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)
what is normal PaO2 for infant ? - ANSWER-50-70 torr.
,A patient arrives in the emergency department after being pulled from a burning house.
The respiratory therapist should recommend obtaining which of the following
measurements to best determine the sever- ity of the patient's smoke inhalation?
A. SpO2
B. HbCO
C. PaO2
D. Hb - ANSWER-B, To best determine the severity of smoke inhalation, an HbCO level
should be determined with a co-oximeter. The SpO2 value should never be evaluated
on a patient suspected of CO poisoning because a pulse oximeter is not capable of
determining what is bound to hemoglobin.
Pulse oximeters work on the principle of spectrophotometry where lightweight probes
direct filtered light of specific wavelengths through the skin or digit. The light absorbed
differs for saturated and desaturated blood, wh ether it's saturated with oxygen or a
combination of oxygen and carbon monoxide. Therefore the reading will be erroneously
high when HbCO is present. (Analysis)
To best determine the severity of smoke inhalation, an HbCO level should be
determined with ? - ANSWER-co-oximeter
The physician has ordered O2 to be administered to an active 3-year-old with an SpO2
of 86%. Which of the following delivery devices would you recommend for this patient?
A. 1- to 2-L nasal cannula
B. Air-entrainment mask
C. Simple O2 mask
D.O2 hood - ANSWER-A, An active 3-year-old generally tolerates a cannula much better
than any kind of mask and is too large for an O2hood. (Application)
The ability of the patient to follow instructions would be indicated by which of the
following?
A. Orientation to person
B. Performance of tasks when asked
C. Ability to feed himself
D. Awareness of time - ANSWER-B, If the patient is able to perform simple tasks when
asked, this best determines his or her ability to follow instructions. This is important
before administering an incentive spirometry or IPPB treatment, which requires the
patient to be able to follow instructions well or the treatment will not be effective.
(Recall)
If the patient is able to perform simple tasks when asked, this best determines his or her
ability to follow instructions. This is important before administering an? - ANSWER-
incentive spirometry or IPPB treatment, which requires the patient to be able to follow
instructions well or the treatment will not be effective. (Recall)
You suspect a patient may have a pulmonary embolism. Which of the following would
be the most appropriate recommendation for diagnosis of this condition?
A. Bronchoscopy
B. V/Q lung scan
C. Coagulation studies
D. Shunt study - ANSWER-B, The best diagnostic test to determine whether a
pulmonary embolism is present is the V/Q lung scan. (Application)
,To most effectively increase a sedated, paralyzed patient's alveolar minute ventilation
while the patient is on volume-controlled ventilation in the assist-control mode, you
would recommend increasing which of the following?
A. PEEP
B. Inspiratory flow
C. VT
D. Ventilator rate - ANSWER-C
Alveolar minute ventilation = (VT - VD) × respiratory rate
It represents the volume actually reaching the alveoli per minute. It takes into account
anatomic dead space (VD), which is approximately 1 mL/lb of body weight. Anatomic
VD is that portion of the airway where no gas exchange occurs. If a patient's alveolar
minute ventilation is to be increased, the VT must be increased. If only the ventilator
rate is increased, the same VT is delivered, even though the minute ventilation (VT ×
RR) increases. (Recall)
what is the formula for alveolar minute ventilation ? - ANSWER-(VT - VD) × respiratory
rate
Failure to hyperoxygenate a patient on a ventilator before ET suctioning may result in
A. Hypoxemia
B. Hypocapnia
C. Bradycardia
D. Hypertension - ANSWER-A, It is important during ET suctioning that the PaO2 be
maintained within a normal range. This requires increasing the oxygen percentage
during the procedure. Failure to hyperoxygenate may cause hypoxemia, resulting in
cardiac arrhythmias. Bradycardia may occur as a result of vagal stimulation.
(Application)
while ET suctioning , Failure to hyperoxygenate may cause hypoxemia, resulting in ? -
ANSWER-cardiac arrhythmias
while ET suctioning a pt, Bradycardia may occur as a result of ? - ANSWER-vagal
stimulation
The most reliable method of determining whether the lungs of a patient receiving
mechanical ventila- tion are getting stiffer and harder to ventilate is by measuring the
A. Static lung compliance
B. Dynamic lung compliance
C. Spontaneous VT
D. PaO2 - ANSWER-A, When lungs get stiffer and harder to ventilate, greater pressure
is required to move the same volume of air. Because peak inspiratory pressure
increases when RAW increases (e.g., when airway secretions are present or water is in
the ventilator tubing), this pressure does not reflect how stiff the lungs actually are. We
determine the plateau or static pressure by holding the volume in the patient's lungs for
1 to 2 s. This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted
from the plateau pressure and this number is divided into the VT. The results determine
how compliant the lungs are. (Application)
We determine the plateau or static pressure by holding the volume in the patient's lungs
for?
, what is the formula for static compliance ? - ANSWER-1 to 2 s.
This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted from the
plateau pressure and this number is divided into the VT. The results determine how
compliant the lungs are.
A 60-kg (132-lb) 52-year-old man is admitted to the ICU for the treatment of refractory
hypoxemia. He is currently on VC-SIMV and pressure support of 10 cm H2O with an
FiO2 of 0.60. Other pertinent data are below:
pH 7.49
PaCO2 30 torr
PaO2 59 torr
Heart rate 120min
Respiratory rate 12
Spontaneous VT 400 ml
Ventilator VT 500 mL
PEEP 5 cm H2O
Total respiratory rate 22/min
Which of the following should the respiratory therapist recommend at this time?
A. Increase the pressure support level to 15 cm H2O
B. Increase PEEP to 8 cm H2O
C. Increase the FiO2 to 0.70 D. Decrease VT to 400 mL - ANSWER-B, Refractory
hypoxemia typically results from atelectasis, pneumonia, or pulmonary edema, whereby
increasing oxygen levels do not correct the hypoxemia. Although the patient is
hyperventilating, VT should not be decreased. The hyperventilation is a result of the low
PaO2, therefore it should be increasing the PaO2 first is necessary. We should not
exceed 60% oxygen to try to correct hypoxemia, so increasing the PEEP level is most
appropriate. (Analysis)
Refractory hypoxemia typically results from ? - ANSWER-atelectasis
pneumonia
pulmonary edema
A peripheral lung mass is to be biopsied. Which of the following procedures should be
recommended to obtain the tissue sample?
A. Electromagnetic navigational bronchoscopy (ENB)
B. Fiberoptic bronchoscopy
C. Bronchoalveolar lavage (BAL)
D. Rigid bronchoscopy - ANSWER-. A, ENB is diagnostic tool that combines
conventional bronchoscopy with
virtual bronchoscopy that allows bronchoscopic instruments to reach peripheral lung
areas that traditional fiberoptic bronchscopes can't reach. (Analysis)
A 70-kg (154-lb) male patient is receiving mechanical ventilation. The respiratory
therapist notes the patient's
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)
what is normal PaO2 for infant ? - ANSWER-50-70 torr.
,A patient arrives in the emergency department after being pulled from a burning house.
The respiratory therapist should recommend obtaining which of the following
measurements to best determine the sever- ity of the patient's smoke inhalation?
A. SpO2
B. HbCO
C. PaO2
D. Hb - ANSWER-B, To best determine the severity of smoke inhalation, an HbCO level
should be determined with a co-oximeter. The SpO2 value should never be evaluated
on a patient suspected of CO poisoning because a pulse oximeter is not capable of
determining what is bound to hemoglobin.
Pulse oximeters work on the principle of spectrophotometry where lightweight probes
direct filtered light of specific wavelengths through the skin or digit. The light absorbed
differs for saturated and desaturated blood, wh ether it's saturated with oxygen or a
combination of oxygen and carbon monoxide. Therefore the reading will be erroneously
high when HbCO is present. (Analysis)
To best determine the severity of smoke inhalation, an HbCO level should be
determined with ? - ANSWER-co-oximeter
The physician has ordered O2 to be administered to an active 3-year-old with an SpO2
of 86%. Which of the following delivery devices would you recommend for this patient?
A. 1- to 2-L nasal cannula
B. Air-entrainment mask
C. Simple O2 mask
D.O2 hood - ANSWER-A, An active 3-year-old generally tolerates a cannula much better
than any kind of mask and is too large for an O2hood. (Application)
The ability of the patient to follow instructions would be indicated by which of the
following?
A. Orientation to person
B. Performance of tasks when asked
C. Ability to feed himself
D. Awareness of time - ANSWER-B, If the patient is able to perform simple tasks when
asked, this best determines his or her ability to follow instructions. This is important
before administering an incentive spirometry or IPPB treatment, which requires the
patient to be able to follow instructions well or the treatment will not be effective.
(Recall)
If the patient is able to perform simple tasks when asked, this best determines his or her
ability to follow instructions. This is important before administering an? - ANSWER-
incentive spirometry or IPPB treatment, which requires the patient to be able to follow
instructions well or the treatment will not be effective. (Recall)
You suspect a patient may have a pulmonary embolism. Which of the following would
be the most appropriate recommendation for diagnosis of this condition?
A. Bronchoscopy
B. V/Q lung scan
C. Coagulation studies
D. Shunt study - ANSWER-B, The best diagnostic test to determine whether a
pulmonary embolism is present is the V/Q lung scan. (Application)
,To most effectively increase a sedated, paralyzed patient's alveolar minute ventilation
while the patient is on volume-controlled ventilation in the assist-control mode, you
would recommend increasing which of the following?
A. PEEP
B. Inspiratory flow
C. VT
D. Ventilator rate - ANSWER-C
Alveolar minute ventilation = (VT - VD) × respiratory rate
It represents the volume actually reaching the alveoli per minute. It takes into account
anatomic dead space (VD), which is approximately 1 mL/lb of body weight. Anatomic
VD is that portion of the airway where no gas exchange occurs. If a patient's alveolar
minute ventilation is to be increased, the VT must be increased. If only the ventilator
rate is increased, the same VT is delivered, even though the minute ventilation (VT ×
RR) increases. (Recall)
what is the formula for alveolar minute ventilation ? - ANSWER-(VT - VD) × respiratory
rate
Failure to hyperoxygenate a patient on a ventilator before ET suctioning may result in
A. Hypoxemia
B. Hypocapnia
C. Bradycardia
D. Hypertension - ANSWER-A, It is important during ET suctioning that the PaO2 be
maintained within a normal range. This requires increasing the oxygen percentage
during the procedure. Failure to hyperoxygenate may cause hypoxemia, resulting in
cardiac arrhythmias. Bradycardia may occur as a result of vagal stimulation.
(Application)
while ET suctioning , Failure to hyperoxygenate may cause hypoxemia, resulting in ? -
ANSWER-cardiac arrhythmias
while ET suctioning a pt, Bradycardia may occur as a result of ? - ANSWER-vagal
stimulation
The most reliable method of determining whether the lungs of a patient receiving
mechanical ventila- tion are getting stiffer and harder to ventilate is by measuring the
A. Static lung compliance
B. Dynamic lung compliance
C. Spontaneous VT
D. PaO2 - ANSWER-A, When lungs get stiffer and harder to ventilate, greater pressure
is required to move the same volume of air. Because peak inspiratory pressure
increases when RAW increases (e.g., when airway secretions are present or water is in
the ventilator tubing), this pressure does not reflect how stiff the lungs actually are. We
determine the plateau or static pressure by holding the volume in the patient's lungs for
1 to 2 s. This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted
from the plateau pressure and this number is divided into the VT. The results determine
how compliant the lungs are. (Application)
We determine the plateau or static pressure by holding the volume in the patient's lungs
for?
, what is the formula for static compliance ? - ANSWER-1 to 2 s.
This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted from the
plateau pressure and this number is divided into the VT. The results determine how
compliant the lungs are.
A 60-kg (132-lb) 52-year-old man is admitted to the ICU for the treatment of refractory
hypoxemia. He is currently on VC-SIMV and pressure support of 10 cm H2O with an
FiO2 of 0.60. Other pertinent data are below:
pH 7.49
PaCO2 30 torr
PaO2 59 torr
Heart rate 120min
Respiratory rate 12
Spontaneous VT 400 ml
Ventilator VT 500 mL
PEEP 5 cm H2O
Total respiratory rate 22/min
Which of the following should the respiratory therapist recommend at this time?
A. Increase the pressure support level to 15 cm H2O
B. Increase PEEP to 8 cm H2O
C. Increase the FiO2 to 0.70 D. Decrease VT to 400 mL - ANSWER-B, Refractory
hypoxemia typically results from atelectasis, pneumonia, or pulmonary edema, whereby
increasing oxygen levels do not correct the hypoxemia. Although the patient is
hyperventilating, VT should not be decreased. The hyperventilation is a result of the low
PaO2, therefore it should be increasing the PaO2 first is necessary. We should not
exceed 60% oxygen to try to correct hypoxemia, so increasing the PEEP level is most
appropriate. (Analysis)
Refractory hypoxemia typically results from ? - ANSWER-atelectasis
pneumonia
pulmonary edema
A peripheral lung mass is to be biopsied. Which of the following procedures should be
recommended to obtain the tissue sample?
A. Electromagnetic navigational bronchoscopy (ENB)
B. Fiberoptic bronchoscopy
C. Bronchoalveolar lavage (BAL)
D. Rigid bronchoscopy - ANSWER-. A, ENB is diagnostic tool that combines
conventional bronchoscopy with
virtual bronchoscopy that allows bronchoscopic instruments to reach peripheral lung
areas that traditional fiberoptic bronchscopes can't reach. (Analysis)
A 70-kg (154-lb) male patient is receiving mechanical ventilation. The respiratory
therapist notes the patient's
