30% is 8 : 1. Add the two ratio parts together and multiply by the lowest choice of the flow rates given that results in a total flow are at least 40 L/min. Which of the following represents the normal value for potassium? A. 1.5 to 3.0 mEq/L B. 3.5 to 5.0 mEq/L C. 5.5 to 7.0 mEq/L D. 7.0 to 8.5 mEq/L - ANSWER-B, The normal value for potassium is 3.5-5.0 mEq/L What is the most appropriate ventilator VT setting on a 75-kg (165-lb) drug overdose patient? A. 400 mL B. 500 mL C. 700 mL D. 900 mL - ANSWER-B, Ventilator VT should be set at 6 to 8 mL/kg of ideal body weight. The most appropriate volume would be 500 mL. Which of the following ventilator parameters, when changed, will alter the inspiratory time during volume-controlled ventilation? A. Rate control B. Peak flow C. PEEP D. FiO2 - ANSWER-. B, When flow is increased, inspiratory time decreases and vice versa. When VT is increased, inspiratory time increases and vice versa. Respiratory rate alters the expiratory time. The FIO2and PEEP do not affect inspiratory or expiratory time. Which of the following situations would result in the high-pressure alarm being activated during volume- controlled ventilation? A. ET tube cuff leak B. Excessive cuff pressure C. Increased airway resistance D. Increased lung compliance - ANSWER-C, Decreasing lung compliance and increased RAW result in higher inspiratory pressures. If the pressure increases enough to reach the high-pressure limit, an alarm sounds and inspiration ends at that time. The pressure limit should be set 10 to 15 cm H2O above the average peak inspiratory pressure. The pressure limit alarm should be set at ? - ANSWER-10 to 15 cm H2O above the average peak inspiratory pressure. Which of the following values will best indicate airway inflammation in asthmatics? A. FENO B. PCO2 C. PO2D. HbCO - ANSWER-A, Measuring fractional concentration of exhaled nitric oxide (FENO) can be helpful in determining airway inflammation. Normal FENO levels in adults is less than 25 parts per billion (ppb) and less than 20 ppb in children. FENO levels begin to rise with airway inflammation. Levels of greater than 50 ppb may indicate the patient needs to increase their normal medication. The FENO level is commonly increased as a result of the patient's noncompliance with their corticosteroid use. Measuring fractional concentration of exhaled nitric oxide (FENO) can be helpful in determining airway inflammation. Normal FENO levels in adults is less than ________parts per billion (ppb) and less than _______ppb in children - ANSWER-25 <20 FENO levels begin to rise with airway inflammation. Levels of greater than 50 ppb may indicate? - ANSWER-the patient needs to increase their normal medication. The FENO level is commonly increased as a result of the patient's noncompliance with their corticosteroid use. After a cardiac arrest, a 48-year-old female begins receiving mechanical ventilation. A pulmonary artery catheter is in place. The following data are obtained: BP 94/52 pulse 116 PCWP 6 PAP 40/20 QT 3.5 Based on these data, which of the following has increased? A. Pulmonary vascular resistance B. Left atrial pressure C. Stroke volume D. Systemic vascular resistance - ANSWER-A, The patient is hypotensive, which is indicated by a decreased SVR. PCWP, a measure of left atrial pressure, is normal; therefore, left atrial pressure cannot be increased. Because QT is decreased, SV would also be decreased. The PAP is elevated, which indicates an increased resistance to blood flow in the pulmonary vasculature A diabetic patient enters the emergency department breathing deeply at a respiratory rate of 32/min. This type of breathing pattern is referred to as A. Kussmaul respiration B. Biot respiration C. Cheyne-Stokes respiration D. Hypopnea - ANSWER-A, Kussmaul respirations are a deep and rapid breathing pattern encountered in patients with severe metabolic acidemia (low pH, low HCO3−). The lungs are making an effort to increase the pH back toward normal by removing CO2 from the blood, which results in an increased pH. A 43-year-old male patient is brought to the ED with benzene exposure as a result of an industrial accident. Which of the following should the respiratory therapist suggest? A. Bronchoscopy B. Capnometry C. Administration of atropine D. Hemoximetry - ANSWER-. D, Inhalation of benzene results in methemoglobin as it combines with hemoglobin. This makes less oxygen being able to combine with hemoglobin and oxygenation decreases. Assessing hemoximetry (CO-oximetry) will help determine the severity of the condition. The following data are obtained from a 32-year-old patient with pneumonia in the ICU on a 60% aerosol mask: RR 28 , pulse 108 PH 7.47 PaCO2 32 PaO2 55 Which of the following would you recommend at this time? A. Intubate and institute mechanical ventilation B. Initiate CPAP C. Increase to 80% aerosol mask D. Change to a nonrebreathing mask at 15 L/min - ANSWER-B, A PaO2of 55 mm Hg on 60% oxygen indicates refractory hypoxemia. Increasing the FIO2most likely won't improve the PaO2. Applying CPAP to help recruit alveoli and allow for more surface area for oxygen to be able to enter the blood is more appropriate