RRT TMC EXAM QUESTIONS WITH 100%
CORRECT ANSWERS!!
Emphysema : Obstructive
Definition, Clinical Evidence, Chest Xray, CBC, ABG, PFT
You may be tempted to utilize high FiO2 because of the severity of hypoxemia. You may
also be tested with an emergency, the only time it is appropriate to use 100% O2 on a
COPD patient
D: Abnormal condition of the alveoli resulting destruction and loss of elasticity
C.E.: Barrel chest, Access. musc. use, Clubbing, Smoking hx, Occupational hazard (smoke,
asbestos, other pulm. irritant)
XR: ^ AP diameter, flattened diaphragm, hyperlucency, diminished pulmonary markings.
CBC: Polycythemia, ^ WBC - possible infection
ABG: Comp. Resp. Acidosis (H PaCO2, N pH) & Hypoxemia
PFT: flows are decreased (FEF 25-75% & FEV1), wheeze, dim.
K.I.: O2 (L FiO2 0.24-0.28), Liq. O2 or trans-trach cannula, home care education, aids to quit
smoking, bronchodilators & corticosteroids
Chronic Bronchitis : Obstructive
Chest xray, CBC, ABG, PFT
The most distinguishing characteristic is that the cough is productive and has been so for a
good portion of the year.
D: Condition where the patient has a productive cough 25% of the year, for at least 2 consecutive
years.
C.E.: Productive cough, purulent sputum, exposure to pulm. irritants, frequent infections.
XR: May be normal, may show hyperlucency, diminished pulmonary markings
CBC: Possible increased WBC due to possible infection
ABG: May be normal, may show slight Resp. Acidosis & hypox.
PFT: flows are decreased (FEF 25-75% & FEV1
,K.I.: Anything that promotes good pulm. hygiene, fluid therapy if dyhyd, O2 if hypox,
bronchodialator, Tetracycline
Bronchiectasis : Obstructive
Definition, Clinical Evidence, Chest xray, Sputum Culture, Bronchogram
D: Abnormal condition where the bronchi secrete large volumes of pus during abnormal dilation
C.E.: Productive cough, often bloody, clubbing, recurrent infections, dyspnea
XR: generally normal
S.C.: gram negative bacteria
Bronchogram: Primary test. "tree in winter pattern"
K.I.: Chest Physio, hydration therapy (thick sputum), fluid therapy (dehydrated), O2 therapy,
bronchodilator, Surgical intervention
Obstructive & Central Sleep Apnea
ABG, Polysomnography
It is important to remember to avoid sending the patient home without some sort of
ventilatory support.
D: The cessation of breathing during sleep. Most commonly obstructive in nature, can be central,
or both. (mixed)
C.E.: Spouse complains of snoring and witnessed apnea for 10 second or longer. Excessive upper
airway tissue, obesity or thick neck. Ability to fall asleep quickly. Dyspnea, Frequent urination
during sleeping hours
ABG: Could be normal, or show slight resp. acid. or hypoxemia
P.: Determines OSA or CSA. If no nasal flow AND no chest movement = CSA, If no nasal flow
WITH chest mvmt. = OSA
K.I.: CSA= ventilatory stim. meds (Doxapram) OSA= use of CPAP or BiPAP, initially indicated
follow up weight loss or upper airway tissue removal. Must be corrected immediately.. If
sending home, send equipment. in the absence of titration studies initial order Pressure is 10-20
cmH2O
, Asthma : Obstructive
Chest xray, CBC, ABG, PFT
When doing PFTs, always do a pre & post bronchodilator study. Consider effective if 12%
or more improvement is noted. Always start oxygen first when presenting in the ER-- part
of the national Asthma Guidelines
D: Abnormal construction of the bronchial's resulting in sputum production and narrowed
airways.
C.E.: Accessory muscle use, Tachycardia, dyspnea, wheezing, congested cough, wet-clammy
skin
XR: hyperinflation, scattered infiltrates, flat diaphragm
CBC- Allergic cases, maybe elevate eosinophils -> yellow sput.
ABG: possible Resp. Acid, could be hypoxic
PFT: Decreased flows in FEV1 but diffusion is normal (DLCO)
K.I.: O2 therapy, bronchodilator, xanthenes via IV, pulm. hyg, if repeated bronchodilator use
doesnt work think status asthmaticus, patient asthma action plan!!
Status Asthmaticus:
Chest xray, ABG, PFT
recognize impending vent. failure. It is very important that you treat it before full vent
failure. There is a frequent need to repeat actions, such as bronchodilator treatments,
which may make you uncomfortable. Do not be afraid to administer several bronchdilators
in succesion. The same is true of the subcutaneous epinephrine. If you give one dose, you
will likely have to give another, and possible another. Continue if symptoms show no signs
of relief.
D: Asthma that will not respond to bronchodilators, persists 24'
C.E.: HX non-response to bronodilators "needs many tx" to feel better, acc. musc. use and
retractions, dyspnea, wheezing, congested cough, wet-clammy skin, pulses paradoxes
XR: hyperinflation, scatter infiltrates, flat diaphragm
ABG: Pos. Resp. Acid., alkalosis due to anxiety, maybe hypoxic
CORRECT ANSWERS!!
Emphysema : Obstructive
Definition, Clinical Evidence, Chest Xray, CBC, ABG, PFT
You may be tempted to utilize high FiO2 because of the severity of hypoxemia. You may
also be tested with an emergency, the only time it is appropriate to use 100% O2 on a
COPD patient
D: Abnormal condition of the alveoli resulting destruction and loss of elasticity
C.E.: Barrel chest, Access. musc. use, Clubbing, Smoking hx, Occupational hazard (smoke,
asbestos, other pulm. irritant)
XR: ^ AP diameter, flattened diaphragm, hyperlucency, diminished pulmonary markings.
CBC: Polycythemia, ^ WBC - possible infection
ABG: Comp. Resp. Acidosis (H PaCO2, N pH) & Hypoxemia
PFT: flows are decreased (FEF 25-75% & FEV1), wheeze, dim.
K.I.: O2 (L FiO2 0.24-0.28), Liq. O2 or trans-trach cannula, home care education, aids to quit
smoking, bronchodilators & corticosteroids
Chronic Bronchitis : Obstructive
Chest xray, CBC, ABG, PFT
The most distinguishing characteristic is that the cough is productive and has been so for a
good portion of the year.
D: Condition where the patient has a productive cough 25% of the year, for at least 2 consecutive
years.
C.E.: Productive cough, purulent sputum, exposure to pulm. irritants, frequent infections.
XR: May be normal, may show hyperlucency, diminished pulmonary markings
CBC: Possible increased WBC due to possible infection
ABG: May be normal, may show slight Resp. Acidosis & hypox.
PFT: flows are decreased (FEF 25-75% & FEV1
,K.I.: Anything that promotes good pulm. hygiene, fluid therapy if dyhyd, O2 if hypox,
bronchodialator, Tetracycline
Bronchiectasis : Obstructive
Definition, Clinical Evidence, Chest xray, Sputum Culture, Bronchogram
D: Abnormal condition where the bronchi secrete large volumes of pus during abnormal dilation
C.E.: Productive cough, often bloody, clubbing, recurrent infections, dyspnea
XR: generally normal
S.C.: gram negative bacteria
Bronchogram: Primary test. "tree in winter pattern"
K.I.: Chest Physio, hydration therapy (thick sputum), fluid therapy (dehydrated), O2 therapy,
bronchodilator, Surgical intervention
Obstructive & Central Sleep Apnea
ABG, Polysomnography
It is important to remember to avoid sending the patient home without some sort of
ventilatory support.
D: The cessation of breathing during sleep. Most commonly obstructive in nature, can be central,
or both. (mixed)
C.E.: Spouse complains of snoring and witnessed apnea for 10 second or longer. Excessive upper
airway tissue, obesity or thick neck. Ability to fall asleep quickly. Dyspnea, Frequent urination
during sleeping hours
ABG: Could be normal, or show slight resp. acid. or hypoxemia
P.: Determines OSA or CSA. If no nasal flow AND no chest movement = CSA, If no nasal flow
WITH chest mvmt. = OSA
K.I.: CSA= ventilatory stim. meds (Doxapram) OSA= use of CPAP or BiPAP, initially indicated
follow up weight loss or upper airway tissue removal. Must be corrected immediately.. If
sending home, send equipment. in the absence of titration studies initial order Pressure is 10-20
cmH2O
, Asthma : Obstructive
Chest xray, CBC, ABG, PFT
When doing PFTs, always do a pre & post bronchodilator study. Consider effective if 12%
or more improvement is noted. Always start oxygen first when presenting in the ER-- part
of the national Asthma Guidelines
D: Abnormal construction of the bronchial's resulting in sputum production and narrowed
airways.
C.E.: Accessory muscle use, Tachycardia, dyspnea, wheezing, congested cough, wet-clammy
skin
XR: hyperinflation, scattered infiltrates, flat diaphragm
CBC- Allergic cases, maybe elevate eosinophils -> yellow sput.
ABG: possible Resp. Acid, could be hypoxic
PFT: Decreased flows in FEV1 but diffusion is normal (DLCO)
K.I.: O2 therapy, bronchodilator, xanthenes via IV, pulm. hyg, if repeated bronchodilator use
doesnt work think status asthmaticus, patient asthma action plan!!
Status Asthmaticus:
Chest xray, ABG, PFT
recognize impending vent. failure. It is very important that you treat it before full vent
failure. There is a frequent need to repeat actions, such as bronchodilator treatments,
which may make you uncomfortable. Do not be afraid to administer several bronchdilators
in succesion. The same is true of the subcutaneous epinephrine. If you give one dose, you
will likely have to give another, and possible another. Continue if symptoms show no signs
of relief.
D: Asthma that will not respond to bronchodilators, persists 24'
C.E.: HX non-response to bronodilators "needs many tx" to feel better, acc. musc. use and
retractions, dyspnea, wheezing, congested cough, wet-clammy skin, pulses paradoxes
XR: hyperinflation, scatter infiltrates, flat diaphragm
ABG: Pos. Resp. Acid., alkalosis due to anxiety, maybe hypoxic
