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Problem 1
You are a respiratory therapist working in a 600-bed urban medical center and
your assignment includes providing care to patients on the general medical floor.
You are asked to assist in the care of a recently admitted 32-year-old male patient
who is 180 cm (5'11") tall, and weighs 53 kg (117 lb). The patient is pale and
complains of persistent cough and fever for over a week. The hospitalist ask you to
evaluate the patient and report your findings. You arrive to the patient's room,
introduce yourself, and explain the purpose of your visit. Which of the following
should you include in your assessment? - Correct Answer: History or present
illness: Flu like symptoms for the past week
Vital signs: Temp 40C (104.1F), HR 42/min, RR 38/min, BP 122/85mmHg
General appearance: Thin male patient, central pillar
Sensorium: Conscious but somnolent and restless
Respiratory pattern: Tachypnea, labored
PMHX: HX of IV drug use, previous admissions for pneumonia
Pulse oximetry: SpO2 86% on room air
Breath sounds: Diminished aeration with coarse crackles throughout
Diagnostic chest percussion: Dull percussion sound in the middle and lower lobes
bilaterally.
, You report your problems to the hospitalist, who ask for your recommendation.
Based on your assessment, which of the following would you recommend?
(Choose one)
Administer naloxone
Initiate antimicrobial therapy
Administer atropine sulfate
Assist ventilation with manual resuscitation bag
Administer oxygen by a nasal cannula at 5L/min - Correct Answer: Administer
oxygen by nasal cannula at 5 L/min
The hospitalist asks what additional testing may be indicated. You should
recommend - Correct Answer: Sputum culture
Sputum acid-fast stain
CBC: RBC 4.1 mill/mm3, HB 12g, Hct 40%, WBC 28,000/mm3
Chest radiograph: consolidation in the middle and lower lobes bilaterally
Drug toxicology
12-Lead Electrocardiogram: Sinus tachycardia
ABG: pH 7.37/45/80/25/+1/SaO2 95%
ELISA test
Serum Electrolytes
Urinalysis
, An ELISA test confirms a diagnosis of HIV and a sputum acid fast stain is negative.
Sputum culture confirms the presence of pneumocystis jiroveci. What additional
therapy would you recommend at this time? (Choose one)
Albuterol sulfate
Streptomycin
Pentamidine
Penicillin
Ribavirin - Correct Answer: Pentamidine
Four hours later, arterial blood gas analysis on 40% oxygen reveals: pH
7.20/60/64/24/BE 0/ SaO2 91%.Breath sounds are diminished with bilateral
wheezing. Which of the following would you recommend? (Choose one)
Increase the FIO2 to 0.50
Repeat Pentamidine
Administer Potassium ChLoride
Initiate Mechanical Ventialtion
Administer albuterol - Correct Answer: Initiate mechanical ventilation
The physician ask you to determine the recommended initial vent settings. Which
of the following would you suggest (Choose one)
VC/AC Vt 350, F 12/min, FIO2 0.50, +3
PC/SIMV PIP 22, F 15/min, FIO2 0.60, +8
VC/SIMV Vt 450, F 12/min, FIO2 0.50, +3
PC/AC PIP 28, F 8/min, FIO2 0.40, +6