NBRC EXAM, Part I|154 Questions with Verified Answers,100% CORRECT

NBRC EXAM, Part I|154 Questions with Verified Answers PATIENT ASSESSMENT: All the following could cause capnography to go from 3 6 to 30 EXCEPT: A. Endotracheal tube positioned in the right mainstream bronchus B. Hyperventilation C. pulmonary emboli D. Hypovolemia - CORRECT ANSWER Endotracheal tube positioned in right mainstem bronchus is a problem but the co2 reading would not change, so ANSWER is A. What is the target Vt for individual on mechanical ventilation - CORRECT ANSWER 6-8 ml/kg (of ideal body weight) This is new strategy as of January 2015 Is the following Static OR Dynamic Compliance: Means flow throughout the respiratory system has stopped and all ventilatory muscle activity is absent. _______ conditions can be imposed with an inspiratory pause when a patient is sedated and mechanically ventilated. - CORRECT ANSWER Static Compliance Is the following Static OR Dynamic Compliance: Flow at airway opening is zero. Mechanics are evaluated under ______ conditions, when non-intubated patient breathes spontaneously. - CORRECT ANSWER Dynamic Compliance A balloon tipped flow directed catheter is positioned in the pulmonary artery with the balloon deflated. Which of the following pressures will be measured by the proximal lumen: a. Cvp b. Pap c. Pwp d. Map - CORRECT ANSWER ANSWER is A. Cvp = deflated/proximal lumen Pap = deflated/distal Pwp = inflated/wedged All of the following will affect the accuracy of a capnography EXCEPT a. Long sampling line b. Low sampling flow c. Condensation in the tubing d. Use of desiccant - CORRECT ANSWER Gas will pass through and out of a long sampling line before reaching analyzer so, low sampling flow will not give you enough information for a good reading, and condensation as a rule is always a problem especially in analyzers. Dessicant removes moisture from the gas, which is a good thing, so ANSWER is D A 1000 g neonate (normal baby is 3000 g) is stable in nicu. Which of the following should the respiratory therapist use to monitor the neonates overall cardiopulmonary status. a. TcPCO2 and TcPO2 monitor b. Arterial blood gas analysis Q4 c. SpO2 monitor d. Capillary gas analysis Q8 - CORRECT ANSWER Since the baby is stable, go less invasive, also go continuous monitoring (not 4 hour or 8 hour), Transcutaneous (Tc) continuous monitoring of CO2 and O2 is the best. Answer is A A unilateral wheeze would most likely indicate which of the following. a. Asthma b. Atelectasis c. Foreign body aspiration d. Epiglottitis - CORRECT ANSWER You wouldn't have asthma on just one side (unilateral), atelectasis would cause diminished breath sounds, with epiglottitis you would get stridor, since you are only hearing wheezing on one side, you are hearing it on the side where you aspirated something, so ANSWER is C All of the following would be associated with the presence of a pneumothorax EXCEPT a. Tracheal deviation b. Dull percussion c. Absent breath sounds d. Respiratory distress - CORRECT ANSWER With pneumothorax you would hear a high pitch hyperresonnance, breath sounds would be absent, and respiratory distress could be present. Dull percussion would NOT be present, so ANSWER is B. What should you recommend FIRST for a patient with multifocal pvc's a. Administration of lidocaine b. Administration of 100% oxygen c. Administration of atropine d. Administration of epinephrine - CORRECT ANSWER Multiple pvc's coming from multiple locations (multifocal) is a real problem and you should administer oxygen FIRST, so ANSWER is B. lidocaine will help reduce irritability of heart and help with pvc's but would not be first option, atropine is used for bradycardia and cardiac irregularities but not pvc's, epinephrine is emergency drug not for pvc's but more for pulseless ventricular tachycardia or ventricular fibrilation where heart is not responding . What is the normal range for the mean pulmonary artery pressure in an adult a. 2-6 mm Hg b. 4-12 mmHg c. 9-18 mmHg d. 21-28 mmHg - CORRECT ANSWER Mean pulmonary artery pressure in an adult should be in the teens so best ANSWER is C A patient in the emergency dept has frothy secretions, moist crackles, and tachypnea. The patient has marked dyspnea and a history of heart disease. Which of the following should the respiratory therapist recommend. on immediately ister 100% oxygen in Fowlers position ister furosemide - CORRECT ANSWER This is an emergency, they are having heart problems, dyspnea, frothy secretions indicating severe pulmonary edema, etc. so 100% oxygen immediately, having the patient in the Fowlers position (an upright position) will help pull fluid down away from the lungs, furosemide is a lasix (loop diuretic) which gets rid of excess fluid. You do NOT suction someone with frothy secretions and heart problems, this just delays appropriate therapy. So ANSWER is 2,3,4 Fine crepitant crackles are most commonly associated with which of the following conditions. a. Bronchiectasis b. Congestive heart failure c. Pneumonia d. Croup - CORRECT ANSWER Crackles are associated with fluid so a, b, and c would be good answers, but "fine crepitant" crackles indicates fluid entering alveoli (pulmonary edema) which is most often caused by heart failure so the best ANSWER is B. (with croup you would hear more of a stridor sound). A patient is found in full cardiopulmonary arrest. CPR is started and the patient is orally intubated with an EtCO2 monitor attached. Which of the following EtCO2 patterns would the respiratory therapist expect to observe on the monitor? a. Initially high, then falling b. Initially low, then rising c. Initially high, stays high d. Initially low, stays low - CORRECT ANSWER Full cardiac arrest will cause the CO2 in the lungs to slowly dissipate out because no blood is flowing, then during CPR when you get blood flowing, the CO2 should slowly rise back up; so ANSWER is B If the blood pressure obtained from the arterial line is higher than the blood pressure obtained from a sphygmomanometer (cuff pressure). Based upon this information, the respiratory therapist should conclude that. a. Non-compliant tubing is being used b. Transducer is placed too low c. Patient was lying flat during the measurement of the arterial line pressure d. Transducer dome contained air bubbles - CORRECT ANSWER Arterial line BP and cuff pressure should be the same, so there is a problem. Non-compliant tubing is a good thing because it's a stiff tubing, if transducer is placed too high (above the heart), the flood will have to go uphill and you will get a lower pressure; transducer dome contained air bubbles would give you erratic readings but not a higher reading, but if the transducer is placed too low (below heart), the blood is flowing downhill & will give a higher pressure reading, so ANSWER is B A 2-year old child enters the emergency room. The mother states that the child was playing with friends and developed violent coughing and unilateral wheezing. Physical examination reveals a hyperresonant percussion note on the left and resonant percussion on the right. Inspiratory and expiratory chest films indicate air trapping with no foreign bodies "noted." The respiratory therapist should suspect the child has. othorax pnea ated a foreign object phylaxis - CORRECT ANSWER Unilateral wheezing indicates aspirated object and fact that the child was playing with friends causes you to believe the child inhaled a small toy or something, hyperresonant percussion indicates air trapping, so you are thinking foreign object but x-ray says no foreign bodies "noted." Just because it says "noted" does not mean something is not there, it just means it could not be seen on the xray, also if the child had swallowed a small plastic toy, "plastic" does not show up on xrays (radiolucent). The ANSWER is C A patient is admitted to the ICU complaining of nausea and chest pain. A nasogastric tube has been inserted to help relieve the nausea. The patient was started on Lasix and nitroglycerin. Which of the following should be monitored to closely identify side effects at this time. a. Cardiac enzymes b. Serum electrolytes c. Arterial blood gases d. Digitalis levels - CORRECT ANSWER Since the patient received Lasix and nasogastric tube, they are losing fluids, and a side effect of fluid loss is a decrease in electrolytes, so ANSWER is B (there isn't enough evidence of heart attack to justify cardiac enzymes, also they are used to confirm a heart attack). Which of the following will determine aortic pulse pressure. a. systolic + systolic + diastolic/3 b. diastolic + pulse pressure/3 c. systolic pressure - diastolic pressure d. stroke volume x heart rate x 10. - CORRECT ANSWER Aortic pulse pressure is just the difference between systolic and diastolic pressure, so ANSWER is C A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease. The patient required a chest tube for a persistent pneumothorax. Two days later the chest radiograph reveals bilateral radiolucency, midline mediastinum, and the right hemidiaphragm slightly elevated. This would indicate A. atelectasis. B. bronchopulmonary dysplasia. C. fluid overload. D. resolution of a pneumothorax. - CORRECT ANSWER bilateral means both sides, radiolucency refers to dark, midline mediastinum is right where is should be, the right hemidiaphragm slightly elevated is normal; so this actually indicates everything is normal. With atelectasis we would see patchy infiltrates, loss of volume, with bronchopulmonary dysplasia it would look similar to ARDS, with fluid overload you would see pattern similar to butterfly or batwing similar to pulmonary edema, so the best ANSWER is D and the pneumothorax has resolved. A chest X-ray shows increased retro-sternal air, flat hemidiaphram, decreased movement, and no vascular markings on the right side. These signs would be most likely associated with: A. pneumothorax B. pleural effusion C. pneumonia D. flail chest - CORRECT ANSWER The flat hemidiaphram indicates pneumothorax, so the ANSWER is A. What is the normal range for the pulmonary artery systolic pressure in an adult? A. 2-6 mm Hg B. 4-12 mm Hg C. 9-18 mm Hg D. 21-28 mm Hg - CORRECT ANSWER The normal pressure is 25 mm Hg, so the ANSWER is D 21-28 mm Hg While assessing a patient's breath sounds the respiratory therapist notes that when the patient is instructed to say the letter "E", it comes through the stethescope sounding like "aaaahhh". This change in the sound is associated with which of the following conditions? A. Pleuritic inflammation B. Pneumonia C. Bronchospasm D. Epiglotitis - CORRECT ANSWER The sound aaaaahhhhh is egotheny and is associated with consolidation in the lung, so the ANSWER is B pneumonia. Pleural inflammation would be a crackling crunching sound, bronchospasm would sound like wheezing, and epiglottitis would be stridor. An 1800 g neonate in the NICU is being monitored with a TcPO2 electrode. The TcPO2 electrode is reading 42 torr with the temperature set at 38oC. The PO2 from an umbilical artery sample is 72 torr. Which of the following would best explain the difference in these readings? A. There was an error in the arterial blood gas results. B. The TcPO2 electrode needs to be repositioned. C. The TcPO2 electrode temperature setting is too low. D. The TcPO2 electrode has been dislodged. - CORRECT ANSWER TcPO2 should be set at 43-45 C so the electrode is not hot enough to make the device work. There is not enough profusion with the electrode so you need to raise the temperature on the electrode, so the ANSWER is C, TcPO2 electrode temperature setting is too low. A multiple trauma victim with internal hemorrhage is being monitored via pulse oximetry. Which of the following conditions would affect the accuracy of her SpO2 readings? A. hypotension B. hyperoxia C. hypocarbia D. hyperthermia - CORRECT ANSWER Since the SpO2 measures the color of the blood and the ability to shine a light through the blood, the only answer that would affect the accuracy of the SpO2 reading would be ANSWER A hypotension because hypotension causes less profusion (needed for the SpO2 reading) A patient with COPD has been admitted for possible pneumonia. The patient is producing moderate amounts of thick yellow sputum and breath sounds are decreased in the right middle lobe. Sputum culture indicates a staphylococcal infection. Which of the following therapies should the respiratory therapist recommend? A. chest physical therapy B. antibiotic therapy C. incentive spirometry D. IPPB - CORRECT ANSWER The priority in this case is the infection and only the antibiotic treatment can get rid of the infection, so the ANSWER is B, Antibiotic treatment. A premature baby is receiving an FIO2 of .40 and CPAP at 5 cmH2O. As the respiratory therapist increases the CPAP to 7 cmH2O, the baby's respiratory rate increases to 58 per minute and the TcPCO2 reading increases with a stable SpO2 monitor reading. The respiratory therapist should recommend which of the following? A. Discontinue the CPAP B. Draw an arterial blood gas sample C. Increase the CPAP to 10 cmH2O D. Place the baby in an oxyhood at an FIO2 0.45 - CORRECT ANSWER Drawing an ABG would give us more information and since this is not an emergency that is the best ANSWER B, arterial blood gas. A 44-year-old woman has just undergone a cholecystectomy. Over the last 48 hours the patient has the following laboratory findings: K+: 3 mEq/L Na+: 115 mEq/L Cl-: 80 mEq/L HCO3-: 24 mEq/L Urine output: 60 mL/hour BP: 125/95 mm Hg Based upon this information the respiratory therapist would conclude A. the patient is hyperkalemic B. the patient requires decreased fluid intake C. the patient is polycythemic D. the patient has a metabolic alkalosis - CORRECT ANSWER Hyperkalemic is high potassium, polycythemic has extra red blood cells, and we do not have Hb measurement, metabolic alkalosis is associated with low potassium but the bicarb is normal (and it would be high with low potassium), the urine output is high so the best ANSWER is B, patient requires reduced fluid intake. A 55-year-old patient is admitted to CCU with chest pain. While assembling an oxygen mask, the respiratory therapist notes the following ECG pattern: Ventricular fibrillation The patient is now unconscious, unresponsive and has no palpable pulse. The therapist's first response should be to: A. administer oxygen by non-rebreather mask. B. deliver a pre-cordial thump. C. recommend intravenous amiodarone. D. perform synchronized cardioversion. - CORRECT ANSWER Since you are actually witnessing a ventricular fibrillation, the very first thing you can do is try to get their heart started again by doing ANSWER B, deliver a pre-cordial thump which is a good thump right in the center of their sternum. The respiratory therapist notices a dampened waveform on a pulmonary arterial line. The therapist's first action should be to A. attempt to draw blood from the line. B. check the transducer dome for air bubbles. C. flush the catheter with heparin solution. D. check the position of the transducer. - CORRECT ANSWER Dampened wave form is when you aren't getting a nice sharp reading, you should get a clear systolic and diastolic pattern; the most common cause is a blood clot, flushing the catheter with heparin might push the blood clot into the lung at this point (not a good idea), another common cause of a dampened wave form is air bubbles in the transducer dome, so the ANSWER is B. A patient in the intensive care unit is suffering left heart failure. Which of the following drugs will increase the strength of contraction and improve cardiac output? A. digitalis B. atropine C. isuprel D. lidocaine - CORRECT ANSWER Atropine is used for bradycardia and increases output but not strength, Isuprel treats bradycardia and output but not strength, Lidocaine reduces irritability of heart, but Digitalis is a cardiac glycoside that increases cardiac output and strengthens cardiac contraction, so ANSWER is A The results of a patient's chest radiograph reveal the presence of a left basilar free fluid accumulation with a meniscus formation. Physical examination of the chest indicates a dull percussion note on the left and trachea shifted to the right. These results are consistent with which of the following conditions? A. Pleural effusion on the left B. Basilar pneumonia of the left lung C. Atelectasis of the left lung D. Pneumothorax in the left lung - CORRECT ANSWER Miniscus formation means accumulation is curling and going up the side, dull percussion can be solid or fluid filled (not just consolidation), since its pushing to the right it has to be a problem outside the lung, so the ANSWER is A. The respiratory therapist has been paged to the ICU to assist in the treatment of a 98 kg (215 lb) man. The patient is pale, diaphoretic, and suddenly loses consciousness. No palpable pulse or blood pressure is measured. The ECG monitor displays the following sinus bradycardia with a rate of 45): The respiratory therapist should: A. confirm the ECG in another lead. B. begin chest compressions. C. perform cardioversion. D. perform defibrillation. - CORRECT ANSWER ECG is showing sinus bradycardia with a rate of 45, all this leads up to begin chest compressions, so ANSWER is B. Do not perform cardioversion or defribulation because there is no arrhythmia so we don't want to mess with anything electrical in the heart, just want to help it out mechanically. The respiratory therapist is assessing a patient's vital signs and notes that the pulse feels weak and thready. This would most likely be associated with which of the following conditions? A. Hypervolemia B. Shock C. Increased cardiac output D. Increased systemic vascular resistance - CORRECT ANSWER A weak and thread pulse can be associated with conditions that decrease the blood pressure like shock or hypovalemia, so the ANSWER is B shock. A patient who recently underwent a total abdominal hysterectomy is complaining of chills and purulent sputum. Breath sounds reveal coarse rales and rhonchi. The results of the CBC indicate a WBC count of 19,000. The most likely diagnosis is that the patient has developed: A. atelectasis B. pneumonia C. hemothorax D. bacterial infection - CORRECT ANSWER Bacterial infections cause purulent sputum which is increased WBC's; viral infections do not. It might be pneumonia, but we do not know without more information, so the best answer is D bacterial infection, After injecting a small amount of air into the balloon of a pulmonary artery catheter, the respiratory therapist sees a small amplitude change with the mean pressure reading 2 points below the PA end-diastolic pressure. Based upon this information, the therapist should conclude that A. there is pressure dampening. B. the transducer is placed too high. C. there is an obstruction in the catheter. D. this is a normal wedge tracing. - CORRECT ANSWER A small amplitude change is normal and the mean pressure reading 2 points below the pulmonary artery end-diastolic pressure is also normal, so the ANSWER is D. A 32-week gestational age infant is receiving mechanical ventilation for hyaline membrane disease. The respiratory therapist suspects that a pneumothorax has developed and performs transillumination, which reveals a brightly illuminated left thorax. The respiratory therapist's FIRST action should be to A. insert a chest tube and connect to a pleural suction system. B. perform a fiberoptic bronchoscopy. C. obtain a STAT chest film. D. suction the infant. - CORRECT ANSWER Since a pneumothorax was suspected, illumination was done and revealed a "brightly illuminated left thorax" (a halo effect would be normal). A brightly illuminated thorax indicates there is definitely too much air or a pneumothorax in the left lung. Whenever there is a pneumothorax, you don't need more information, you need to insert a chest tube and connect to a pleural suction system, so the ANSWER is A. A patient with a history of myasthenia gravis has just been admitted for increased muscle weakness. The respiratory therapist should recommend which of the following diagnostic tests to monitor the patient's drug therapy? A. polysomnography B. electroencephalography C. tensilon challenge test D. methacholine challenge test - CORRECT ANSWER Polysomnography is a sleep study, Electroencephalography is an EEG brain test, Methacholine Challenge Test is a pulmonary function test used to check the reactivity of a patients airways, it will induce bronchospasm; Tensilon Challenge Test is specifically for Myasthenia Gravis, it helps them breath right away but only lasts a few minutes, so the ANSWER is D. While assessing a patient's breath sounds the respiratory therapist notes that when the patient says "ninety-nine", it sounds very loud through the stethescope. This would be associated with which of the following conditions? A. Pneumothorax B. Pneumonia C. Pleural effusion D. Epiglottitis - CORRECT ANSWER 99 is a sound that produces vibrations in the lung, if 99 sounds very loud through the stethoscope you know consolidation is present, so the ANSWER is B. Pleural effusion you don't usually hear anything. A 47-year-old patient admitted for sepsis has a CaO2 value of 12.5 vol%. The patient does not appear cyanotic. Which of the following would be the most important to further evaluate the patient's oxygenation status? A. PaO2 B. SaO2 C. Hb D. PAO2 - CORRECT ANSWER CaO2 IS best measurement of oxy delivered to the tissues, normal is 18-20%, this patient's is 12.5% which is low so patient is suffering from anemia (not enough oxy rich hemoglobin). So ANSWER is C. The tip of a catheter used to measure the wedge pressure should be positioned in the: A. superior vena cava B. right atrium C. pulmonary artery D. pulmonary vein - CORRECT ANSWER Tip of catheter used to measure the wedge pressure should be positioned in the... Answer C pulmonary artery A 64-year-old patient is being resuscitated for full cardiopulmonary arrest. After several unsuccessful attempts, the patient is orally intubated with a size 7.0 mm endotracheal tube. The physician is unable to establish a peripheral or central intravenous line. The ECG monitor now shows the following rhythm (sinus rhythm with regular positive p-wave, bradycardia). The respiratory therapist should recommend administration of: A. lidocaine by small volume nebulizer. B. atropine through the endotracheal tube. C. epinephrine by intra-cardiac injection. D. amiodarone by intraosseous injection. - CORRECT ANSWER Graph shows sinus rhythm with regular positive p-wave, bradycardia (slow heart rate, heart beat more than 5 boxes wide is bradycardia; boxes less than 3 wide is tachycardia). Since no IV can be inserted, we will administer drugs through endotracheal tube.... but what drug...lidocaine would be for gag reflex or coughing, epinephrine very powerful used for emergencies, for flat line, amiodarone might be used for ventricular disrythmias, pvc's; atropine is for Bradycardia so ANSWER is Atropine. A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. To determine the cause of the problem the respiratory therapist should recommend A. administering 100% oxygen. B. a V/Q scan. C. streptokinase. D. a STAT chest x-ray. - CORRECT ANSWER long bone fracture combined with patient just lying around makes them very susceptible for pulmonary emboli; so which of these 4 would best find pulmonary emboli. A V/Q scan will show areas of ventilation and profusion and pulmonary emboli could cause area of deadspace, so ANSWER is B (streptokinase is an effective clot buster, STAT chest x-ray would be helpful but not be the best for diagnosing emboli). The respiratory therapist is called to the emergency department to evaluate a patient who was brought in via an ambulance due to a motor vehicle accident. The patient is cold and clammy with a blood pressure of 82/46 mm Hg. The ECG monitor shows sinus tachycardia with occasional PVC. Which of the following should the therapist evaluate at this time? A. Serum electrolytes B. Cardiac enzymes C. Hb and Hct levels D. 12 lead ECG - CORRECT ANSWER Patient seems to be experiencing shock, serum electrolytes would be a good choice, cardiac enzymes would be good but very expensive, 12 lead ECG is another good test but more appropriate if we were mainly concerned with the heart; Hb and Hct most closely corresponds to shock because you know the patient was in an accident and probably had a lot of blood loss, so ANSWER is C Hb and Hct Viral infections cause WBC to (INCREASE OR DECREASE) Bacterial infections cause WBC to (INCREASE OR DECREASE) - CORRECT ANSWER Viral WBC Decrease Bacterial WBC Increase Which of the following drugs should the respiratory therapist recommend to lower a patient's blood pressure as well as decrease his ventricular afterload? A. Norepinephrine B. Propranolol C. Procainamide D. Sodium nitroprusside - CORRECT ANSWER Norepinephrine will increase blood pressure and afterload; Propranolol will slow the heart down but doesn't do anything for the afterload; Procainamide is an antirhythmic agent; Sodium Nitroprusside is a vasodilator, which will reduce blood pressure and decrease the afterload. A pleural friction rub is associated with all of the following conditions EXCEPT A. pneumonia. B. tuberculosis. C. pleurisy. D. pulmonary edema. - CORRECT ANSWER Pulmonary edema has a lot of excess fluid in the lung so there would be no friction rub, so ANSWER is D pulmonary edema A 40-year-old patient who smokes 2 packs of cigarettes per day has a carboxyhemoglobin level of 6.4%. These results are most consistent with A. Severe COPD B. History of dyspnea on exertion C. Need for supplemental oxygen D. Expected level for this patient - CORRECT ANSWER Nothing about COPD will give you a carboxyhemoglobin level of 6.4%; 6.4% is a typical level for a heavy smoker so ANSWER is D, Expected level for this patient. The following data has been obtained from a 28-week gestational age infant who was born premature: Color: Cyanotic Chest x-ray: Cardiac enlargement Chest Sounds: Systolic murmur Respiratory rate: 55 Br/min. SpO2: 80% Which of the following diagnostic tests should the respiratory therapist recommend? A. Pre- and post-ductal blood gas studies B. L/S ratio C. New Ballard Score D. Capillary blood gas - CORRECT ANSWER L/S ratio is done prior to birth to measure ability to produce surfactant; Ballard Score measures gestational age, Capillary blood gas is not going to determine the heart problems we are seeing, so ANSWER is A, Pre and Post-ductal blood gas studies; AIRWAY CARE: A nasopharyngeal airway is indicated for which of the following patients? A. unconscious patient with a closed head injury B. conscious patient with an ineffective cough C. alert patient who is expectorating a large amount of secretions D. uncooperative patient - CORRECT ANSWER Nasopharyngeal airway is not for unconscious or uncooperative patients. Patients conscious and expectorating large amounts of secretions on their own does not indicate need for nasopharyngeal airway. So, ANSWER is B, conscious patient with an ineffective cough is the answer and best use of this airway. A 43-week gestational age infant has just been delivered and is stained with meconium. The physician has asked that the baby be intubated and suctioned immediately. The respiratory therapist should recommend intubating the baby with which of the following size endotracheal tubes? A. 2.0 mm B. 2.5 mm C. 3.0 mm D. 4.0 mm - CORRECT ANSWER This baby is post-term (by 3 weeks) so the baby probably weighs about 3,000 grams at full term so you can go a full-size airway at 3.0mm ANSWER is C, 3.0 mm. You wouldn't use a 4.0mm until the baby is about 1 year old. A patient being mechanically ventilated requires endotracheal suctioning. The patient is on high levels of PEEP therapy and has periods of hypotension. The respiratory therapist hyperoxygenates the patient before beginning the procedure. As the therapist disconnects the patient from the ventilator circuit, the following pattern is seen on the ECG monitor: Which of the following could be the cause of this patient's ECG pattern? Bradycardia rythm A. loss of PEEP B. inadequate hyperoxygenation time C. vagus nerve stimulation D. normal response to suctioning - CORRECT ANSWER Answer is A, Loss of PEEP Which of the following describes the proper technique when using a stylet? A. The distal end should be recessed at least 1 cm from the tip of the endotracheal tube B. The distal end should be positioned at the level of the beveled end C. The distal end should be proximal to the "Murphy's Eye" D. The distal end should be positioned proximal to the cuff - CORRECT ANSWER ANSWER is A, the distal end should be recessed at least 1 cm from the tip of the endotracheal tube (or just past the Murphy's Eye which is approximately 2 cm from the tip of the tube) A patient is diagnosed with a necrotizing pulmonary fistula in the right lung. The physician has requested that the right lung be ventilated at a pressure 10 cmH2O lower than the left lung. The respiratory therapist should recommend providing this type of ventilation via a: A. Transtracheal catheter device B. Double-lumen endobronchial tube C. Cricothyroidotomy D. 14 gauge endotracheal catheter - CORRECT ANSWER The physician wants independent lung ventilation (you would need two ventilators to do this); and with a double-lumen endobronchial tube, one lumen will go to the right lung and one would go to the left, so the ANSWER is B. A patient has been intubated in order to receive volume control ventilation. To inflate the endotracheal tube cuff, the respiratory therapist should add air to the cuff A. until no leak is heard during inspiration. B. and then remove it until a slight leak is heard at peak inspiration. C. to establish a pressure of 20 mmHg. D. to establish a pressure of 40 cmH2O. - CORRECT ANSWER We don't want a minimal leak because that would let secretions get past; you don't want too low pressure and don't want too much pressure, so ANSWER is C, to establish a pressure of 20 mm Hg A 16-year-old male patient involved in a motorcycle accident presents to the ER with massive maxillary and nasal trauma. Which of the following devices would be most appropriate for maintaining the patient's airway? A. nasal endotracheal tube B. fenestrated tracheostomy tube C. oral pharyngeal airway D. oral endotracheal tube - CORRECT ANSWER Patient with massive maxillary and nasal trauma would be difficult to intubate; you might need to bypass the face completely, so ANSWER is B, fenestrated tracheostomy tube (could be fenestrated or not fenestrated, either would work). What is the function of the one-way valve on a mouth-to-valve mask resuscitation device? A. Increase the delivered FIO2 B. Prevent the patient from exhaling back C. Prevent the patient from breathing room air D. Control the flow of gas to the patient - CORRECT ANSWER A mouth-to-valve mask resuscitation device eliminates direct contact with the patient as in mouth-to-mouth resuscitation. The one-way valve on this device prevents the patient from exhaling back, so the ANSWER is B. A 57-year-old post-op patient is receiving volume control ventilation. The respiratory therapist is having difficulty removing secretions when suctioning. The patient weighs 85 kg (187 lb), is orally intubated with a size 9.0 mm ID endotracheal tube, the vacuum level is set at 90 mm Hg and the suction catheter being used is a size 14 Fr. The therapist should A. switch to a larger catheter size. B. increase the vacuum level. C. switch to a Coude catheter. D. instill normal saline prior to suctioning. - CORRECT ANSWER Difficulty removing secretions when suctioning. The airway is large enough at 9.0 mm. For the catheter size, cut airway size in half and multiply by three, this would be 13.5 and they are using 14, so catheter is good size; normal vacuum level for adult is 100 to 120 mm Hg, so ANSWER is B, increase vacuum level. (Coude catheter curves to the left at the end so if you had a problem with the left lung you could use this) A respiratory therapist is in the cafeteria when an adult visitor begins to choke. The therapist has administered 7 subdiaphragmatic thrusts without clearing the patient's airway, although the patient remains conscious. The therapist should A. administer 5 back blows. B. continue subdiaphragmatic thrusts. C. attempt to ventilate. D. check for presence of a pulse. - CORRECT ANSWER Back blows are only appropriate with infants, so ANSWER is B, continue subdiaphragmatic thrusts. Clearing airway is #1 priority, you can't do anything else until this is done or the patient will die anyway! Question is missing - see answer - CORRECT ANSWER Question 6 of 15 - Missing inlet valve would be most likely cause (air won't go to the patient it will go out the side of the bag where the missing inlet valve is). A patient is receiving continuous mechanical ventilation with 100% oxygen. While suctioning the patient, the respiratory therapist observes the following ECG pattern (Sinus Rhythm w Multi-Focal PVCs) on the monitor . The therapist should: A. decrease the suction time per pass. B. increase the oxygenation time. C. use a smaller suction catheter. D. decrease the suction pressure. - CORRECT ANSWER Monitor shows sinus rhythm with multi-focal pvc's (related to oxygenation), hypoxemia, BEST thing to do is ANSWER A, always decrease the suction time per pass. While performing orotracheal intubation for a patient in respiratory arrest, the respiratory therapist notices that the stylet has advanced from its original position. The respiratory therapist should A. continue with the intubation procedure. B. stop the procedure, manually ventilate the patient, and reposition the stylet. C. retract the stylet immediately. D. remove the stylet and continue with the procedure. - CORRECT ANSWER Retract stylet immediately...this answer just stops. But ANSWER B, stop procedure, manually ventilate the patient, and reposition the sytlet is the best "complete" answer. Which of the following is the best method to minimize damage to the tracheal wall caused by an endotracheal tube cuff? A. Measuring the volume used to inflate the cuff B. Palpating the inflation of the pilot balloon C. Utilizing a cuff pressure manometer D. Using minimal occluding volume to seal the airway - CORRECT ANSWER Using minimal occluding volume to seal the airway is an older standard (may be used in practice but not for this test), so, ANSWER is C, Utilizing a cuff pressure manometer. THERAPEUTIC PROCEDURES: A patient is on a continuous flow CPAP system. The respiratory therapist notes that the pressure drops to zero during inspiration. The therapist should: A. Initiate mechanical ventilation B. Change to an IPAP/EPAP system C. Increase the flow D. Decrease the threshold resistor - CORRECT ANSWER Anytime there is a loss of pressure it is due to 1) a leak, or 2) not enough flow, so look for one of these answers; so the ANSWER is C, increase the flow. A chronic hypercapnic patient enters the emergency room complaining of shortness of breath. The patient is coughing up inspissated, pale, yellow secretions. Which of the following would you recommend at this time? A. Sputum culture and sensitivity B. Oxygen at 2 LPM via nasal cannula C. A-P and lateral chest x-ray D. Arterial blood gases - CORRECT ANSWER This is a COPD patient (chronic hypercapnic). Since all four answers are good, look at the one you should do first, so ANSWER is B, oxygen at 2 lpm nasal cannula. A patient with known reversible airway disease takes two puffs of albuterol from his metered-dose inhaler. The respiratory therapist measures the patient's peak flow following the administration of the medication and determines that the peak flow has increased only minimally. The therapist should A. add a spacer to the metered-dose inhaler. B. change the medication to levalbuterol C. administer the medication by small volume nebulizer. D. contact the physician concerning the care of this patient. - CORRECT ANSWER ANSWER is A, add a spacer to the metered-dose inhaler. This will give you a better result with the metered-dose inhaler and since the question does "not" say the med was administered with the spacer in place, you can assume it was not since this option is one of the answers. An H cylinder of oxygen has 1200 psi remaining in the tank. How long will it take to decrease to 200 psi if the flow is 5 LPM? A. 1 hour B. 10 hours C. 60 hours D. 600 hours - CORRECT ANSWER An "H" cylinder has 1200 psi minus 200 psi = how long to use 1000 psi at 5 lpm. Take 1000 x 3.14 (tank factor) = 3000 liters / 5 lpm = 600 min. / 60 min. = 10 hours, so ANSWER is B, 10 hours While receiving postural drainage and percussion to her right lower lobe, a 44-year-old patient suddenly vomits and aspirates. The respiratory therapist should immediately A. place the patient in Fowlers position. B. encourage the patient to take deep breaths. C. suction the patient. D. administer acetylcysteine by SVN. - CORRECT ANSWER placing patient in Fowlers position is good... but not until you have cleared away the vomit so they do not aspirate anything further, so ANSWER is C, suction the patient. An air flowmeter and an oxygen flowmeter are being used to deliver 40% oxygen to a patient via a non-rebreathing mask. A total flow of 12 LPM is required to prevent the non-rebreathing bag from deflating. How many liters of air and how many liters of oxygen should the therapist use? A. 2 LPM air, 6 LPM oxygen B. 4 LPM air, 8 LPM oxygen C. 6 LPM air, 6 LPM oxygen D. 9 LPM air, 3 LPM oxygen - CORRECT ANSWER air flowmeter and oxygen flowmeter must equal 12 lpm, with 40% oxygen, so air must be 60%; this is a ratio of 3 to 1 (this is a common ratio), so ANSWER is D 9 lpm air, 3 lpm oxygen (which is 3 to 1) A 26-week gestational age infant requires intensive monitoring and care in the NICU. Which device would be most appropriate for maintaining a neutral thermal environment for this infant? A. radiant warmer B. isolette C. croupette D. bassinet - CORRECT ANSWER Both the isolette and the radiant warmer can be neutral thermal environments. The key to this question, making one better than the other, is access to the patient since this baby requires continuous monitoring. Supposedly, the radiant warmer provides better access to the baby than the isolette. Which of the following formulas will calculate the number of hours an E cylinder will provide oxygen to a patient? A. tank pressure (PSI) x 0.3 / flowrate (LPM) B. flowrate (LPM) x 0.3 / tank pressure (PSI) C. [tank pressure (PSI) x 0.3 / flowrate (LPM)] / 60 D. [flowrate (LPM) x 0.3 / tank pressure (PSI)] / 60 - CORRECT ANSWER Question 2 of 15 - psi x 0.3 / flowrate / 60 (to give you the hours) A 26-year-old patient with shortness of breath is admitted to the emergency room. The patient states that he was running in Central Park with a friend and could not catch his breath. Bedside assessment reveals the following data: Pulse: 120 Respirations: 25 br/min Color: pale SpO2: 89% on room air Breath sounds: slightly diminished on the right The respiratory therapist should: A. request a STAT chest x-ray. B. administer 100% oxygen. C. insert a large bore needle into the 2nd intercostal space on the right side in the midclavicular line. D. insert a chest tube into the 2nd intercostal space on the right side in the midclavicular line. - CORRECT ANSWER Request a STAT x-ray is good but the patient currently has shortness of breath and is uncomfortable, so what would you do FIRST, ANSWER is B, administer 100% oxygen A patient is receiving CPAP therapy and the pressure is fluctuating between +5 and -8 cmH2O. What should the therapist do to stabilize the CPAP therapy? A. increase the flowrate B. decrease the pressure C. check for system leaks D. check for sticking valves - CORRECT ANSWER Because the flow was 5+ and 8-, you don't check for leak, you want to maintain a positive pressure on both inspiration and expiration, so you should increase the flowrate to meet patient demand and maintain a positive pressure on both inspiration and expiration, so ANSWER is A increase flowrate. Which of the following supply pressures would be appropriate for an air/oxygen proportioner? A. 30 psi B. 50 psi C. 100 psi D. 760 psi - CORRECT ANSWER appropriate pressure at which a blender should operate (air/oxygen proportioner), just about all respiratory care equipment operates at 50 psi and the minimum would be 40 psi, so ANSWER is B, 50 psi. A patient is receiving IPPB by mouthpiece. The therapist notes that the machine fails to cycle into the expiratory phase. The respiratory therapist should A. increase the flow. B. decrease the sensitivity. C. adjust the apnea timer. D. increase the pressure. - CORRECT ANSWER IPPB machines are pressure cycled and have to reach a preset pressure to turn off inspiration and go into the expiratory phase. Two reasons a machine would not reach a preset pressure, 1) there is a leak, 2) not enough flow, so ANSWER is A, increase the flow. Decreasing sensitivity only controls the machine turning on; and don't increase pressure because the machine would have to reach an even higher preset pressure to go into the expiratory phase. What total flow is delivered to a patient if the air entrainment mask is set at 35% oxygen and the flowmeter is set at 6 L/min? A. 20 - 25 L/min B. 30 - 35 L/min C. 40 - 45 L/min D. 50 - 55 L/min - CORRECT ANSWER Question 12 of 15 - Need I:E ratio of 35% X 6 L/min While performing routine ventilator parameter checks on a patient on a microprocessor ventilator with a wick humidification system, the respiratory therapist notices there is very little condensation in the tubing. The most likely explanation is that the A. temperature probe is placed distal to the wye adapter. B. room temperature is lower than normal. C. heating element is not functioning properly. D. water level is just slightly above the refill line. - CORRECT ANSWER Question is asking why is there very little condensation in the tubing of a ventilator that uses a wick system? ANSWER is C, heating element is not functioning properly. Question A 34-week gestation age infant has just been delivered. The one and five minute apgar scores are 4 and 6. The physician has written an order for 40% humidified oxygen. Which of the following would be the most appropriate device? A. an incubator set at 40% oxygen B. a radient warmer set at 40% C. a oxygen hood set at 40% D. a high humidity oxygen tent set at 40% - CORRECT ANSWER Infant requires 40% oxygen with humidity. The best way to do this is a oxygen hood set at 40% and hooked to a humidifier. Incubator would not keep the oxy at 40%, it could fluctuate. A patient will be away from their room for two hours while undergoing a special procedure in the radiology department. They will be using a full E cylinder. What is the maximum flow that the therapist could use without running out of oxygen? A. 2 LPM B. 5 LPM C. 8 LPM D. 10 LPM - CORRECT ANSWER A full E cylinder is 2200 psi x cylinder factor is 0.3 = 660 / 120 min. = 5.5 LPM Which of the following devices would provide adequate humidity with minimal condensation in the ventilator tubing? A. heated cascade humidifier B. heated wick humidifier C. heat moisture exchanger D. ultrasonic nebulizer - CORRECT ANSWER Heated cascade humidifier causes moisture in the tubing, heated wick humidifier also causes moisture in the tubing, ultrasonic nebulizer probably gives you the most moisture in the tubing, so the ANSWER is C, heat moisture exchanger (HME). This device traps moisture from exhaled gas in the device and uses it to humidify the next breath; this is indicated for short term use (transportation, weaning off ventilator) because does not give you 100% moisture. A 24-year-old post-operative male patient is receiving intermittent positive pressure therapy at 20 cm H2O. The patient complains that the machine is cycling off too soon. The patient's post-operative spontaneous vital capacity is 3.5 L. Which of the following should the respiratory therapist recommend? A. Increase the pressure to 25 cm H2O B. Discontinue therapy, encourage deep breathing and coughing frequently on his own C. Switch to a volume incentive spirometry device D. Recommend decreasing the flow - CORRECT ANSWER The key is that the patient's post-operative spontaneous vital capacity is 3.5L, which shows he can take a pretty good deep breath on his own, so the simplest, easiest ANSWER is B, discontinue therapy, encourage deep breathing and coughing frequently on his own. If they can do it on their own, that's the best therapy of all. What total flow is delivered to a patient if the nebulizer is set to 40% oxygen and the flowmeter is set at 9 L/min? A. 15 - 20 L/min B. 25 - 30 L/min C. 35 - 40 L/min D. 45 - 50 L/min - CORRECT ANSWER Flow Rate = FiO2 of 40% is a ratio of 3:1. 3+1 = 4. 4 x 9 L/min = 35-40 L/min ANSWER C Air to Oxygen Ratios: 30% oxygen 35% oxygen 40% oxygen - CORRECT ANSWER 30% oxy = 8:1 35% oxy= 5:1 40% oxy = 3:1 The respiratory therapist notices that a mask CPAP system is unable to maintain the desired level of pressure. Which of the following might be causing the level to not be maintained? 1. Sticking valve in the system 2. Loose fitting mask 3. Faulty humidifier connection 4. Leak around the airway cuff - CORRECT ANSWER Sticking valve could stick open (lose pressure) or stick closed (increase pressure); loose fitting mask would cause a leak and lose pressure, faulty humidifier connection is also a leak; leak around the airway cuff is NOT appropriate with CPAP mask (it does not exist). GENERAL PATIENT CARE: Which of the following are true statements concerning an automated medication dispensing system? 1. Maintains accurate information about when medication was dispensed. 2. Allows multiple practitioners to access patient medication. 3. Assists with management of medication inventory. A. 2 only B. 1 and 3 only C. 1 and 2 only D. 1, 2, and 3 - CORRECT ANSWER ALL three are good so D is the answer. In order to assist a patient with his efforts to quit smoking, the respiratory therapist could recommend Varenicline Naloxone Bupropion HCI A. Yes No Yes B. No No No C. Yes Yes Yes D. No Yes No - CORRECT ANSWER Answer is A. Varenicline is chantex which is help reduce erge of smoking. Naloxone is narcan which is used to flip the effects of narcotics. Bupropion HCI is a anti-depressant so would help while trying to quit smoking. The ICU director wishes to implement a protocol to reduce the risk of ventilator-associated pneumonia (VAP) for patients requiring mechanical ventilation. The respiratory therapist should recommend that the protocol include A. placing the patient in the prone position. B. changing the ventilator circuit each day. C. utilizing a closed-suction catheter system. D. intubating the patient with a Carlens tube. - CORRECT ANSWER Answer is C. Prone position is good which is what I picked but not the nest answer. The most important is making sure the suction catherter is enclosed. A 75-year-old patient with COPD is receiving oxygen at home by nasal cannula with a bubble humidifier. How should the respiratory therapist instruct the patient to clean his humidifier? A. Place it on the top shelf of the dishwasher. B. Soak it in an acetic acid solution for 20 minutes and rinse with water. C. Rinse it with distilled water and allow to air dry. D. Soak it in an alkaline glutaraldehyde solution for 30 minutes and rinse with water. - CORRECT ANSWER Answer is B. Dishwasher would ruin it by the heat. Answer d would sterilize it but to expensive and not practical for home setting. In order to monitor compliance of hospital employees in a smoking cessation program, the respiratory therapist should monitor the employees' A. PaO2. B. FECO. C. PETCO2. D. FENO. - CORRECT ANSWER Answer is B. FEC0 is high means they have been smoking shows the carbon monoxide levels. It's the exhaled c0 levels. A patient complains of shortness of breath while receiving oxygen via transtracheal catheter. Her pulse oximeter reading has decreased from 92% to 85%. The respiratory therapist should first A. increase the flow to the catheter. B. flush the catheter with saline. C. administer metaproterenol via small volume nebulizer. D. replace the transtracheal catheter with a nasal cannula. - CORRECT ANSWER Answer is B. Mucus plugging is a big problem. It's a common problem . C is a bronchodilator theres no need for one right now. And D would be a good second choice. But first try to clear the catheter we already have in place. A patient is being discharged from the hospital. The physician has ordered portable oxygen therapy at home. The patient has been instructed to use the oxygen at 1-2 L/min during the day and PRN at night. Which of the following should the respiratory therapist recommend? A. E cylinders B. Concentrator C. Liquid system D. Molecular sieve - CORRECT ANSWER Answer is C. E cylinders are portable but don't last last for regular use. Concentrator must be plugged in so not portable. Liquid system is going to last long and is very portable. Molecular sieve is a concentrator so obviously they are both wrong. An oxygen conservation cannula would be most appropriate for which of the following patients? A. A patient with pneumonia requiring low flow oxygen. B. A patient with emphysema who is experiencing increased shortness of breath. C. A patient with a severe exacerbation of asthma. D. A patient with pulmonary fibrosis requiring long term oxygen therapy. - CORRECT ANSWER Answer is D. conservation cannula is for long term patient can turn down the flow but get the same oxygen percent. D is the right answer because it point out LONG TERM OXYGEN THERAPY. SPECIAL PROCEDURES: A patient suffering from decompression sickness requires hyperbaric oxygen therapy. The respiratory therapist should initiate therapy at A. 2 ATA. B. 4 ATA. C. 6 ATA. D. 8 ATA. - CORRECT ANSWER Answer is A. ATA is Absolute this machine can go from 2-6 but you want to start the patient off at the lowest. A patient is breathing a mixture of 70% He / 30% O2 via non-rebreather mask. The oxygen flowmeter indicates a flow of 12 L/min. What is the actual flow of gas to the mask? A. 12 L/min B. 16 L/min C. 19 L/min D. 22 L/min - CORRECT ANSWER Answer is C. flow 12 x 1.6 =19.2 so round off 19 is closest. 1.6 is the factor for He at 70% Which of the following is a potential side effect of inhaled nitric oxide therapy? A. Systemic hypotension B. Formation of nitrous oxide C. Oxygen toxicity D. Methemoglobinemia - CORRECT ANSWER Answer is D. Nitric oxide is for pulmonary hypertension. Nitric oxide can alterate hemoglobin which is why D is the best answer. While assisting a pulmonologist performing thoracentesis on a 58-year-old man, the respiratory therapist observes that the pleural fluid is clear with a light straw color. This fluid would best be described as A. exudate. B. transudate. C. purulent. D. serosanguineous - CORRECT ANSWER Answer is B. exudate is blood puss. Purulent is fluid with puss. Serosanguineous is sero fluid and blood. The following pneumogram is obtained (this patient is showing signs of obstructive sleep apnea) while a 47-year-old woman undergoes polysomnography: The respiratory therapist should recommend that the patient receive: A. doxapram. B. oxygen therapy. C. non-invasive ventilation. D. nasal CPAP. - CORRECT ANSWER Answer is D. this patient is showing signs of obstructive sleep apnea because there is no air flow but the thoracic is showing. If there is no chest rise abdomen then it would be central sleep apnea but since it is obstructive sleep apnea CPAP is your best choice. In preparing to perform a cardiopulmonary stress test on a 60-year-old man, the respiratory therapist must determine the target heart rate range for the patient. What is the patient's maximum heart rate? A. 130 beats/minute B. 160 beats/minute C. 190 beats/minute D. 220 beats/minute - CORRECT ANSWER heart rate is 220, minus patients age so... 220-60. So answer is B. Following indirect calorimetry, a 66-year-old patient's RQ is calculated to be 1.01. What food group is being primarily metabolized by this patient? A. Proteins B. Fats C. Carbohydrates D. Amnio acids - CORRECT ANSWER Protein 0.82, fats generate RQ 0.71, Carbohydrates RQ the highest at about 1.0,Amnio Acids RQ is similar to proteins since it's a protein block. A 28-week gestational age neonate is experiencing frequent apneic episodes with bradycardia. Which of the following should the respiratory therapist recommend? A. An FIO2 of 0.40 via oxyhood B. Suctioning the neonate during apnea episode C. Administering beclomethasone D. Administering theophylline - CORRECT ANSWER Answer is D. Beclomethasone is a steroid given to mother before birth to get more surfactant for the child so wouldn't help with stimulating the baby to breath. Theophylline is a respiratory stimulant so would help the baby with apnea. While performing a routine ventilator check on a patient in the ICU, the respiratory therapist notes that the patient's cardiac monitor shows ventricular tachycardia at a rate of 165. The therapist determines the presence of a carotid pulse, although the patient is hypotensive and unresponsive. Which of the following should the respiratory therapist recommend? A. prepare for defibrillation B. administer a precordial thump C. prepare for synchronized cardioversion D. administer 1mg/kg of lidocaine - CORRECT ANSWER Answer is C. defribrillation is for pulseless tachycardia. Precordial thump is a punch also needs to be pulsless. Synchronized cardioversion low watted shock non lethal and used with patients with a pulse. Lidocaine is for PVCs. A 2 kg (4.4 lb) neonate requires transportation to a tertiary care center for cardiac surgery. The infant has a heart rate of 140 and a BP of 60/30.The neonate is intubated with a size 2.5 mm uncuffed endotracheal tube and ventilation is being assisted manually at a rate of 40/min. Which of the following should the respiratory therapist recommend? A. postpone the transport until the neonate has spontaneous respirations B. prepare for the transport immediately C. delay the transport and stabilize the patient D. wait 24 hours and then reassess the patient - CORRECT ANSWER Answer is B. PULMONARY DIAGNOSTIC TESTING; A respiratory therapist is performing spirometry on a patient with chronic bronchitis. Which of the following equipment would the respiratory therapist need? A. ergometer B. water seal spirometer C. pneumogram D. turbine pneumotachometer - CORRECT ANSWER Ergometer measures strength, water seal spirometer measures volume, pneumogram measures respiratory movements, like in a sleep study; turbine pneumotachometer is an air speed meter so it measures flow, so ANSWER is B water seal spirometer. It is not most convenient device but would be most accurate in this case. A patient has come to the pulmonary function lab for pre-op testing. The patient performs a maximum inspiration followed by a maximum forceful expiration. This procedure would measure: A. RV B. FRC C. TLC D. FVC - CORRECT ANSWER The hint is "forceful" ANSWER is D, FVC A respiratory therapist is performing spirometry on a patient with chronic bronchitis. Which of the following equipment would produce an unreliable measurement? A. body plethysmograph B. water seal spirometer C. wright respirometer D. pressure differential pneumotachometer - CORRECT ANSWER A body plethysmograph (body ox) measures missing volumes (FRC, RV,TLC); water seal spirometer is most accurate to test chronic bronchitis; wright respirometer (turbine spirometer) measures air speed and is LEAST accurate, so ANSWER is C, wright respirometer; pressure differential pneumotachometer measures air speed but is electronic and more accurate than the wright respirometer. A patient complaining of dyspnea has the following arterial blood gas results: pH: 7.36 PaCO2: 56 torr PaO2: 49 torr HCO3-: 34 mEq/L SaO2: 80% FIO2: .21 These results are best described as: A. acute respiratory acidosis B. acute metabolic alkalosis C. chronic respiratory acidosis D. chronic metabolic alkalosis - CORRECT ANSWER To know whether it is "acute" or "chronic"... If the pH or bicarb is "compensating" it is said to be "Chronic", so the ANSWER is C, chronic respiratory acidosis. A patient in the intensive care unit has the following blood gas results: Arterial pH: 7.42 PaCO2: 39 torr PaO2: 90 torr SaO2: 97% HCO3-: 25 mEq/L BE: +1 mEq/L Hb: 14 g/dL Venous pH: 7.39 PvCO2: 46 torr PvO2: 50 torr SvO2: 80 % HCO3-: 25 mEq/L BE: +1 mEq/L What should the respiratory therapist report as the patient's C(a-v)O2? A. 1.8 vol% B. 3.3 vol% C. 5.2 vol% D. 7.3 vol% - CORRECT ANSWER Shortcut for figuring patients C(a-v)O2 Take the difference between SaO2 - SvO2 x 2 = 34, then place decimal between 3.4, so ANSWER is B 3.3 vol% A patient in the intensive care unit has the following data obtained: pH: 7.41 PaCO2: 40 torr PaO2: 235 torr SaO2: 99% HCO3-: 23 mEq/L BE: +1 mEq/L FIO2: 1.0 VD/VT: 0.35 Hb: 15 g/dL RER: 0.8 PB: 747 What should the respiratory therapist report as the P(A-a)O2? A. 210 torr B. 415 torr C. 535 torr D. 620 torr - CORRECT ANSWER This is common called the A-a gradient. P(A-a)O2, ANSWER is B, 415 torr. A patient is being ventilated with a Servo 300 ventilator in the intensive care unit. The following data is obtained: Mode: SIMV Mandatory rate: 12 b/min Total rate: 12 b/min VE: 8.6 L FIO2: 0.60 PIP: 31 cm H2O PEEP: 10 cm H2O pH: 7.41 PaCO2: 40 torr PaO2: 95 torr SaO2: 96% HCO3-: 23 mEq/L BE: +1 mEq/L A-aDO2: 300 torr C(a-v)O2: 3.6 vol% What should the therapist report as the QS/QT? A. 15% B. 18% C. 20% D. 25% - CORRECT ANSWER QS/QT is the shunt (5% is normal) Shortcut - Start with 5%, add another 5% for each 100 of A-a gradient, so 5% + 15% = 20, so the ANSWER is C, 20% The FRC (functional residual capacity) is measured on a patient using the helium dilution technique and the result is 3.0 liters. The same patient is then tested in a body box and the result is 4.5 liters. Which of the following would account for the difference? A. The patient has significant non-ventilated lung volume B. There was a leak during the helium dilution procedure C. The patient did not perform the maneuver properly D. Hysteresis is present - CORRECT ANSWER Question is asking why is there a difference in the FRC between helium test and body box test. A body box is more accurate, it measures ALL gases in the chest. Helium will not measure any "trapped" gases. So, the difference must be the trapped gases, so the ANSWER is A, the patient has significant non-ventilated lung volume (which is a fancy name for trapped gases). What is the PAO2 for a patient breathing 30% oxygen at sea level? A. 100 - 105 torr B. 120 - 140 torr C. 155 - 170 torr D. 210 - 220 torr - CORRECT ANSWER PAO2 of patient breathing 30% oxygen - ANSWER is C, 155 - 170 torr PAO2 Shortcut take FiO2 x 7 - 50 = 160 (30% x 7 = 210 - 50 = 160) Prior to performing spirometry on a pre-op patient, the respiratory therapist calibrates the spirometer using a 3.0 L super syringe. The three volumes achieved are: 2.80 L, 2.80 L, 2.79 L. Based upon the information obtained the therapist should conclude that the 1. spirometer is precise. 2. spirometer is accurate. 3. super syringe was advanced too slowly. 4. spirometer may have a leak. A. 1 and 3 only B. 1 and 4 only C. 2 and 3 only D. 2 and 4 only - CORRECT ANSWER When you use a 3.0 L syringe it should come out within .1, so 2.80, 2.79 are too low. Spirometer is "precise" means "consistent" it does not mean accurate of perfect. Spriometer is accurate means average (the average of the 3 numbers should come out to 3.0). Spirometer has a leak is why when you blow 3.0 L, you only get volumes of 2.80, 2.80 and 2.79, so ANSWER is B 1 and 4 A patient is observed to have an increased respiratory rate and depth of breathing. Their breath has a fruit-like aroma. This would most likely be associated with: A. head trauma B. metabolic acidosis C. drug overdose D. chronic obstructive lung disease - CORRECT ANSWER A patient breathing deep and fast is Kushmals breathing (body trying to push out CO2 to get rid of metabolic acidosis). The fruit-like breath is also associated with the metabolic acidosis, so ANSWER is B, metabolic acidosis. A patient is on a ventilator and is in the process of being weaned. What is the best way to continuously monitor the minute ventilation? A. Chest transducers B. Thermistors C. Water seal spirometer D. Pneumotachometer - CORRECT ANSWER Best way to continuously monitor minute ventilation. Chest transducers measure effort to breathe; thermistor is a temperature probe that will measure effort; water seal spirometer is very accurate in measuring volumes but it can't continuously measure minute ventilation because it will run out of room; Pneumotachometer will measure flow passing through it for as long as you want, so ANSWER is D, Pneumotachometer. The best way to check the accuracy of an air/oxygen proportioner is by using: A. polarographic electrode analyzer B. precision geisler tube analyzer C. infrared absorption analyzer D. teflon membrane analyzer - CORRECT ANSWER ANSWER is A, polarographic electrode analyzer Which of the following would equal the vital capacity (VC)? A. VT + IRV B. ERV + RV C. IRV + VT + ERV D. IRV + VT + ERV + RV - CORRECT ANSWER Question 13 of 15 - What equals vital capacity (look at Kevin's chart) A patient involved in a motor vehicle accident has sustained a long bone fracture and remains in traction. The patient suddenly complains of chest pain, and becomes tachypneic and tachycardiac. After administering 100% oxygen, the therapist should recommend A. a barium swallow. B. a CT of the chest. C. starting heparin therapy. D. starting lasix. - CORRECT ANSWER Long bone fractures combined with lying around is a recipe for pulmonary embolism. So now lets confirm this. If a VQ scan was there it would be the best answer after 100% oxygen. Since I don't see the answers I'm looking for, eliminate what you would NOT do. CT scan will be too focused (need to see profusion, etc.), starting Lasix is a diuretic to get rid of excess fluids, but ANSWER C, starting heparin therapy would be appropriate to dissolve or break up the suspected embolism. A patient's PvO2 has decreased from 30 torr to 20 torr. This is indicative of a/an: A. Decreased SVR B. Increased cardiac index C. Decreased cardiac output D. Decreased PVR - CORRECT ANSWER PvO2 decreased. Venous decreases and increases are directly associated with cardiac output. Cardiac index goes up and down with cardiac output so it would not increase; Decreased PVR is talking about pulmonary resistance. ANSWER is C, decreased cardiac output. A physician asks the respiratory therapist to measure a patient's ability to cough and clear secretions from his airway. Which of the following would the therapist utilize to evaluate the patient? A. wright respirometer B. flutter valve C. aneroid manometer D. spacer - CORRECT ANSWER Wright respirator measures volume; flutter valve is used for bronchial hygiene therapy; "aneroid" manometer is another way to say "pressure" manometer so would measure patients ability to cough (generate "pressure") and thus clear secretions, so ANSWER is C, aneroid manometer. A 62-year-old female has the following arterial blood gas results on room air: pH: 7.37 PaCO2: 38 torr PaO2: 60 torr The co-oximeter is currently down for repair at this time. The physician has asked you to estimate the SaO2. You would estimate the SaO2 to be which of the following? A. 75% B. 80% C. 85% D. 90% - CORRECT ANSWER To estimate the SaO2; PaO2 + 30 =SaO2 The following pulmanary function measurements have been determined for a 42-year-old male patient with asthma: VC: 5.1 L. FRC: 2.4 L. ERV: 1.4 L. VT: 0.5 L. IRV: 3.2 L. What should the therapist report as the total lung capacity