Lindsey Jones J Test Questions With Correct Answers

Which of the following can cause inverted T waves on a 12-lead ECG? A. second degree heart block B. hypokalemia C. digitalis toxicity D. hyperkalemia - Answer C. digitalis toxicity There are two causes of inverted T waves: cardiac ischemia and digitalis toxicity. How many portable oxygen E cylinders will be required for a 12-hour car trip with a flow rate of 2 L/min? A. 5 B. 2 C. 3 D. 4 - Answer C. 3 To answer this question you must know that the tank factor for an E cylinder is 0.28. A full E cylinder is 2200 PSI. Therefore 2200x0.28 is equal to 616 L. 616 divided by two is equal to 308 min. A 12 hour car trip is 720 min. Therefore the patient will need three E cylinders of oxygen to go on a 12 hour trip. An oral pharyngeal airway is measured from the patient's jaw angle to the tip of the chin. After placement, the semi-conscious patient repeatedly pushes the airway out with his tongue. The therapist should A. insert a larger airway. B. replace with a nasal endotracheal tube C. reinsert the oral airway. D. secure the airway with tape. - Answer C. reinsert the oral airway. It is normal for a patient to reject an oral airway with their tongue. Reinserting the airway is most appropriate. A respiratory therapist changes from a normal adult ventilator circuit to a heated-wire circuit. Arterial blood gases are as follows: pH 7.31 PaCO2 48 torr PaO2 81 torr HCO3- 24 mEq/L BE 0 mEq/L Which of the following changes is most indicated? A. increase inspiratory flow rate B. revert to the normal non-heated wire circuit C. remove 50-100 mL of deadspace between the wye and patient D. add 100 mL of deadspace at the patient-ventilator interface - Answer C. remove 50-100 mL of deadspace between the wye and patient Removing deadspace is the best option and is the only option that will reduce carbon dioxide. What also makes this appropriate is the fact that CO2 is off target by a very small amount, making a change in deadspace appropriate. A patient in the emergency room, who is breathing rapidly and deeply, is receiving heated aerosol by mask and large-volume nebulizer with FIO2 set at 1.0 and the flow set at 15 L/min. The therapist notices the aerosol disappears completely with each breath. Pulse oximetry shows an oxygen saturation of 88%. The therapist should recommend A. switch to a non-rebreathing mask at the same flow B. increase flow to 20 L/min C. decrease FIO2 to 0.6 D. a tandem aerosol device - Answer D. a tandem aerosol device A large volume nebulizer set at 60% with a flow of 15 L/min is producing a total gas flow of 15 L/min. Because this patient is breathing rapidly and deeply and is hypoxic, it is likely that the total flow is not meeting the inspiratory demands of the patient. Because the flow of the large-volume nebulizer may not be increased significantly due to back pressure the solution for this case is to add another tandem large-volume nebulizer device, producing a total gas flow of 30 L/min. A respiratory therapist is assisting in a cardiopulmonary stress testing of a patient. After several increases in workload by increasing the incline on the treadmill, heart rate is 120/min, blood pressure is 130/95 mmHg and O2 Sat is 97%. Increasing the treadmill further shows no further increase in these values, but the patient appears pale in color. The therapist should recommend A. after two minutes, increase workload B. discontinue the test, document findings C. monitor the patient closely D. decrease workload - Answer B. discontinue the test, document findings The laboratory results of a sputum culture and sensitivity have returned for a patient who has bilateral bacterial pneumonia. The culture reveals streptococcus, a gram-positive bacteria. The medical records indicates the patient is allergic to penicillin. Which of the following should the respiratory therapist recommend? A. Amoxicillin B. Cephalexine (Keflex) C. Methacillin D. Nafcillin - Answer B. Cephalexine (Keflex) Normally gram-positive bacteria may be killed by penicillin-type antibiotics. But, because the patient is allergic to penicillin, a suitable drug is cephalexine. Nafcillin and methacillin are suitable antibiotics when a patient is penicillin-resistant but not when they are allergic. A patient with cystic fibrosis develops rhonchi after 5 minutes of PEP therapy at 20 cm H2O. The respiratory therapist should A. switching to flutter therapy B. discontinue treatment, report to findings to the physician C. begin cool bland aerosol therapy D. continue the therapy - Answer D. continue the therapy The development of rhonchi in response to PEP therapy is considered to be a good outcome for the therapy. The purpose of the therapy is to mobilize and promote expectoration of secretions. The development of rhonchi is an indication that secretions are moving from small and middle-sized airways to the larger size airways where they may be naturally expectorated or suctioned. The therapy should be continued because it is effective. Excessive bubbling is noted in the water seal chamber of a chest tube drainage system. Which of the following could be the cause? A. water seal fluid level is too high B. water seal fluid level is too low C. wall pressure is too low D. leak in the drainage tubing coming from the patient - Answer D. leak in the drainage tubing coming from the patient A leak in the drainage tubing coming from a patient's chest will cause the entrainment of additional air into the system which will show up as excessive bubbling in the water-seal compartment. Normally gentle bubbling should be observed. When excessive bubbling is present, a leak most likely exists somewhere between the waterseal compartment and the patient's lung tissue and may be caused from a perforation or hole in the lung tissue. Which of the following would result in an increase in anatomical airway resistance? A. an undersized endotracheal tube B. autoPEEP C. pulmonary secretions D. water build up in the ventilator circuit - Answer C. pulmonary secretions Airway resistance is increased in the presence of pulmonary secretions and bronchoconstriction. The other examples listed are not anatomically related. A patient presents in the emergency department (ED) with shallow, irregular respirations. Which of the following diagnostic procedures would best help rule out a pleural effusion? A. PA chest radiograph B. series of oblique chest radiographs C. pulmonary angiogram D. ventilation/perfusion (V/Q scan) - Answer B. series of oblique chest radiographs Pleural effusions may be diagnosed through obtaining a lateral decubitus x-ray or by obtaining a series of x-rays from oblique angles and different positions. The pulmonary function data shows decreased flows but normal volumes with decreased DLCO A. asthma B. emphysema C. chronic bronchitis D. pulmonary fibrosis - Answer B. emphysema only obstructive disease with a low DLCO A patient with ARDS receiving volume-controlled ventilation has the following arterial blood results on the settings below: Mode Assist/control Mandatory rate 22 VT 350 mL FIO2 0.70 PEEP 22 cm H2O C.I. 2.2 L/min/m2 Heart rate 102 pH 7.35 PaCO2 45 torr PaO2 58 torr HCO3- 25 mEq/L BE +1 mEq/L Which of the following changes is most appropriate? A. increase FIO2 to 0.8 B. decrease PEEP to 20 cm H2O C. increase PEEP to 25 cm H2O D. decrease FIO2 to 0.6 - Answer C. increase PEEP to 25 cm H2O This patient is hypoxic. To correct this problem either PEEP or FIO2 must be increased. Because the patient is already on 70% the next logical step is to increase PEEP. Hemodynamic data, namely a normal cardiac output, supports this change. A patient complaining of shortness of breath presents with severe hyperglycemia, marked hyperpnea, and normal oxygen levels. What should the respiratory therapist expect when analyzing an ABG? A. anemic hypoxemia B. metabolic acidosis C. compensated respiratory alkalosis D. respiratory failure - Answer B. metabolic acidosis Metabolic acidosis results in a significantly low pH, which causes an increased respiratory drive in order to attempt to normalize the pH. High glucose levels are often seen with metabolic acidosis. Oxygenation remains normal. A patient admitted to the emergency room for chest pain is diaphoretic with cold extremities. These data are most consistent with which of the following A. pulmonary tuberculosis B. myocardial infarction C. pneumothroax D. pulmonary embolism - Answer B. myocardial infarction Chest pain, diaphoresis, and cold extremities is associated with myocardial infarction. Other terminology that would describe this includes cold, wet, clammy skin. The next most appropriate action, although not asked in this question, would be to administer oxygen and to obtain an ECG. A patient is receiving bi-level therapy at the following settings: IPAP 15 cm H2O EPAP 5 cm H2O FIO2 0.5 Recent arterial blood gas results reveal hypoxemia. To compensate, the respiratory therapist increases the EPAP setting to 8 cm H2O. What other change should be made to ensure a consistent level of ventilatory support is maintained during spontaneous breaths? A. Switch to full ventilatory support with a mandatory rate and a PEEP of 8 cm H2O B. Add a back-up rate C. Decrease IPAP to 10 cm H2O D. Increase IPAP to 18 cm H2O - Answer D. Increase IPAP to 18 cm H2O When correcting hypoxemia with noninvasive positive pressure ventilation, EPAP should be increased. However, so as not to decrease ventilation inadvertently, the IPAP setting should be increased by the same amount in order to keep the distance between EPAP an IPAP unchanged. Which of the following benefits from continuous low-flow supplemental oxygen should be expressed to a patient with COPD who is participating in a pulmonary rehabilitation program? A. establish normal pulmonary function volumes B. reverse lung disease C. return to normal life D. increase ability to perform ADLs - Answer D. increase ability to perform ADLs A patient scheduled for abdominal surgery can be assessed for potential post-operative risk for complications by assessing which of the following? A. C(a-vDO2) B. alveolar oxygen tension on room air (FIO2 0.21) C. incentive spirometry with flow-type spirometer D. basic spirometry - Answer D. basic spirometry While turning a patient for a V/Q scan, the therapist suspects the endotracheal tube changed position. Currently the ET tube markings are 19 at the lip line. The therapist should FIRST do which of the following to assess tube position? A. observe chest rise B. withdraw the ET tube by 5 cm C. advance the ET tube by 2 cm D. obtain a chest radiograph - Answer A. observe chest rise When trying to quickly determine the location of the endotracheal tube the action that must be taken first is that which is the quickest. Of the options offered, observing chest rise is the quickest. Which of the following pulmonary function volume calculations may be used to determine functional residual capacity (FRC)? A. ERV-RV B. VT + ERV + RV C. TLC - IC D. VC - ERV - Answer C. TLC - IC FRC may be calculated in a variety of ways by adding and subtracting specific lung volumes. To answer this question, one must take each option and do the calculation to determine if the desired volume can be achieved. In this case, FRC may be calculated by subtracting inspiratory capacity (IC) from total lung capacity (TLC). A radiographic image shows an upper lobe cavitation. Which of the following conditions is most closely associated with this finding? A. Tuberculosis B. Pneumonia C. Bronchiectasis D. Asbestosis - Answer A. Tuberculosis Cavitations in the upper lobes are generally associated with tuberculosis. Bronchiectasis is a condition affecting the bronchioles or airways and is seen throughout the lung. Pneumonia is not a cavitation and can also be seen throughout the lung on X-ray. Asbestosis is seen throughout the lung with reduced lucency. A patient has a fenestrated tracheostomy tube configured to allow speech. In preparation for a positive pressure breathing treatment, the respiratory therapist should do which of the following? A. remove the cap, inflate the cuff, insert the inner cannula B. remove the inner cannula, deflate the cuff, place the cap C. inflate the cuff, insert the inner cannula, remove the cap D. remove the cap, deflate the cuff and replace the inner cannula - Answer A. remove the cap, inflate the cuff, insert the inner cannula A 7-year-old patient is receiving mechanical ventilation with a PB 840 volume ventilator with an adult circuit. The end-tidal CO2 monitor is indicating a PetCO2 of 56 mmHg. Which of the following is most appropriate? A. remove 50 mL of deadspace B. add 50 mL of deadspace C. increase mandatory rate D. switch to a pediatric circuit - Answer C. increase mandatory rate This may be done by increasing tidal volume or increasing rate. Adding dead space would increase end-tidal and arterial CO2 even further. Removing dead space, while a step in the right direction, isn't a sufficient response. Changing to a pediatric circuit is not helpful. A patient undergoing pulmonary function testing in a body box has an airway resistance (Raw) of 2.7 cm H2O/L/sec. The respiratory therapist should provide which of the following interpretations? A. asthma B. Guillain-Barre Syndrome C. normal results D. restrictive pulmonary disease - Answer A. asthma An airway resistance of 2.7 cmH2O/L/sec is considered high. Elevated airway resistance is associated with asthma.