Kettering Questions And Answers ( TEST BANK) With Complete Solutions

A 65 kg spinal cord injured patient has developed atelectasis. His inspiratory capacity is 30% of his predicted value. What bronchial hygiene therapy would be most appropriate initially? correct answer: IPPB with normal saline A patient on VC ventilation has demonstrated auto-PEEP on ventilator graphics. Which of the following controls, when adjusted independently, would increase expiratory time? (select all that apply) 1. Tidal volume 2. Respiratory Rate 3. Inspiratory flow 4. Sensitivity correct answer: 1, 2, and 3 Immediately after extubation of a patient in the ICU, the respiratory therapist observes increasing respiratory distress with intercostal retractions and marked stridor. The SpO2 on 40% oxygen is noted to be 86%. Which of the following would be most appropriate at this time? A. cool mist aerosol treatment B. aerosolized racemic epinephrine C. manual ventilation with resuscitation bag and mask D. reintubation correct answer: reintubation Which of the following patients would most likely benefit from pressure support ventilation? A. An intubated patient with an absent respiratory drive. B. A patient on SIMV with set rate of 12; total rate of 24 C. A patient with acute lung injury. D. A patient who requires short-term post-operative ventilatory support. correct answer: Patient on SIMV with set rate of 12; total rate of 24 Which of the following information may be obtained from a FVC maneuver during bedside pulmonary function testing? (select all that apply) 1. FEV1 2. PEFR 3. FRC 4. RV correct answer: 1 and 2 only What value for the apnea-hypopnea index (AHI) is consistent with mild obstructive sleep apnea? A. Less than 5 B. 5 to 15 C. 16 to 30 D. Greater than 30 correct answer: 5 to 15 While monitoring a newborn utilizing a transcutaneous monitor, you notice a change in PtcO2 from 60 to 142 torr and simultaneously the (PtcCO2) changes from 37 to 2 torr. What is the most likely explanation for these changes? correct answer: Air leak A patient on the general medical ward is on a 28% air entrainment mask with the flowmeter set at 5 L/min. What is the total flow delivered to the patient? A. 5 L/min B. 55 L/min C. 88 L/min D. 140 L/min correct answer: Air:Oxygen ratio for 28 = 10:1 Total flow = (5 x 10) + (5 x 1) = 50 + 5 = 55 L/m Sleep apnea can be defined as repeated episodes of complete cessation of airflow for correct answer: 10 seconds or longer A patient in the ICU receiving mechanical ventilation has just undergone a fiberoptic bronchoscopy in which a tissue biopsy was collected. Immediately after the procedure, the respiratory therapist notes that the peak inspiratory pressure on the ventilator has increased. Potential causes for this include all of the following EXCEPT : A. hypoxemia. B. pneumothorax. C. pulmonary hemorrhage. D. bronchospasm/laryngospasm. correct answer: Hypoxemia Bronchial breath sounds heard over the lung periphery indicate : correct answer: Consolidation At 1 minute post-delivery, a newborn has blue extremities with a pink body, heart rate is 90/min, respiratory rate is 20/min with a weak cry, cough reflex is present, and there is some flexion of the extremities. What APGAR score should be assigned? correct answer: 1 minute APGAR = 6 Appearance - 1 Pulse - 1 Grimace - 2 (because of cough reflex) Activity - 1 Respiration - 1 A 60 kg (132 lb) patient is being mechanically ventilated with the following settings: VC, A/C; VT 500 mL, respiratory rate 12/min, FIO2 1.00 and 10 cm H2O PEEP. The patient's peak airway pressure is 60 cm H2O and his SpO2 is 85%. A current chest x-ray shows diffuse bilateral infiltrates. Which of the following is the most appropriate action in order to reduce peak airway pressure? A. Increase the frequency. B. Change to airway pressure release ventilation. C. Decrease the inspiratory time. D. Increase PEEP to 15 cm H2O. correct answer: Change to airway pressure release ventilation While performing diagnostic chest percussion, the respiratory therapist notes decreased resonance to percussion. Which of the following are potential causes of this finding? (select all that apply) 1. pneumothorax 2. pleural effusion 3. pneumonia 4. atelectasis correct answer: 2, 3, and 4 only A 60 year-old male is admitted to the ED with chest pain. The CBC and electrolytes are normal. Troponin level is 0.4 ng/mL. The physician should report to the patient that he is suffering from : A. pulmonary embolism. B. gastroesophageal reflux. C. myocardial infarction. D. valvular stenosis. correct answer: Myocardial infarction A 16 year-old patient with cystic fibrosis attends public high school. Which of the following bronchial hygiene therapies would be most appropriate for this patient? A. intrapulmonary percussive ventilation B. dornase alpha therapy C. vibratory / oscillatory PEP D. postural drainage and manual percussion correct answer: Vibratory / oscillatory PEP The most probable cause of air bronchograms and increased tactile frenitus on a chest x-ray is : correct answer: Pneumonia A post-operative patient is receiving mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO2 0.50 and 10 cm H2O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 mm Hg and the SpO2 is 90%. The patient is alert and oriented with stable vital signs. Which of the following should the respiratory therapist recommend? A. Decrease the PEEP. B. Increase the FIO2. C. Initiation diuretic therapy. D. Continue to monitor closely correct answer: Continue to monitor closely Which of the following findings is LEAST compatible with hyperlucency as seen on a chest x-ray? A. Increased fremitus B. Decreased intensity of breath sounds C. Diminished diaphragmatic excursion D. Hyperresonance to percussion correct answer: Increased fremitus A 52 year-old post-operative patient's chest radiograph demonstrates infiltrates in the posterior basal segments of the lower lobes. Which of the following is the appropriate postural drainage position? A. Head down, patient supine with a pillow under knees B. Patient prone with a pillow under head, bed flat C. Patient supine with a pillow under knees, bed flat D. Head down, patient prone with a pillow under hips correct answer: Head down, patient prone with a pillow under hips Following blunt chest trauma, a 35-year-old male is orally intubated and continuous mechanical ventilation is initiated. Physical assessment of the neck and chest reveal a midline trachea and significant reduction in thoracic expansion of the left chest. There are diminished breath sounds in the left lung compared to the right lung. These findings most likely indicate which of the following? A. flail chest on right thorax B. right tension pneumothorax C. endobronchial intubation