Therapist Multiple-Choice(Tmc) Examination: Practice Testbank 2023/2024

THERAPIST MULTIPLE-CHOICE(TMC) EXAMINATION: PRACTICE TESTBANK 2023/20241. The physician orders a 35% aerosol mask to be set up for a patient who requires an inspiratory flow of 42 L/min. What is the minimum flow rate to which the flowmeter must be set to meet this patient's in- spiratory flow demands? A. 6 L/min B. 8 L/min C. 10 L/min D. 12 L/min ANSWER - B, The air/O2ratio for a 35% oxygen mixture is 5 : 1. To calculate total flow output from this device, add the ratio parts together and multiply by the liter flow: 6 ×6 = 36 L/min, 6 ×8 = 48 L/min, 6 × 10 = 60 L/min, 6 ×12 = 72 L/min. Total flow needed: 42 L/min. The minimum flow necessary is 8, giving a total flow of 48 L/min. (Analysis) 2. A premature 3-week-old infant is receiving 1 L/min of O via a nasal cannula and has a PaO of 43 torr22 and a PaCO2 of 40 torr. The respiratory therapist should recommend which of the following? A. Increase the cannula flow to 2 L/min. B. Intubate and institute mechanical ventilation C. Initiate CPAP of 4 cm H2O and 50% O2 D. Increase the cannula flow to 5 L/min. ANSWER - A, A PaO2 of 43 torr represents hypoxemia. The normal PaO2 for an infant is 50-70 torr. Increasing the cannula flow by 1 L/min is the most appropriate choice to return the PaO2 to normal. With a normal PaCO2 of 40 torr, mechanical ventilation is not indicated. (Analysis) 3. what is normal PaO2 for infant ? ANSWER - 50-70 torr. 4. A patient arrives in the emergency department after being pulled from a burning house. The respiratory therapist should recommend obtaining which of the following measurements to best determine the sever- ity of the patient's smoke inhalation? A. SpO2 B. HbCO ESTUDY C. PaO2 D. Hb ANSWER - B, To best determine the severity of smoke inhalation, an HbCO level should be determined with a co-oximeter. The SpO2 value should never be evaluated on a patient suspected of CO poisoning because a pulse oximeter is not capable of determining what is bound to hemoglobin. Pulse oximeters work on the principle of spectrophotometry where lightweight probes direct filtered light of specific wavelengths through the skin or digit. The light absorbed differs for saturated and desaturated blood, whether it's saturated with oxygen or a combination of oxygen and carbon monoxide. Therefore the reading will be erroneously high when HbCO is present. (Analysis) 5. To best determine the severity of smoke inhalation, an HbCO level should be determined with ? ANSWER - co-oximeter 6. The physician has ordered O2 to be administered to an active 3-year-old with an SpO2 of 86%. Which of the following delivery devices would you recommend for this patient? A. 1- to 2-L nasal cannula B. Air-entrainment mask C. Simple O2 mask D.O2 hood ANSWER - A, An active 3-year-old generally tolerates a cannula much better than any kind of mask and is too large for an O2hood. (Application) 7. The ability of the patient to follow instructions would be indicated by which of the following? A. Orientation to person B. Performance of tasks when asked C. Ability to feed himself D. Awareness of time ANSWER - B, If the patient is able to perform simple tasks when asked, this best determines his or her ability to follow instructions. This is important before administering an incentive spirometry or IPPB treatment, which requires the patient to be able to follow instructions well or the treatment will not be effective. (Recall) 8. If the patient is able to perform simple tasks when asked, this best determines his or her ability to follow instructions. This is important before administering an? ANSWER - incentive spirometry or IPPB treatment, which requires the patient to be able to follow instructions well or the treatment will not be effective. (Recall) ESTUDY 9. You suspect a patient may have a pulmonary embolism. Which of the following would be the most appropriate recommendation for diagnosis of this condition? A. Bronchoscopy B. V/Q lung scan C. Coagulation studies D. Shunt study ANSWER - B, The best diagnostic test to determine whether a pulmonary embolism is present is the V/Q lung scan. (Application) 10. To most effectively increase a sedated, paralyzed patient's alveolar minute ventilation while the patient is on volume-controlled ventilation in the assist-control mode, you would recommend increasing which of the following? A. PEEP B. Inspiratory flow C. VT D. Ventilator rate ANSWER - C Alveolar minute ventilation = (VT - VD) × respiratory rate It represents the volume actually reaching the alveoli per minute. It takes into account anatomic dead space (VD), which is approximately 1 mL/lb of body weight. Anatomic VD is that portion of the airway where no gas exchange occurs. If a patient's alveolar minute ventilation is to be increased, the VT must be increased. If only the ventilator rate is increased, the same VT is delivered, even though the minute ventilation (VT × RR) increases. (Recall) 11. what is the formula for alveolar minute ventilation ? ANSWER - (VT - VD) × respiratory rate 12. Failure to hyperoxygenate a patient on a ventilator before ET suctioning may result in A. Hypoxemia B. Hypocapnia C. Bradycardia D. Hypertension ANSWER - A, It is important during ET suctioning that the PaO2 be maintained within a normal range. This requires increasing the oxygen percentage during the procedure. Failure to hyperoxygenate may cause hypoxemia, resulting in cardiac arrhythmias. Bradycardia may occur as a result of vagal stimulation. (Application) ESTUDY 13. while ET suctioning , Failure to hyperoxygenate may cause hypoxemia, resulting in ? ANSWER - cardiac arrhythmias 14. while ET suctioning a pt, Bradycardia may occur as a result of ? ANSWER - vagal stimulation 15. The most reliable method of determining whether the lungs of a patient receiving mechanical ventila- tion are getting stiffer and harder to ventilate is by measuring the A. Static lung compliance B. Dynamic lung compliance C. Spontaneous VT D. PaO2 ANSWER - A, When lungs get stiffer and harder to ventilate, greater pressure is required to move the same volume of air. Because peak inspiratory pressure increases when RAW increases (e.g., when airway secretions are present or water is in the ventilator tubing), this pressure does not reflect how stiff the lungs actually are. We determine the plateau or static pressure by holding the volume in the patient's lungs for 1 to 2 s. This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted from the plateau pressure and this number is divided into the VT. The results determine how compliant the lungs are. (Application) 16. We determine the plateau or static pressure by holding the volume in the patient's lungs for? what is the formula for static compliance ? ANSWER - 1 to 2 s. This pressure closely relates to alveolar pressure. PEEP (if used) is subtracted from the plateau pressure and this number is divided into the VT. The results determine how compliant the lungs are. A 60-kg (132-lb) 52-year-old man is admitted to the ICU for the treatment of refractory hypoxemia. He is currently on VC-SIMV and pressure support of 10 cm H2O with an FiO2 of 0.60. Other pertinent data are below: pH 7.49 PaCO2 30 torr ESTUDY PaO2 59 torr Heart rate 120min Respiratory rate 12 Spontaneous VT 400 ml Ventilator VT 500 mL PEEP 5 cm H2O Total respiratory rate 22/min Which of the following should the respiratory therapist recommend at this time? A. Increase the pressure support level to 15 cm H2O B. Increase PEEP to 8 cm H2O C. Increase the FiO2 to 0.70 D. Decrease VT to 400 mL ANSWER - B, Refractory hypoxemia typically results from atelectasis, pneumonia, or pulmonary edema, whereby increasing oxygen levels do not correct the hypoxemia. Although the patient is hyperventilating, VT should not be decreased. The hyperventilation is a result of the low PaO2, therefore it should be increasing the PaO2 first is necessary. We should not exceed 60% oxygen to try to correct hypoxemia, so increasing the PEEP level is most appropriate. (Analysis) Refractory hypoxemia typically results from ? ANSWER - atelectasis pneumonia pulmonary edema A peripheral lung mass is to be biopsied. Which of the following procedures should be recommended to obtain the tissue sample? A. Electromagnetic navigational bronchoscopy (ENB) B. Fiberoptic bronchoscopy C. Bronchoalveolar lavage (BAL) D. Rigid bronchoscopy ANSWER - . A, ENB is diagnostic tool that combines conventional bronchoscopy with virtual bronchoscopy that allows bronchoscopic instruments to reach peripheral lung areas that traditional fiberoptic bronchscopes can't reach. (Analysis) A 70-kg (154-lb) male patient is receiving mechanical ventilation. The respiratory therapist notes the ESTUDY patient's SpO2 drops from 97% to 86%. The right lung is expanding more than the left, with clear breath sounds on the right but absent breath sounds on the left. The patient's ET tube is taped at the 29-cm mark at the lip. Which of the following should the respiratory therapist do at this time? A. Withdraw the tube to the 24-cm mark B. Recommend an immediate chest x-ray C. Advance the ET tube 2 cm D. Obtain immediate ABG levels ANSWER - A, The ET tube should be positioned 2 to 6 cm above the level of the carina. That means the ET tube should be at the 21- to 25-cm mark at the teeth. In this question, the tube is at the 29-cm mark and the patient has decreased breath sounds in the left lung, which indicates the tube is in the right mainstem bronchus and must be withdrawn. how far should The ET tube should be positioned to the main carina? That means the ET tube should be at the ______ to ________-cm mark at the teeth. ANSWER - 2 to 6 cm above the level of the carina. 21- to 25 the tube is at the 29-cm mark and the patient has decreased breath sounds in the left lung, which indicates? ANSWER - the tube is in the right mainstem bronchus and must be withdrawn. Which one of the following sets of ABG measure- ments would indicate compensated respiratory acidosis? A. pH 7.26, PCO2 60 torr, PO2 68 torr, HCO326 mEq/L, BE 0 B. pH 7.42, PCO2 39 torr, PO2 87 torr, HCO322 mEq/L, BE 1 C. pH 7.25, PCO2 61 torr, PO2 75 torr, HCO326 mEq/L, BE 1 D. pH 7.37, PCO2 58 torr, PO2 60 torr, HCO331 mEq/L, BE 8 ANSWER - . D, A blood gas level is considered compensated when both the PaCO2and HCO3−are abnormal and the pH level is normal. Respiratory acidosis is caused by an elevated PaCO2, which drops the pH to below normal levels. If the patient's lungs are not ventilated better to decrease the PaCO2, the HCO3−levels in the blood begin to increase (renal compensation), which increases the pH toward normal. When the pH reaches the normal range, it is called fully compensated. The most ESTUDY common example of this type of blood gas level is the patient with severe COPD who has chronic retention of CO2and remains in a constant state of compensation. (Application) the following data have been collected on 75-kg male pt receiving volume-controlled ventilation : TV 600 mL pH 7.29 SIMV PaCO 50 torr Vent rate 4 PaO2 72 spontaneous rate HCO 26 FIO2 0.35 On the basis of these data, which of the following should the respiratory therapist recommend? A. Increase the VT to 650 mL B. Increase the FiO2 to 0.40 C. Increase the ventilator rate to 8/min D. Change to assist-control mode at a rate of 15/min ANSWER - C, This patient's increased PaCO2 level indicates hypoventilation, which can be reversed by increasing the minute ventilation. This can be accomplished by increasing the ventilator rate or VT, both of which are choices. We must assume the patient is being weaned from the ventilator based on the low ventilator rate (SIMV rate of 4). Weaning is accomplished as we reduce the ventilator rate and allow the patient to breathe more on his or her own. If the patient's PaCO2 begins to increase during weaning, we increase the rate, not the VT. The ventilator VT is at the maximum level of 8 mL/kg based on the patient's weight of 75 kg (8 x 75 = 600), therefore increasing the ventilator rate is the most acceptable choice. The following data have been collected on a patient receiving continuous mechanical ventilation: 1:00pm 3:00pm Delivered VT 600 600 Peak airway pressure 44 52 Static airway pressure 25 33 Inspiratory flow 40 40 PEEP 5 5 Which of the following is the best interpretation of these data? A)The peak airway pressure increased as a result of increased airway resistance. B)The peak airway pressure increased as a result of decreased lung compliance. C)The patient's lung compliance is improving. D)The patient's dynamic compliance is increasing. ANSWER - B. Notice that while peak inspiratory pressure increased, the static airway pressure ESTUDY increased as well. Static pressure closely resembles alveolar pressure. An increasing static pressure is a sign that it is taking more pressure to ventilate the lung; therefore, lung compliance is decreasing. In this question, if the PIP would have increased with no increase in the static pressure, then choice A would have been the correct answer. When airway resistance increases because of airway secretions, water in the ventilator tubing, or bronchospasm, PIP increases, but static pressure remains unchanged. Static pressure closely resembles alveolar pressure. An increasing static pressure is a sign that it is taking more pressure to ventilate the lung; therefore, lung ? ANSWER - compliance is decreasing. if the PIP would have increased with no increase in the static pressure, what would be the cause ? ANSWER - When airway resistance increases because of airway secretions, water in the ventilator tubing, or bronchospasm, PIP increases, but static pressure remains unchanged. Tracheal secretions tend to dry out in an intubated patient when inspired air has which of the following characteristics? A. A water vapor pressure of 47 mm Hg B. 50 mg of particulate water/L of gas C. An absolute humidity of 24 mg/L of gas D. 44 mg of particulate water/L of gas ANSWER - . C, When air that is not fully saturated at body temperature is delivered to an intubated patient, a humidity deficit exists and secretions get thicker because of lack of inspired water. The inspired air must contain 44 mg H2O per liter of gas or exert a water vapor pressure of 47 mm Hg to be fully saturated at body temperature. (Analysis) It is important to monitor plateau pressure in a patient receiving mechanical ventilation because it best reflects A. Lung compliance B. PaO2 C. PaCO2 D. ICP ANSWER - A, Lung compliance is determined by dividing the VT by the plateau pressure. The respiratory therapist palpates no pulse on a patient, but the ECG monitor shows QRS complexes on the tracing. The therapist should A. Get a stat ABG B. Recommend defibrillation at 250 J C. Begin cardiac compressions ESTUDY D. Recommend cardioversion at 120 J ANSWER - C, Regardless of what the ECG monitor is recording, if the patient has no pulse, compressions must be started immediately. An example of this rare situation is electromechanical dissociation (EMD), also referred to as pulseless electrical activity (PEA), in which the ECG monitor does not reflect the actual mechanical activity of the heart. (Analysis) Regardless of what the ECG monitor is recording, if the patient has no pulse, compressions must be started immediately. An example of this rare situation is electromechanical dissociation (EMD), also referred to as? ANSWER - pulseless electrical activity (PEA) A patient is receiving volume-controlled ventilation, and the low-pressure alarm suddenly sounds. The corrective action is to? A)Suction the patient B)Begin manual ventilation C)Increase the flow D)Determine whether the patient is disconnected from the ventilator ANSWER - D, The low-pressure alarm will sound if there is a leak in the ventilator tubing or around the ET-tube cuff, the patient is disconnected from the ventilator, or the low-pressure alarm is set too high. what are the causes of low pressure alarm sounding in volume controlled ventilation ? ANSWER - leak in the ventilator tubing or around the ET-tube cuff patient is disconnected from the ventilator low-pressure alarm is set too high. if the high-pressure alarm is triggered, what should you do ? ANSWER - Suctioning the patient After a patient has received bronchodilator therapy, the respiratory therapist attempts to perform nasotra- cheal suction on the patient. As the catheter enters the oropharynx, the following ECG waveform is observed on the ECG Monitor. bradycardia . ESTUDY This ECG pattern is most likely the result of which of the following? A. Excessive suction pressure B. Hypoxemia C. Vagal nerve stimulation D. Hypercapnia ANSWER - C, The ECG strip indicates sinus bradycardia, which results from vagal stimulation from suctioning. The vagus nerve runs through the oropharynx. *When the vagus nerve is stimulated, bradycardia and hypotension result*. Thus, a catheter placed in the oropharynx during suctioning may elicit this response. Hypoxemia may also result in bradycardia, but with the catheter in the oropharynx, hypoxemia is unlikely. (Application) A 6-day-old premature infant of 30 weeks' gestational age is experiencing frequent periods of apnea with desaturation. Which of the following medications should the respiratory therapist recommend? A. Surfactant (Survanta) B. Albuterol (Proventil) C. Theophylline D. Naloxone (Narcan) ANSWER - C, Theophylline has respiratory stimulant properties that help prevent apneic spells in neonates. Albuterol is a bronchodilator. Naloxone is often administered to newborns to reverse the narcotic depressant effects sometimes passed from the mother to the infant through the placenta before birth. Surfactant is used to treat alveolar collapse in the newborn when is Naloxone often administered to newborns? ANSWER - reverse the narcotic depressant effects sometimes passed from the mother to the infant through the placenta before birth Surfactant is used to treat? ANSWER - alveolar collapse in the newborn. ET tube cuff pressure should be maintained at which of the following levels? A. 5-10 cm H2O B. 20-30 cm H2O C. 35-45 cm H2O ESTUDY D. 40-50 cm H2O ANSWER - B, A cuff exerting a pressure of more than 30 cm H2O will increase the potential of obstructing blood flow to the tracheal wall resulting in damage to the mucosa. Cuff pressures should be kept between 20-30 cm H2O to avoid tracheal damage. (Recall) A postoperative 46-year-old, 80-kg (176-lb) patient is breathing spontaneously at a rate of 30/min with an FiO2 of 0.50. The following ABG results are obtained: pH 7.29 PaCO2 62 torr PaO2 64 torr HCO3 29 mEq/L BE 4 Mechanical ventilation is instituted with a VT of 600 mL and an FiO2 of 0.5. The SIMV rate should be set on A. 4/min B. 8/min C. 15/min D. 20/min ANSWER - C, The initial ventilator rate on the exam should be 10/min to 16/min. Generally, do not select a rate that is below 10 or above 16 for the initial rate setting. Higher rates may be indicated on ARDS patients. (Analysis) The initial ventilator rate on the exam should be? ANSWER - 10/min to 16/min. The respiratory therapist is setting up a portable liquid O2 system for a patient with COPD. The patient ison a 2-L/min nasal cannula, and the portable O2container holds 4 lb of O2. The therapist should explain to the patient that the O2 supply will last for approximately what length of time? A. 4.5 hours B. 8 hours C. 11.5 hours D. 14 hours ANSWER - C,