CRT RRT NBRC CORRECT FINAL EXAM QUESTIONS
AND ANSWERS SURE A+
✔✔Antiviral agents - ✔✔-Ribavirin = treat RSV
-RSV Immune Globulin IV (RespiGam) = prevention of RSV
-palivizumab (Synagis) = man-made antibody to RSV
✔✔pentamidine - ✔✔-treat Pneumocystis Jirovecii (carinii) infections (commonly with
AIDS)
-must use one way valve and bacteria filter to avoid spreading
✔✔Vaccines - ✔✔-against influenza and staphylococcus pneumoniae = Pneumovax for
> 60 yrs
-Children at risk for RSV should be immunize with RespiGam and Synagis
✔✔Patient Positions - ✔✔-Prone = ARDS
-Fowler's = CHF
-Lateral Fowler's = obese
-good lung down for unilateral lung disease
✔✔Sustained Maximal Inspiration (SMI) - ✔✔-Prevention of atelectasis
-Date, time, volume should be charted (not durations)
-must be taught before surgery
-auscultate BS before and after
-Inhale! not exhale
✔✔IPPB Indications - ✔✔-Prevent or correct atelectasis in patients unable to take a
deep breath
-prevent/decrease pulmonary edema
-decrease WOB
-mechanical bronchodilation
-distribute aerosols more evenly
,-Hazards include: hyperventilation (breathe slower), Impeding venous return,
pneumothorax
-contraindications: pulmonary hemorrhage, untreated pneumothorax
✔✔Bird Mark 7 - ✔✔-Pressure Cycled
-increase flow = decrease i-time
-Air mix off = 100% source gas, low flow rate because air not entrained, increase flow
setting when air mix off
-pressure limit controls volume
-
✔✔Bird Mark 7 changes that affect FiO2 - ✔✔-increase pressure will increase FiO2
-decrease flow will increase FiO2
-Air mix off will give 100% FiO2
-use of nebulize will increase FiO2 on PR-II
-Use of terminal flow on PR-2 will decrease FiO2
✔✔Bird Mark 7 control changes that affect volume - ✔✔-increasing pressure will
increase volume
-decreasing flow will increase volume
-increasing the flow will decrease volume
✔✔Bird Mark 7 control changes that affect the I:E ratio - ✔✔-increased pressure will
increase i-time and change I:E
-increased flow will decrease i-time
-increased rate will decrease e-time
✔✔IPPB Troubleshooting - ✔✔-Loss of pressure = leak, low flow
-Excessive pressure = obstruction, excessive flow
-fail to cycle into inspiration = sensitivity, seal around mouthpiece
-fail to cycle into expiration = leak (mouthpiece, cuff, trach tube, loose connection)
-Pressure does not rise normally (needle reads low or negative) = insufficient flow
✔✔Mask CPAP - ✔✔-short term, temporary use
-CO poisoning
-pneumonia
-post-op atelectasis, etc.
✔✔Nasal CPAP - ✔✔-neonates since they are obligate nose breathers
-readjust nasal prongs if losing CPAP
✔✔Troubleshooting CPAP - ✔✔-loss of pressure = leak, insufficient flow
-increased pressure = obstruction, excessive flow
, ✔✔Non-Invasive PPV (NPPV) - ✔✔-avoid intubation in patients with COPD, CHF, and
pulmonary edema
-long term ventilation at home
-periodic support with NMD, restrictive chest wall, sleep apneas
✔✔General Considerations of NPPV - ✔✔-patient with uncomplicated obstructive sleep
apnea started @ EPAP of 5-10 cmH2O
-patient started on EPAP for hypoxemia at 6-8 cmH2O and increased as necessary
-patients with NMD @ 10-15 cmH2O
-low level of EPAP (5cmH2O) prevents small airway collapse on exhalation
-oxygen must be titrated into the system to achieve desired FiO2
-IPAP always greater than EPAP
-I:E of 1:2 preferred
✔✔Capillary Samples - ✔✔-should not be used to monitor oxygen therapy
-PO2 values DO NOT correlate very well with arterial blood, especially when arterial
PO2 is >60 torr
✔✔Air Bubbles in ABG sample - ✔✔-PaCO2 decreases toward 0 torr
-PaO2 increases to 150 torr
-pH increases
✔✔Improper cooling of ABG sample - ✔✔-PaCO2 increases
-PaO2 decreases
-pH decreases
✔✔Too much heparin in ABG sample - ✔✔-pH decreases towards 7.0
-PaCO2 decreases toward 0
-PaO2 increases towards room air
✔✔Severinghaus Electrode - ✔✔Measures PCO2
✔✔Clark Electrode - ✔✔Measures PO2
✔✔Sanz Electrode - ✔✔Measures pH
✔✔Levey Jennings Charts - ✔✔-detecting a machine that is out of control
-±2 Standard Deviations
-If random error = do nothing
✔✔A-a Gradient interpretations - ✔✔-25-65 mmHg on 100% = Normal
-66-300 mmHg = V/Q Mismatch
->300 mmHg = shunting
each 100 mmHg = 5% shunt + 5% normal shunt
AND ANSWERS SURE A+
✔✔Antiviral agents - ✔✔-Ribavirin = treat RSV
-RSV Immune Globulin IV (RespiGam) = prevention of RSV
-palivizumab (Synagis) = man-made antibody to RSV
✔✔pentamidine - ✔✔-treat Pneumocystis Jirovecii (carinii) infections (commonly with
AIDS)
-must use one way valve and bacteria filter to avoid spreading
✔✔Vaccines - ✔✔-against influenza and staphylococcus pneumoniae = Pneumovax for
> 60 yrs
-Children at risk for RSV should be immunize with RespiGam and Synagis
✔✔Patient Positions - ✔✔-Prone = ARDS
-Fowler's = CHF
-Lateral Fowler's = obese
-good lung down for unilateral lung disease
✔✔Sustained Maximal Inspiration (SMI) - ✔✔-Prevention of atelectasis
-Date, time, volume should be charted (not durations)
-must be taught before surgery
-auscultate BS before and after
-Inhale! not exhale
✔✔IPPB Indications - ✔✔-Prevent or correct atelectasis in patients unable to take a
deep breath
-prevent/decrease pulmonary edema
-decrease WOB
-mechanical bronchodilation
-distribute aerosols more evenly
,-Hazards include: hyperventilation (breathe slower), Impeding venous return,
pneumothorax
-contraindications: pulmonary hemorrhage, untreated pneumothorax
✔✔Bird Mark 7 - ✔✔-Pressure Cycled
-increase flow = decrease i-time
-Air mix off = 100% source gas, low flow rate because air not entrained, increase flow
setting when air mix off
-pressure limit controls volume
-
✔✔Bird Mark 7 changes that affect FiO2 - ✔✔-increase pressure will increase FiO2
-decrease flow will increase FiO2
-Air mix off will give 100% FiO2
-use of nebulize will increase FiO2 on PR-II
-Use of terminal flow on PR-2 will decrease FiO2
✔✔Bird Mark 7 control changes that affect volume - ✔✔-increasing pressure will
increase volume
-decreasing flow will increase volume
-increasing the flow will decrease volume
✔✔Bird Mark 7 control changes that affect the I:E ratio - ✔✔-increased pressure will
increase i-time and change I:E
-increased flow will decrease i-time
-increased rate will decrease e-time
✔✔IPPB Troubleshooting - ✔✔-Loss of pressure = leak, low flow
-Excessive pressure = obstruction, excessive flow
-fail to cycle into inspiration = sensitivity, seal around mouthpiece
-fail to cycle into expiration = leak (mouthpiece, cuff, trach tube, loose connection)
-Pressure does not rise normally (needle reads low or negative) = insufficient flow
✔✔Mask CPAP - ✔✔-short term, temporary use
-CO poisoning
-pneumonia
-post-op atelectasis, etc.
✔✔Nasal CPAP - ✔✔-neonates since they are obligate nose breathers
-readjust nasal prongs if losing CPAP
✔✔Troubleshooting CPAP - ✔✔-loss of pressure = leak, insufficient flow
-increased pressure = obstruction, excessive flow
, ✔✔Non-Invasive PPV (NPPV) - ✔✔-avoid intubation in patients with COPD, CHF, and
pulmonary edema
-long term ventilation at home
-periodic support with NMD, restrictive chest wall, sleep apneas
✔✔General Considerations of NPPV - ✔✔-patient with uncomplicated obstructive sleep
apnea started @ EPAP of 5-10 cmH2O
-patient started on EPAP for hypoxemia at 6-8 cmH2O and increased as necessary
-patients with NMD @ 10-15 cmH2O
-low level of EPAP (5cmH2O) prevents small airway collapse on exhalation
-oxygen must be titrated into the system to achieve desired FiO2
-IPAP always greater than EPAP
-I:E of 1:2 preferred
✔✔Capillary Samples - ✔✔-should not be used to monitor oxygen therapy
-PO2 values DO NOT correlate very well with arterial blood, especially when arterial
PO2 is >60 torr
✔✔Air Bubbles in ABG sample - ✔✔-PaCO2 decreases toward 0 torr
-PaO2 increases to 150 torr
-pH increases
✔✔Improper cooling of ABG sample - ✔✔-PaCO2 increases
-PaO2 decreases
-pH decreases
✔✔Too much heparin in ABG sample - ✔✔-pH decreases towards 7.0
-PaCO2 decreases toward 0
-PaO2 increases towards room air
✔✔Severinghaus Electrode - ✔✔Measures PCO2
✔✔Clark Electrode - ✔✔Measures PO2
✔✔Sanz Electrode - ✔✔Measures pH
✔✔Levey Jennings Charts - ✔✔-detecting a machine that is out of control
-±2 Standard Deviations
-If random error = do nothing
✔✔A-a Gradient interpretations - ✔✔-25-65 mmHg on 100% = Normal
-66-300 mmHg = V/Q Mismatch
->300 mmHg = shunting
each 100 mmHg = 5% shunt + 5% normal shunt
