LINDSEY JONES FORM L WITH
COMPLETE SOLUTIONS
A ventilator is sounding two alarms - low temperature and low volume. This could be
caused by which of the following?
A. depleted humidification reservoir
B. ruptured ET tube cuff
C. disconnected temperature probe in the ventilator circuit
D. disconnect in the patient-ventilator interface - ANSWER-C. disconnected
temperature probe in the ventilator circuit
The combination of low temperature and low volume alarms is commonly caused by a
problem related to the temperature probe. As the temperature probe is inserted inside
the inspiratory limb of the ventilator circuit, it can sometimes become dislodged creating
a leak in the circuit. If the probe becomes dislodged, it is no longer exposed to the
heated gases and can therefore, trigger a low-temperature alarm. A low volume alarm
will result from the leak through the port where the probe is normally nestled.
If the respiratory therapist notices the reservoir bag on a nonrebreather mask is failing
to partially collapse with each breath, the therapist should
A. tighten the elastic straps on the mask
B. obtain a new nonrebreather mask
C. increase oxygen flow to the reservoir
D. remove the one-way valve disk - ANSWER-A. tighten the elastic straps on the mask
For a patient who is breathing oxygen through a non-rebreather mask, failing to cause a
partial collapse of the reservoir with each breath is an indication that either the mask is
not tight enough or that the flow to the mask is excessive. It is most likely that the mask
requires tightening, which can be done by pulling on the elastic straps.
A patient is found to have a rhythm on the ECG monitor consistent with asystole. Which
of the following is the best initial action of the respiratory therapist?
A. Defibrillate at 360 joules, unsynchronized
B. Confirm in a second lead
C. Begin chest compressions
D. Defibrillate at 50 joules, synchronized - ANSWER-B. Confirm in a second lead
This rhythm is called asystole. When observed, prior to starting chest compressions, the
rhythm should be confirmed in his second lead.
,Within 5 minutes of oral extubation, the patient demonstrates mild inspiratory and
expiratory stridor, some accessory muscle use, and an SpO2 of 92% on 40% air-
entrainment mask. The therapist should recommend
A. benzocaine spray to the oropharynx
B. aerosolized racemic epinephrine
C. heated bland aerosol
D. reintubation - ANSWER-B. aerosolized racemic epinephrine
The presence of inspiratory and expiratory stridor can be addressed by the therapist
through the administration of racemic epinephrine. This medication is an alpha-1 type
drug that constricts tissue. However, this can only be used when the level of stridor is
considered mild or moderate. In the presence of severe or marked stridor, immediate
establishment of an airway is preferred.
A respiratory therapist is alerted by a ventilator alarm of a 62-year-old patient with
COPD who was intubated for bacterial pneumonia. Upon arrival, the therapist notes the
activation of the low PEEP alarm. For which of the following should the therapist
investigate to determine the source of the alarm?
A. pinched inspiratory limb of the circuit
B. occlusion of the ET tube
C. reduced ET tube cuff pressure
D. lung tissue perforation - ANSWER-C. reduced ET tube cuff pressure
A low PEEP alarm occurs when there is a continuous leak in the system, disallowing
PEEP pressure to accumulate and hold steady. Of the options given, a reduction in ET
tube cuff pressure could be the only likely cause. A pinched circuit or an occlusion of the
ET tube would trigger a high-pressure alarm. A perforation in the lung tissue could
indeed cause a low pressure, low volume, or low PEEP alarm but it is very unlikely.
A patient is engaged in a smoking cessation program. During a routine visit to the
counseling clinic, the patient describes shortness of breath (dyspnea) after every meal.
Which of the following instruction should the therapist provide?
A. drink 10-16 8oz glasses of water daily, even when not thirsty
B. eat small meals more frequently, avoid too many carbohydrates
C. consume only low-fat meats and pure grains
D. increase complex carbohydrate consumption between meals - ANSWER-B. eat
small meals more frequently, avoid too many carbohydrates
The general nutritional advice for a patient with chronic obstructive pulmonary disease
is to eat smaller meals more frequently and to avoid excessive consumption of
carbohydrates, which produce carbon dioxide and place a greater ventilatory load on
the patient.
,The best way to determine the accuracy of a vane respirometer is a
A. Geizler tube ionizer
B. Douglas bag
C. galvanic analyzer
D. 1.5-liter calibrated syringe - ANSWER-D. 1.5-liter calibrated syringe
A vane respirometer is a device that measures volume and must be calibrated from time
to time. This can be done with a three-liter super syringe or a syringe that comes in 1.5
L. This syringe is certified and calibrated for accuracy and should be trusted above all
other instruments in the pulmonary function laboratory.
The respiratory therapist should recommend which of the following FIRST?
A. increase oxygen flow to 4 L/min
B. place on NIV
C. switch to an air-entrainment mask at 28%
D. administer oxygen by nonrebreather mask - ANSWER-C. switch to an air-
entrainment mask at 28%
An air-entrainment device is superior at delivering a consistent FIO2, which could help
this patient achieve an SpO2 of 90%.
A volume-pressure ventilator graphic is observed on a patient who is receiving VC A/C
ventilation on the following settings:
FIO2 0.4
Mandatory rate 16/min
Total rate 20/min
VT 450 mL
Flow 50 L/min
PEEP 5 cm H2O
(FISH TAIL GRAPH)
The patient seems anxious and SpO2 is fluctuating between 89-94%. The therapist
should suggest
A. utilizing flow triggering
B. increasing VT
C. increasing inspiratory flow rate
D. decreasing sensitivity - ANSWER-A. utilizing flow triggering
This pressure-volume loop demonstrates that the patient is required to inhale
significantly before the ventilator is triggered, thereby producing significant negative
pressures to actuate a ventilator breath. This increase in work of breathing can cause
, the patient to deteriorate. One way of dealing with this is to increase the sensitivity so
that the ventilator actuates more quickly with a negative deflection in pressure.
However, this is not an option in the question. Flow triggering is another more sensitive
way to detect patient effort and actuate a ventilator breath.
An infrared PetCO2 detector is attached to the end of an ET tube on a patient who was
just intubated after being discovered apneic for at least several minutes. What initial
end-tidal CO2 reading would the respiratory therapist expect to observe once manual
resuscitation begins?
A. normal PetCO2 followed by a slight reduction
B. high PetCO2 followed by a gradual decrease
C. low PetCO2 followed by a gradual rise
D. plateau PetCO2 followed by a steady decrease - ANSWER-C. low PetCO2 followed
by a gradual rise
For a patient who was apneic, initial end-tidal CO2 readings will likely be low at first
because CO2 has not been perfused across the alveolar capillary membrane into the
alveoli. Therefore, initial readings will be low but will then slowly rise as the patient is
ventilated. Eventually, exhaled CO2 will demonstrate a plateau and then gradually
decrease.
The respiratory therapist should recommend which of the following to confirm the
placement of an 8.0 mm oral endotracheal tube?
A. Chest radiograph
B. Auscultation of the chest
C. Observation of chest rise and symmetry
D. Notation of the ET tube markings at the teeth - ANSWER-A. Chest radiograph
There are several methods in which one may determine the proper position of an
endotracheal tube. Those methods include such observations as symmetry of chest
rise, breath sounds, and radiographic assessment. However, of these options only a
radiographic assessment is confirming in nature and will show the absolute position of
the endotracheal tube.
Immediately after placing a sterile tracheostomy tube in a patient who has maintained a
stoma for 4 years, the patient coughs vigorously and expectorates the tube out onto the
sterile napkin resting on the chest of the patient. The therapist should
A. immediately insert an obdurator into the stoma
B. obtain a larger tracheostomy tube
C. re-insert the expectorated trach tube
D. obtain a new, sterile trach tube - ANSWER-B. obtain a larger tracheostomy tube
COMPLETE SOLUTIONS
A ventilator is sounding two alarms - low temperature and low volume. This could be
caused by which of the following?
A. depleted humidification reservoir
B. ruptured ET tube cuff
C. disconnected temperature probe in the ventilator circuit
D. disconnect in the patient-ventilator interface - ANSWER-C. disconnected
temperature probe in the ventilator circuit
The combination of low temperature and low volume alarms is commonly caused by a
problem related to the temperature probe. As the temperature probe is inserted inside
the inspiratory limb of the ventilator circuit, it can sometimes become dislodged creating
a leak in the circuit. If the probe becomes dislodged, it is no longer exposed to the
heated gases and can therefore, trigger a low-temperature alarm. A low volume alarm
will result from the leak through the port where the probe is normally nestled.
If the respiratory therapist notices the reservoir bag on a nonrebreather mask is failing
to partially collapse with each breath, the therapist should
A. tighten the elastic straps on the mask
B. obtain a new nonrebreather mask
C. increase oxygen flow to the reservoir
D. remove the one-way valve disk - ANSWER-A. tighten the elastic straps on the mask
For a patient who is breathing oxygen through a non-rebreather mask, failing to cause a
partial collapse of the reservoir with each breath is an indication that either the mask is
not tight enough or that the flow to the mask is excessive. It is most likely that the mask
requires tightening, which can be done by pulling on the elastic straps.
A patient is found to have a rhythm on the ECG monitor consistent with asystole. Which
of the following is the best initial action of the respiratory therapist?
A. Defibrillate at 360 joules, unsynchronized
B. Confirm in a second lead
C. Begin chest compressions
D. Defibrillate at 50 joules, synchronized - ANSWER-B. Confirm in a second lead
This rhythm is called asystole. When observed, prior to starting chest compressions, the
rhythm should be confirmed in his second lead.
,Within 5 minutes of oral extubation, the patient demonstrates mild inspiratory and
expiratory stridor, some accessory muscle use, and an SpO2 of 92% on 40% air-
entrainment mask. The therapist should recommend
A. benzocaine spray to the oropharynx
B. aerosolized racemic epinephrine
C. heated bland aerosol
D. reintubation - ANSWER-B. aerosolized racemic epinephrine
The presence of inspiratory and expiratory stridor can be addressed by the therapist
through the administration of racemic epinephrine. This medication is an alpha-1 type
drug that constricts tissue. However, this can only be used when the level of stridor is
considered mild or moderate. In the presence of severe or marked stridor, immediate
establishment of an airway is preferred.
A respiratory therapist is alerted by a ventilator alarm of a 62-year-old patient with
COPD who was intubated for bacterial pneumonia. Upon arrival, the therapist notes the
activation of the low PEEP alarm. For which of the following should the therapist
investigate to determine the source of the alarm?
A. pinched inspiratory limb of the circuit
B. occlusion of the ET tube
C. reduced ET tube cuff pressure
D. lung tissue perforation - ANSWER-C. reduced ET tube cuff pressure
A low PEEP alarm occurs when there is a continuous leak in the system, disallowing
PEEP pressure to accumulate and hold steady. Of the options given, a reduction in ET
tube cuff pressure could be the only likely cause. A pinched circuit or an occlusion of the
ET tube would trigger a high-pressure alarm. A perforation in the lung tissue could
indeed cause a low pressure, low volume, or low PEEP alarm but it is very unlikely.
A patient is engaged in a smoking cessation program. During a routine visit to the
counseling clinic, the patient describes shortness of breath (dyspnea) after every meal.
Which of the following instruction should the therapist provide?
A. drink 10-16 8oz glasses of water daily, even when not thirsty
B. eat small meals more frequently, avoid too many carbohydrates
C. consume only low-fat meats and pure grains
D. increase complex carbohydrate consumption between meals - ANSWER-B. eat
small meals more frequently, avoid too many carbohydrates
The general nutritional advice for a patient with chronic obstructive pulmonary disease
is to eat smaller meals more frequently and to avoid excessive consumption of
carbohydrates, which produce carbon dioxide and place a greater ventilatory load on
the patient.
,The best way to determine the accuracy of a vane respirometer is a
A. Geizler tube ionizer
B. Douglas bag
C. galvanic analyzer
D. 1.5-liter calibrated syringe - ANSWER-D. 1.5-liter calibrated syringe
A vane respirometer is a device that measures volume and must be calibrated from time
to time. This can be done with a three-liter super syringe or a syringe that comes in 1.5
L. This syringe is certified and calibrated for accuracy and should be trusted above all
other instruments in the pulmonary function laboratory.
The respiratory therapist should recommend which of the following FIRST?
A. increase oxygen flow to 4 L/min
B. place on NIV
C. switch to an air-entrainment mask at 28%
D. administer oxygen by nonrebreather mask - ANSWER-C. switch to an air-
entrainment mask at 28%
An air-entrainment device is superior at delivering a consistent FIO2, which could help
this patient achieve an SpO2 of 90%.
A volume-pressure ventilator graphic is observed on a patient who is receiving VC A/C
ventilation on the following settings:
FIO2 0.4
Mandatory rate 16/min
Total rate 20/min
VT 450 mL
Flow 50 L/min
PEEP 5 cm H2O
(FISH TAIL GRAPH)
The patient seems anxious and SpO2 is fluctuating between 89-94%. The therapist
should suggest
A. utilizing flow triggering
B. increasing VT
C. increasing inspiratory flow rate
D. decreasing sensitivity - ANSWER-A. utilizing flow triggering
This pressure-volume loop demonstrates that the patient is required to inhale
significantly before the ventilator is triggered, thereby producing significant negative
pressures to actuate a ventilator breath. This increase in work of breathing can cause
, the patient to deteriorate. One way of dealing with this is to increase the sensitivity so
that the ventilator actuates more quickly with a negative deflection in pressure.
However, this is not an option in the question. Flow triggering is another more sensitive
way to detect patient effort and actuate a ventilator breath.
An infrared PetCO2 detector is attached to the end of an ET tube on a patient who was
just intubated after being discovered apneic for at least several minutes. What initial
end-tidal CO2 reading would the respiratory therapist expect to observe once manual
resuscitation begins?
A. normal PetCO2 followed by a slight reduction
B. high PetCO2 followed by a gradual decrease
C. low PetCO2 followed by a gradual rise
D. plateau PetCO2 followed by a steady decrease - ANSWER-C. low PetCO2 followed
by a gradual rise
For a patient who was apneic, initial end-tidal CO2 readings will likely be low at first
because CO2 has not been perfused across the alveolar capillary membrane into the
alveoli. Therefore, initial readings will be low but will then slowly rise as the patient is
ventilated. Eventually, exhaled CO2 will demonstrate a plateau and then gradually
decrease.
The respiratory therapist should recommend which of the following to confirm the
placement of an 8.0 mm oral endotracheal tube?
A. Chest radiograph
B. Auscultation of the chest
C. Observation of chest rise and symmetry
D. Notation of the ET tube markings at the teeth - ANSWER-A. Chest radiograph
There are several methods in which one may determine the proper position of an
endotracheal tube. Those methods include such observations as symmetry of chest
rise, breath sounds, and radiographic assessment. However, of these options only a
radiographic assessment is confirming in nature and will show the absolute position of
the endotracheal tube.
Immediately after placing a sterile tracheostomy tube in a patient who has maintained a
stoma for 4 years, the patient coughs vigorously and expectorates the tube out onto the
sterile napkin resting on the chest of the patient. The therapist should
A. immediately insert an obdurator into the stoma
B. obtain a larger tracheostomy tube
C. re-insert the expectorated trach tube
D. obtain a new, sterile trach tube - ANSWER-B. obtain a larger tracheostomy tube
