L JU: TMC FORM C QUESTION AND ANSWERS
2 PM 5 PM
Peak airway pressure 45 cm H2O 56 cm H2O
Static airway pressure 35 cm H2O 46 cm H2O
PEEP 5 cm H2O 5 cm H2O
Delivered tidal volume 750 mL 750 mL
Inspiratory flow 55 L/min 55 L/min
The following data is available for a patient receiving mechanical ventilation:
What is the next action the respiratory therapist should take?
A. Decrease tidal volume
B. Perform bronchial hygiene
C. Increase inspiratory flow
D. Obtain a chest radiograph - ansThe correct answer is : D
Explanation :
This data shows an increase in static airway pressure which indicates the lungs are becoming stiffer or less
compliant. There is no specific, immediate treatment for this but additional data may be gathered to determine
the possible cause of the change in compliance. Of the options offered, obtaining a chest radiograph is most
appropriate.
A 100-kg (220-lb), 6-ft, 2-in (188-cm) adult male is orally intubated with a 7.0-mm endotracheal tube. The
therapist reports difficulty removing secretions with the suction pressure set to 120 mmHg. The respiratory
therapist will FIRST
A. lubricate the suction catheter
B. decrease suction pressure to 100 mmHg
C. switch to a 9.0-mm ET tube
D. increase suction pressure to 130 mmHg - ansThe correct answer is : C
,Explanation :
The problem we should recognize first, in this case, is it the patient's ideal body weight is significant. The ET
tube used is likely too small. 100 kg male should have an ET tube size of about 9 mm to 10 mm. Use of a larger
tube will allow the use of a larger suction catheter, which will drastically improve suctioning efficiency.
A 33-year-old female has been rehabilitated from a motor vehicle accident where she suffered a spinal injury.
She has been admitted to the emergency department with flu-like symptoms, is febrile, and is expectorating
yellow sputum. Arterial blood gas results are:
pH 7.27
PaCO2 52 torr
PaO2 67 torr
HCO3- 25 mEq/L
BE -1 mEq/L
The respiratory therapist should recommend
A. non-invasive positive pressure ventilation (NPPV)
B. intermittent positive pressure ventilation (IPPV)
C. pressure support ventilation (PSV)
D. high frequency chest wall oscillation (HFCWO) - ansThe correct answer is : A
Explanation :
Arterial blood gas reveal hypoventilation and hypoxemia. However, the patient is not quite yet demonstrating
acute ventilatory failure. When CO2 rises and pH falls below 7.25, acute ventilatory failure is present and
mechanical ventilatory assistance is indicated. In this case, the patient is just shy of acute ventilatory failure
and may benefit from non-invasive positive pressure ventilation (NIPPV or BiPAP).
A 38-week gestational age infant is receiving supplemental oxygen by oxyhood. An air/oxygen blender is set at
40% and the heated large volume aerosol is set at 100%. A capillary blood sample reveals the following values:
pH 7.45
,PcCO2 35 torr
PcO2 47 torr
HCO3- 22 mEq/L
BE -2 mEq/L
SpO2 is reading 97% and the patient appears to have good color. The therapist should conclude which of the
following?
A. nasal CPAP of 4 cmH2O should be implemented
B. the air/oxygen blender should be set to 100%
C. these are normal findings
D. FIO2 should be increased - ansThe correct answer is : C
Explanation :
Infants have the same blood gas values as adults except for the PaO2. Close examination of the data provided
shows that arterial CO2 and arterial oxygen is not what is being reported. The small "c" noted before the CO2
and O2 level indicate the blood was taken from the capillaries. When this is the case it must be remembered
that capillary CO2 and the corresponding pH may be trusted but capillary oxygen levels are not accurate and
may not be used. Therefore, this capillary blood gas reveals normal levels in term so ventilation. But the
capillary oxygen data must be ignored entirely.
A 4-year-old patient in the emergency room (E.R.) shows significant signs of respiratory distress including
inspiratory stridor and tachypnea. The patient is drooling. The physician feels the patient has acute epiglottitis
and orders intubation. Which of the following methods of intubation would be most appropriate?
A. visualize the oropharynx with a tonsil suction device
B. perform oral intubation with a stylet
C. nasal intubation with magill forceps
D. intubate with a bronchoscope - ansThe correct answer is : D
Explanation :
Acute epiglottitis is characterized by significant inflammation in the upper airway. If intubation is opted, the
respiratory care practitioner must use extreme caution and be careful not to increase the inflammation by
probing or touching the tissues in the upper airway. This is considered to be a complicated intubation. Thus,
, the patient must either receive a tracheostomy or be intubated with direct visualization through a
bronchoscope.
A 42-year-old female presents in the emergency department (ED) complaining of body aches and general
malaise. The patient reports sickness over the last two days with excessive vomiting and diarrhea. Which of the
following laboratory tests should the respiratory therapist suggest?
A. Theophylline level
B. Blood urea nitrogen (BUN)
C. Serum electrolytes
D. Arterial blood gas - ansThe correct answer is : C
Explanation :
Body aches and general malaise is most often a clear indicator of electrolyte imbalance. This suggestion is
further indicated by the fact that the patient has been expectorating fluid in various forms and has likely
become dehydrated. Loss of fluid often results in electrolyte imbalance.
A 45 year-old patient is recovering in the intensive care unit after undergoing a surgical procedure to repair a
hernia. The patient remains unconscious. To prevent soft tissue obstruction, the respiratory therapist should
recommend a(n)
A. bite block
B. double-lumen endobronchial tube
C. oropharyngeal airway
D. nasopharyngeal airway - ansThe correct answer is : C
Explanation :
An oral pharyngeal airway is the primary mechanism used to prevent the time from falling back and obstructing
the airway. Although a double lumen endobronchial tube would also do this, it is far too invasive and not
necessary.
A 45-year-old 74-kg (163-lb) adult female is receiving mechanical ventilatory support. Settings are as follows:
2 PM 5 PM
Peak airway pressure 45 cm H2O 56 cm H2O
Static airway pressure 35 cm H2O 46 cm H2O
PEEP 5 cm H2O 5 cm H2O
Delivered tidal volume 750 mL 750 mL
Inspiratory flow 55 L/min 55 L/min
The following data is available for a patient receiving mechanical ventilation:
What is the next action the respiratory therapist should take?
A. Decrease tidal volume
B. Perform bronchial hygiene
C. Increase inspiratory flow
D. Obtain a chest radiograph - ansThe correct answer is : D
Explanation :
This data shows an increase in static airway pressure which indicates the lungs are becoming stiffer or less
compliant. There is no specific, immediate treatment for this but additional data may be gathered to determine
the possible cause of the change in compliance. Of the options offered, obtaining a chest radiograph is most
appropriate.
A 100-kg (220-lb), 6-ft, 2-in (188-cm) adult male is orally intubated with a 7.0-mm endotracheal tube. The
therapist reports difficulty removing secretions with the suction pressure set to 120 mmHg. The respiratory
therapist will FIRST
A. lubricate the suction catheter
B. decrease suction pressure to 100 mmHg
C. switch to a 9.0-mm ET tube
D. increase suction pressure to 130 mmHg - ansThe correct answer is : C
,Explanation :
The problem we should recognize first, in this case, is it the patient's ideal body weight is significant. The ET
tube used is likely too small. 100 kg male should have an ET tube size of about 9 mm to 10 mm. Use of a larger
tube will allow the use of a larger suction catheter, which will drastically improve suctioning efficiency.
A 33-year-old female has been rehabilitated from a motor vehicle accident where she suffered a spinal injury.
She has been admitted to the emergency department with flu-like symptoms, is febrile, and is expectorating
yellow sputum. Arterial blood gas results are:
pH 7.27
PaCO2 52 torr
PaO2 67 torr
HCO3- 25 mEq/L
BE -1 mEq/L
The respiratory therapist should recommend
A. non-invasive positive pressure ventilation (NPPV)
B. intermittent positive pressure ventilation (IPPV)
C. pressure support ventilation (PSV)
D. high frequency chest wall oscillation (HFCWO) - ansThe correct answer is : A
Explanation :
Arterial blood gas reveal hypoventilation and hypoxemia. However, the patient is not quite yet demonstrating
acute ventilatory failure. When CO2 rises and pH falls below 7.25, acute ventilatory failure is present and
mechanical ventilatory assistance is indicated. In this case, the patient is just shy of acute ventilatory failure
and may benefit from non-invasive positive pressure ventilation (NIPPV or BiPAP).
A 38-week gestational age infant is receiving supplemental oxygen by oxyhood. An air/oxygen blender is set at
40% and the heated large volume aerosol is set at 100%. A capillary blood sample reveals the following values:
pH 7.45
,PcCO2 35 torr
PcO2 47 torr
HCO3- 22 mEq/L
BE -2 mEq/L
SpO2 is reading 97% and the patient appears to have good color. The therapist should conclude which of the
following?
A. nasal CPAP of 4 cmH2O should be implemented
B. the air/oxygen blender should be set to 100%
C. these are normal findings
D. FIO2 should be increased - ansThe correct answer is : C
Explanation :
Infants have the same blood gas values as adults except for the PaO2. Close examination of the data provided
shows that arterial CO2 and arterial oxygen is not what is being reported. The small "c" noted before the CO2
and O2 level indicate the blood was taken from the capillaries. When this is the case it must be remembered
that capillary CO2 and the corresponding pH may be trusted but capillary oxygen levels are not accurate and
may not be used. Therefore, this capillary blood gas reveals normal levels in term so ventilation. But the
capillary oxygen data must be ignored entirely.
A 4-year-old patient in the emergency room (E.R.) shows significant signs of respiratory distress including
inspiratory stridor and tachypnea. The patient is drooling. The physician feels the patient has acute epiglottitis
and orders intubation. Which of the following methods of intubation would be most appropriate?
A. visualize the oropharynx with a tonsil suction device
B. perform oral intubation with a stylet
C. nasal intubation with magill forceps
D. intubate with a bronchoscope - ansThe correct answer is : D
Explanation :
Acute epiglottitis is characterized by significant inflammation in the upper airway. If intubation is opted, the
respiratory care practitioner must use extreme caution and be careful not to increase the inflammation by
probing or touching the tissues in the upper airway. This is considered to be a complicated intubation. Thus,
, the patient must either receive a tracheostomy or be intubated with direct visualization through a
bronchoscope.
A 42-year-old female presents in the emergency department (ED) complaining of body aches and general
malaise. The patient reports sickness over the last two days with excessive vomiting and diarrhea. Which of the
following laboratory tests should the respiratory therapist suggest?
A. Theophylline level
B. Blood urea nitrogen (BUN)
C. Serum electrolytes
D. Arterial blood gas - ansThe correct answer is : C
Explanation :
Body aches and general malaise is most often a clear indicator of electrolyte imbalance. This suggestion is
further indicated by the fact that the patient has been expectorating fluid in various forms and has likely
become dehydrated. Loss of fluid often results in electrolyte imbalance.
A 45 year-old patient is recovering in the intensive care unit after undergoing a surgical procedure to repair a
hernia. The patient remains unconscious. To prevent soft tissue obstruction, the respiratory therapist should
recommend a(n)
A. bite block
B. double-lumen endobronchial tube
C. oropharyngeal airway
D. nasopharyngeal airway - ansThe correct answer is : C
Explanation :
An oral pharyngeal airway is the primary mechanism used to prevent the time from falling back and obstructing
the airway. Although a double lumen endobronchial tube would also do this, it is far too invasive and not
necessary.
A 45-year-old 74-kg (163-lb) adult female is receiving mechanical ventilatory support. Settings are as follows:
