TMC QUESTIONS FROM LINDSEY
JONES (PART 2) WITH COMPLETE
SOLUTIONS
Which of the following test results would NOT be helpful in determining whether a
patient should receive Bi-level therapy with supplemental oxygen? - ANSWER-MVV 50L
in 12 seconds
· MVV, or maximum voluntary ventilation is a test completed during a complete
pulmonary function evaluation.It is not a part of weaning parameters assessed on
mechanically ventilated patients. It is also a test that should be completed on patients
who are otherwise very healthy and in their best condition, not a critically ill patient
receiving mechanical ventilation. The other tests are appropriate to assess when
deciding to terminate mechanical ventilation.
A morbidly obese patient who is trached with a fenestrated tracheostomy tube is
experiencing frequent dislodging with minor movement or cough. What should the
respiratory therapist suggest? - ANSWER-Increase the length of the tracheostomy tube
· Due to the increased neck circumference of a morbidly obese patient, special
tracheostomy tubes that have long proximal extensions allow for the increased distance
from the interior tracheal wall to the opening of the stoma at the skin.
Which device is most appropriate to send to the central processing department for
sterilization after use on an infectious patient? - ANSWER-Battery-powered
laryngoscope handle
· In this example the laryngoscope handle is an electronic device and may be damaged
with customary soaking in glutaraldehyde. A fiber-optic laryngoscope blade and a
reusable stylet can both be soaked in a glutaraldehyde solution. An infant ventilator
cannot be soaked or sent for sterilization. A ventilator is wiped down. The use of filters
prevents contamination of the inner parts.
Following extubation after shoulder surgery a 15-year-old male patient is experiencing
30-second periods of apnea. The respiratory therapist should - ANSWER-Ventilate with
a manual resuscitator
,· 30-second periods of apnea indicate the need for immediate assistance with
ventilation. Of the choices offered, only ventilation with a manual resuscitator meets this
requirement. One may be tempted to choose to intubate the patient, but intubation does
not automatically imply that mechanical ventilation will be provided. Intubation is for
airway protection.
When transitioning from a speaking configuration to a positive pressure ventilation
configuration in a trach patient, what is the order? - ANSWER-the first step is to remove
the cap, then inflate the cuff, and finally, insert the inner cannula.
A patient is experiencing reduced tidal volumes on a volume-cycled ventilator. There is
a gurgling sound coming from his mouth with each breath and the endotracheal tube
marking is 19 cm at the lips. The respiratory therapist should - ANSWER-Add air to the
pilot balloon while auscultating over the neck
· The scenario presents an airway management problem including an air leak with an
endotracheal tube. The cause is likely due to a lack of air in the cuff, but could be
several other things, such as a hole in the cuff, or a misplaced tube. By first adding air
to the cuff the respiratory therapist will either solve the problem, or further isolate the
problem. For example, if a hole exists in the cuff, the leak will shortly return, and the
therapist will know to replace the tube.
A 72-kg (158-lb) patient is receiving volume-cycled mechanical ventilation on the
following settings:
Mode SIMV
Rate 12
VT 550 ml
FIO2 0.40
PEEP 10 cm H2O
Which of the following alarm settings is most appropriate? - ANSWER-Low VT alarm of
450mL
· The low tidal volume alarm should be set at about 100 mL below the preset/returned
tidal volume. Be prepared to lower the low VT alarm when the patient's lung compliance
increases.
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? - ANSWER-Increase mandatory rate
· An end-tidal CO2 of 56 mmHg approximates an arterial CO2 of about 66 mm Hg. This
is a definite indication of hypoventilation and would best be remedied by increasing
minute ventilation. 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 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? - ANSWER-Remove 50-100mL of
deadspace between the wye and patient
· When arterial carbon dioxide is high, there are three options. Respiratory rate may be
increased, tidal volume may be increased, or deadspace may be removed. Of the
options offered 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 is receiving oxygen by non-rebreathing mask at a flow of 10 L/min.
Spontaneous tidal volume is 500 mL and spontaneous respiratory rate is 20 /min. What
change should the therapist recommend? - ANSWER-Increase flow to 14L/min
· A patient who is breathing a tidal volume of 600 mL at a rate of 20/min has a minute
ventilation of 12 L. If the non-rebreathing mask is set at only 10 L/min, the total flow to
the patient is insufficient. The flowrate should meet or exceed the inspiratory demand of
the patient. Therefore, increasing to 14 L/min is most appropriate.
The following pulmonary function test results are reported for a 60-year-old male patient
who weighs 65-kg (143-lb) and is 5-ft, 6-in (168 cm) tall.
% of predicted
Actual Value
FVC 82
SVC 91
Fev1.0/FVC% 58%
Fev1.0 62
FEF 200-1200 79
FEF25-75 60
DLCO 88
Based on this information the patient has - ANSWER-Mild obstructive defect
, · A mild obstructive defect is suggested by a Fev1/FVC% of 58% and a Fev1 of 62% of
predicted.
The following pulmonary function test results are reported for a 57-year-old male patient
with a smoking history of 50-pack years.
% of predicted
Actual Value
FVC 56
SVC. 68
Fev1.0/FVC% 67%
Fev1.0 62
FEF 200-1200 68
FEF25-75 68
DLCO. 18
Based on this information the patient has - ANSWER-Emphysema
· This patient is demonstrating an obstructive defect as shown by an Fev1/FVC of 67%,
which is less than the 75% required to be normal. Additionally, DLCO is also less than
80% of predicted indicating mild diffusion impairment. These two conditions, together,
are associated with pulmonary emphysema.
An 8-year-old pediatric patient with a 6.0 mm endotracheal tube requiring endotracheal
suctioning is experiencing bradycardia during the procedure. Suction pressure is set to -
100 mm Hg. A respiratory therapist is suctioning for approximately 15 seconds using a 9
Fr catheter and is able to clear the airway effectively. To remedy the problem, the
therapist should - ANSWER-Decrease suction duration time
· If suctioning is not adequate, correct the problem in this order: 1. check connections,
change collection bottle if full 2. ensure suction pressure is in the right range 3. increase
to the maximum size catheter within range 4. increase pressure within range 5. increase
suction time
An adult is receiving NT suctioning and experiences a decrease in SpO2 from 98% to
80% during the procedure. The respiratory should - ANSWER-Stop the suction
procedure
· The respiratory therapist should immediately stop suctioning if any signs of distress
are present cardiac, desaturation, or otherwise).
What is a molecular sieve device also known as? - ANSWER-Oxygen concentrator
JONES (PART 2) WITH COMPLETE
SOLUTIONS
Which of the following test results would NOT be helpful in determining whether a
patient should receive Bi-level therapy with supplemental oxygen? - ANSWER-MVV 50L
in 12 seconds
· MVV, or maximum voluntary ventilation is a test completed during a complete
pulmonary function evaluation.It is not a part of weaning parameters assessed on
mechanically ventilated patients. It is also a test that should be completed on patients
who are otherwise very healthy and in their best condition, not a critically ill patient
receiving mechanical ventilation. The other tests are appropriate to assess when
deciding to terminate mechanical ventilation.
A morbidly obese patient who is trached with a fenestrated tracheostomy tube is
experiencing frequent dislodging with minor movement or cough. What should the
respiratory therapist suggest? - ANSWER-Increase the length of the tracheostomy tube
· Due to the increased neck circumference of a morbidly obese patient, special
tracheostomy tubes that have long proximal extensions allow for the increased distance
from the interior tracheal wall to the opening of the stoma at the skin.
Which device is most appropriate to send to the central processing department for
sterilization after use on an infectious patient? - ANSWER-Battery-powered
laryngoscope handle
· In this example the laryngoscope handle is an electronic device and may be damaged
with customary soaking in glutaraldehyde. A fiber-optic laryngoscope blade and a
reusable stylet can both be soaked in a glutaraldehyde solution. An infant ventilator
cannot be soaked or sent for sterilization. A ventilator is wiped down. The use of filters
prevents contamination of the inner parts.
Following extubation after shoulder surgery a 15-year-old male patient is experiencing
30-second periods of apnea. The respiratory therapist should - ANSWER-Ventilate with
a manual resuscitator
,· 30-second periods of apnea indicate the need for immediate assistance with
ventilation. Of the choices offered, only ventilation with a manual resuscitator meets this
requirement. One may be tempted to choose to intubate the patient, but intubation does
not automatically imply that mechanical ventilation will be provided. Intubation is for
airway protection.
When transitioning from a speaking configuration to a positive pressure ventilation
configuration in a trach patient, what is the order? - ANSWER-the first step is to remove
the cap, then inflate the cuff, and finally, insert the inner cannula.
A patient is experiencing reduced tidal volumes on a volume-cycled ventilator. There is
a gurgling sound coming from his mouth with each breath and the endotracheal tube
marking is 19 cm at the lips. The respiratory therapist should - ANSWER-Add air to the
pilot balloon while auscultating over the neck
· The scenario presents an airway management problem including an air leak with an
endotracheal tube. The cause is likely due to a lack of air in the cuff, but could be
several other things, such as a hole in the cuff, or a misplaced tube. By first adding air
to the cuff the respiratory therapist will either solve the problem, or further isolate the
problem. For example, if a hole exists in the cuff, the leak will shortly return, and the
therapist will know to replace the tube.
A 72-kg (158-lb) patient is receiving volume-cycled mechanical ventilation on the
following settings:
Mode SIMV
Rate 12
VT 550 ml
FIO2 0.40
PEEP 10 cm H2O
Which of the following alarm settings is most appropriate? - ANSWER-Low VT alarm of
450mL
· The low tidal volume alarm should be set at about 100 mL below the preset/returned
tidal volume. Be prepared to lower the low VT alarm when the patient's lung compliance
increases.
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? - ANSWER-Increase mandatory rate
· An end-tidal CO2 of 56 mmHg approximates an arterial CO2 of about 66 mm Hg. This
is a definite indication of hypoventilation and would best be remedied by increasing
minute ventilation. 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 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? - ANSWER-Remove 50-100mL of
deadspace between the wye and patient
· When arterial carbon dioxide is high, there are three options. Respiratory rate may be
increased, tidal volume may be increased, or deadspace may be removed. Of the
options offered 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 is receiving oxygen by non-rebreathing mask at a flow of 10 L/min.
Spontaneous tidal volume is 500 mL and spontaneous respiratory rate is 20 /min. What
change should the therapist recommend? - ANSWER-Increase flow to 14L/min
· A patient who is breathing a tidal volume of 600 mL at a rate of 20/min has a minute
ventilation of 12 L. If the non-rebreathing mask is set at only 10 L/min, the total flow to
the patient is insufficient. The flowrate should meet or exceed the inspiratory demand of
the patient. Therefore, increasing to 14 L/min is most appropriate.
The following pulmonary function test results are reported for a 60-year-old male patient
who weighs 65-kg (143-lb) and is 5-ft, 6-in (168 cm) tall.
% of predicted
Actual Value
FVC 82
SVC 91
Fev1.0/FVC% 58%
Fev1.0 62
FEF 200-1200 79
FEF25-75 60
DLCO 88
Based on this information the patient has - ANSWER-Mild obstructive defect
, · A mild obstructive defect is suggested by a Fev1/FVC% of 58% and a Fev1 of 62% of
predicted.
The following pulmonary function test results are reported for a 57-year-old male patient
with a smoking history of 50-pack years.
% of predicted
Actual Value
FVC 56
SVC. 68
Fev1.0/FVC% 67%
Fev1.0 62
FEF 200-1200 68
FEF25-75 68
DLCO. 18
Based on this information the patient has - ANSWER-Emphysema
· This patient is demonstrating an obstructive defect as shown by an Fev1/FVC of 67%,
which is less than the 75% required to be normal. Additionally, DLCO is also less than
80% of predicted indicating mild diffusion impairment. These two conditions, together,
are associated with pulmonary emphysema.
An 8-year-old pediatric patient with a 6.0 mm endotracheal tube requiring endotracheal
suctioning is experiencing bradycardia during the procedure. Suction pressure is set to -
100 mm Hg. A respiratory therapist is suctioning for approximately 15 seconds using a 9
Fr catheter and is able to clear the airway effectively. To remedy the problem, the
therapist should - ANSWER-Decrease suction duration time
· If suctioning is not adequate, correct the problem in this order: 1. check connections,
change collection bottle if full 2. ensure suction pressure is in the right range 3. increase
to the maximum size catheter within range 4. increase pressure within range 5. increase
suction time
An adult is receiving NT suctioning and experiences a decrease in SpO2 from 98% to
80% during the procedure. The respiratory should - ANSWER-Stop the suction
procedure
· The respiratory therapist should immediately stop suctioning if any signs of distress
are present cardiac, desaturation, or otherwise).
What is a molecular sieve device also known as? - ANSWER-Oxygen concentrator
