TMC PRACTICE QUESTIONS AND ANSWERS 2023

TMC PRACTICE QUESTIONS AND ANSWERS 2023 A patient receiving O2 via concentrator at 2L/min at home complains he can't feel O2 coming out the prongs of the cannula. Which of the following should the RT do first? a. Place the cannula under water and see if bubbling occurs b. Attach the cannula to a cylinder/flowmeter setup c. Increase the flow to 5L/min d. Replace the concentrator with a new one a. Place the cannula under water and see if bubbling occurs The first step is to check to make sure there is flow passing through the cannula by having the patient remove the cannula and place it in a cup of water. Bubbling will occur if there is flow. If no bubbling occurs, the patient should make sure the cannula is attached to the flowmeter outlet and the flowmeter is turned on. If there's any doubt, the patient should connect the cannula to the cylinder back-up and call the home care company. A pt is breathing 16 times per minute and has a Vt of 450mL. What is this pt's minute ventilation? a. 4.2L b. 6.1L c. 7.2L d. 8.6L c. 7.2L Vt x R = Ve A pt is breathing spontaneously using a 50% aerosol mask with the following ABG: ph: 7.36 CO2: 43 O2: 48 HCO3: 24 Based on this information, the most appropriate recommendation is which of the following? a. Initiate CPAP b. Increase the O2 percentage to 70% c. Change to a nonrebreathing mask d. Change to a simple O2 mask at 10L/min a. Initiate CPAP A PaO2 of 55 mm Hg on 50% oxygen indicates refractory hypoxemia. Increasing the FIO2 most likely won't improve the PaO2 in addition to increasing the potential for lung damage. Applying CPAP to help recruit alveoli and allow for more surface area for oxygen to be able to enter the blood is more appropriate A pt is receiving mechanical ventilation with the following settings Vt: 750 RR: 12 Mode: AC PEEP: 10 FiO2: 80% pH: 7.41 CO2: 38 O2: 174 Based on these information, what would be the appropriate ventilator settings? a. Decrease PEEP to 8 b. Decrease FiO2 to 70% c. Decrease Vt to 650 d. Increase Insp. Flow b. Decrease FiO2 to 70% Because the patient is hyperoxygenating, the PaO2 may be decreased by reducing FIO2 or PEEP. Because the FIO2 is 0.80, it should be reduced first. Once the FIO2 is 0.50-0.60, the PEEP should then be decreased. The reduction in urinary output caused by mechanical ventilation may be the result of 1. Decreased renal blood flow 2. Decreased production of ADH 3. Increased renal blood flow 4. Increased production ofADH a. 1 only b. 1 and 4 c. 2 and 3 d. 3 and 4 b. 1 and 4 Positive pressure ventilation has the potential for decreasing venous blood return to the heart. This results from this pressure being transferred to the superior and inferior vena cavae, which restricts blood flow back into the heart. Baroreceptors (pressure receptors) sense this lower pressure in the right atrium and send signals to the brain, which causes an increased production of ADH by the pituitary gland. This causes the body to hold on to more fluid as a compensatory mechanism because the right side of the heart is sensing a low pressure. The decreased cardiac output results in decreased perfusion to the kidneys, which also reduces urine output. Which values indicate that a patient is most likely ready to be weaned from mechanical ventilation? 1. Vd/Vt Ratio of .45 2. MIP of -31cmH2O 3. RSBI of 145 4. VC of 8 a. 1 and 2 b. 2 and 3 c. 1, 2 and 4 d. 2, 3 and 4 a. 1 and 2 A VD/VT of less than 0.60 and an MIP of at least -20 cm H2O indicate weaning should be attempted. For weaning to be attempted, RSBI needs to be less than 105 and the VC more than 10 to 15 mL/kg of body weight. A pt receiving VC ventilation with a Vt of 800mL, the exhaled volume displayed is reading 500mL. The RT wants to determine the volume that the ventilator is actually delivering. To most accurately measure this volume, the RT should place a respirometer at the a. Exhalation valve b. Patient wye connector c. Ventilator outlet d. Humidifier outlet c. Ventilator outlet The respirometer should be placed at the ventilator outlet because if it is placed anywhere else in the circuit and a leak is present, the reading will not be accurate. A pt is receiving VC ventilation in AC Mode. The low pressure alarm is sounding. Which of the following may be the cause of the alarm activation? a. Water in the tubing b. Pt disconnected from the ventilator c. Secretions in the pt's airway d. Kink in the ventilator tubing b. Pt disconnected from the ventilator The low-pressure alarm on volume-controlled ventilation will be activated if the patient becomes disconnected from the circuit or if leaks are present in the system. Choices A, C, and D could result in the high-pressure alarm being activated as a result of increased airway resistance. You have just obtained blood from the pt's radial artery to determine ABG results. As you run the blood through the blood gas analyzer, you notice you failed to remove an air bubble from the sample. The blood gas results will most likely reflect values with a a. High pH and Low PO2 b. Low PCO2 and Low PO2 c. Low PCO2 and High PO2 d. High PCO2 and High PO2 c. Low PCO2 and High PO2 Because air contains little CO2 and a much higher amount of O2, these values will be reflected if an air bubble is in the sample. You are monitoring a GBS for signs of respiratory muscle weakness. Which one of the following variables would signal the earliest indication? a. PaO2 b. PaCO2 c. MIP d. Vt c. MIP MIP, sometimes referred to as NIF, measures the patient's respiratory muscle strength. It is obtained when the patient inhales as deeply as possible through a mouthpiece or mask that is attached to a pressure manometer. The MIP is measured periodically in patients with neuromuscular disease to determine weakness in the ventilatory muscles. A normal MIP is -50 to -100 cm H2O. After PEEP is initiated for a patient, the RT should expect which of the following to occur? 1. Increased FRC 2. Increased Pplat 3. Increased Lung Compliance 4. Decreased P(A-a)O2 a. 1 and 2 b. 3 and 4 c. 1, 3 and 4 d. 2, 3 and 4 c. 1, 3 and 4 PEEP increases FRC by recruiting collapsed alveoli. This results in a decrease in the plateau pressure (pressure needed to ventilate the lungs) and an increase in lung compliance. When more alveoli are opened, more oxygen will diffuse into the blood, which will increase the PaO2 and result in a decrease in the A-a gradient A 70kg (154lb) patient in the ICU is receiving VC ventilation in he AC Mode, Rate of 10, Vt of 700, PEEP of 5 on a 40% FiO2. ABG levels are as followed: pH: 7.52 CO2: 31 O2: 57 HCO3: 23 Which of the following vent. changes is most appropriate at this time? a. Increase O2 to 50% b. Decrease the Vt to 600 c. Increase the PEEP to 10 d. Decrease the Vent Rate to 8 a. Increase the O2 to 50% These ABG results indicate alveolar hyperventilation with hypoxemia. Many may select to decrease the rate or tidal volume, but this is not indicated because of the hypoxemia. The reason the patient is hyperventilating is because of the low PaO2. If the hypoxemia is reversed, the patient will no longer feel the need to hyperventilate, and the PaCO2 will normalize along with the pH. Always look at the PaO2 when the patient is hyperventilating. If it is at a normal level or above normal, decrease the rate or tidal volume. If hypoxemia is present, increase either the FIO2 or PEEP level, depending on what FIO2 the patient is receiving. Because the patient is on less than 50% oxygen, the board exams will want you to increase the oxygen level. Had the oxygen level been at 50% or higher, then the correct choice would be to increase the PEEP level, except for hypotensive patients or head trauma patients. In those cases, do not increase PEEP levels as this may worsen their situation A patient has a pH of 7.18 and a CO2 of 24. Which of the following can be concluded regarding this blood gas data? a. Respiratory Acidosis is present b. The patient is hypoventilating c. Metabolic Acidosis is present d. The base excess must be increased c. Metabolic Acidosis is present Sometimes on the exams, all the blood gas data will not be provided. In this case, only the pH and PaCO2 are given. There are two instances when the pH is acidotic: when the PaCO2 is increased or when the HCO3− level is decreased. In this question, the PaCO2 is low, which results in an alkalotic pH, so we know that the PaCO2 is not responsible for the low pH. It has to be a decreased HCO3− causing the acidosis. Therefore, a metabolic acidosis is present. An alert, spontaneously breathing pt has a PaCO2 of 33torr, and a PaO2 of 55torr while receiving an FiO2 of 70%. Which of the folllowing is the most appropriate way to increase the pt's PaO2? a. Increase the FiO2 only. b. Intubate and increase the FiO2 c. Apply CPAP @ 60% d. Apply CPAP @ 100% c. Apply CPAP @ 60% The blood gas data provided indicates the patient is hyperventilating with hypoxemia while receiving 70% oxygen. This indicates an intrapulmonary shunt and refractory hypoxemia with a dangerously high oxygen level. On the exams, try to maintain adequate oxygen without exceeding 60% oxygen. If CPAP is applied, FRC will increase and oxygenation should improve. This will allow the oxygen level to be reduced to a safer level (60%). The RT is assessing the pt's spontaneously ventilatory variables. The PaCO2 is 50torr and the PeTCO2 is 30torr, and the Vt is 600mL. What is the pt's dead space volume? a. 150 b. 240 c. 360 d. 480 b. 240 ((PaCO2 - PeTCO2) / PaCO2) x Vt = Vd/Vt Volume The high pressure alarm on VC ventilation should be set approximately 10cmH2O pressure above which of the following? a. PEEP level b. Pplat c. Mean Airway Pressure d. Peak Airway Pressure d. Peak Airway Pressure To prevent excessive pressure in the lungs, set the high pressure limit around 5 to 10 cm H2O above the average peak airway pressure because peak airway pressure is the highest pressure of the other choices. While assessing a patient's chest radiograph, you observe an area of hyperlucency. This may be the result of which of the following? 1. Hyperinflation 2. Atelectasis 3. Emphysema 4. Pneumothorax a. 1 and 3 b. 2 and 3 c. 1, 3 and 4 d. 2, 3 and 4 c. 1, 3 and 4 Lucency is defined as black areas on a chest film. Hyperlucency indicates excessive black areas. Air is black on chest x-rays; therefore, more air is present than normal. This is caused by hyperinflation, emphysema (due to air-trapping), and a pneumothorax. When a pneumothorax is present, the lung collapses and air enters into the pleural space. The excessive air in the pleural space results in hyperlucency. The RT is called to a patient's room to check the O2 setup. The flow to the pt's non-rebreathing mask is supplied by an air flowmeter running @ 10L/min and an O2 flowmeter running @ 10L/min. The delivered O2 percentage from this device is a. 24% b. 35% c. 40% d. 60% d. 60% , Go back and review the air/O2 entrainment ratios in Chapter 1. Although we do not use them clinically, the NBRC does have test questions on them. In this question, the ratio of oxygen flow and air flow is 1 : 1 (10 L/min O2, 10 L/min air). This provides an oxygen level of 60%. Divide the O2 flow into the air flow, and the ratio will be given: 10/10 = 1, or a 1 : 1 ratio. If the air flow would have been 12 L/min with an O2 flow of 4 L/min, then the ratio would be 12/4 = 3, or a 3:1 ratio, which is 40%. Another method for obtaining the oxygen percentage in this problem is with the use of the following equation A patient with severe COPD is on a 28% AE Mask and has a PaO2 of 61torr. Which of the following should the RT recommend @ this time? a. Initiate CPAP b. No changes required at this time c. Increase O2 to 40% d. Place the pt on a non-rebreathing mask b. No changes required at this time The normal PaO2 for a patient with severe COPD is 50 to 65 mm Hg. This ABG level indicates normal oxygenation for this patient; therefore, no change in therapy is necessary. The RT is called to the PICU to suction an 8 year old ventilator pt with pneumonia who is intubated with a 6.0 ETT. Which of the following represents the most appropriate catheter size and suction pressure to use on this patient? a. 8Fr catheter, -100 mmHg b. 10Fr catheter, -60 mmHg c. 8Fr catheter, -80 mmHg d. 10Fr catheter, -100 mmHg d. 10Fr catheter, -100 mmHg To determine proper suction catheter size, double the ET size and drop down to the next lowest number that represents a suction catheter size. The most common catheter are sizes are 6.5 Fr, 8 Fr, 10 Fr, 12 Fr, and 14 Fr. By doubling the ET size (6 × 2 = 12) and dropping down to the next lower number of catheter size, you will select 10 Fr as the proper size. This equation ensures that the catheter that is used occupies no more than half the diameter of the ET tube. This is what the NBRC exams prefer. The normal suction level for children is -80 to -100 mm Hg.