Kettering National Seminars Review Workbook

Kettering National Seminars Review Workbook Questions Which of the following advanced directives describes the treatment a patient would want if he became terminally ill, but has not specifically appointed someone else to make the medical decision? - ANS C. Notarized living will A 67 year-old male patient who weighs 320 lb (145 kg) is scheduled for a tracheostomy procedure. The operating room nurse calls the respiratory therapy department and states that the physician is having trouble finding an appropriate tracheostomy tube for this patient. Which of the following tracheostomy tubes should the therapist suggest? - ANS D. Extended To provide a precise oxygen concentration while a patient is using a non-rebreather mask, the respiratory therapist should utilize a/an - ANS A. air oxygen preportioner An adult patient required positive pressure ventilation for six weeks because of ARDS. Two days following extubation, the patient develops stridor. The respiratory therapist should assess the patient for evidence of - ANS D. tracheostenosis The main indication for sustained maximal inspiration is to - ANS A. treat collapsed alveoli An 48 year-old male patient with Guillain Barre syndrome is having difficulty coughing and removing his secretion. Which of the following would be the most appropriate airway clearance technique to utilize with this patient? - ANS D. Manually assisted coughing A 30 week-gestation age newborn is in the NICU. The physician suspects the newborn may have a patient ductus arteriosus. To confirm the diagnosis, the respiratory therapist should recommend performing - ANS C. an umbilical artery catheter sample A 53 year-old male patient is in the ICU for pneumonia secondary to Pneumocystis Jiroveci. The physician is performing a flexible bronchoscopy procedure. During the procedure, the physician had taken several biopsy samples. Following the last biopsy, the physician reports that there is localized hemorrhaging at the biopsy site. The respiratory therapist should recommend - ANS A. a saline lavage The physician suspects a patient may have a pulmonary embolism. The result of the ventilation/perfusion scan and spiral CT scan are inconclusive. The respiratory therapist should recommend a/an - ANS C. pulmonary angiogram A patient's systemic vascular resistance value has been steadily increasing over the last several hours. The most likely explanation for the change in this value is - ANS B. Vasoconstricting agents All of the following could cause a capnograph reading to change from 32 to 22 torr EXCEPT - ANS B. effective cardiac compressions A 1600 g neonate is stable in the NICU. Which of the following should the respiratory therapist utilize to continuously monitor the patient's respiratory status? - ANS C. Transcutaneous monitoring A patient who has suffered a myocardial infraction would most likely show an increased level of - ANS D. troponin A hospital employee recently had a Mantoux test performed. Forty-eight hours after the injection, the injection site appears as a hardened, raised red area. Which of the following should the respiratory therapist recommend to the physician in order to treat this response? - ANS A. Anti-tubercular agents Ischemia will result in what changes on a 12-lead ECG tracing? - ANS C. Inverted T wave During radiographic assessment, the respiratory therapist determines that there is increased density and consolidation in the left upper lobe with air bronchograms. The surgical resident asks the therapist to interpret the findings. The therapist should respond that the patient has - ANS C. pneumonia A patient in end-stage liver failure develops ascites and shortness of breath. Tissue edema would most likely be visible in the patient's - ANS B. abdomen A patient is currently enrolled in a 6-week smoking cessation program through the local hospital. The respiratory therapist can monitor abstinence of cigarette smoking in the participant by measuring which of the following - ANS B. FEco levels A patient's recent chest radiograph reveals diffusely black lung parenchyma without evidence of blood vessels. The respiratory therapist should interpret this X-ray as - ANS C. overexposed A 78 year-old patient recently underwent abdominal surgery for repair of a complicated left hernia. Two days after surgery, the patient's chest X-ray reveals an elevated diaphragm on the left, crowded pulmonary vessels and scattered thin-layered densities. These findings would be most consistent with - ANS A. atelectasis A patient is in the intensive care unit after undergoing an aortic valve replacement. A pulmonary artery catheter has been inserted and the respiratory is asked to assess proper catheter placement. Where should the catheter appear on the chest radiograph? - ANS B. In the right lower lung field Proper position of the tip of an endotracheal tube on an AP chest radiograph should include which of the following? 1. Two - six cm above the carina 2. Visible below the vocal cords 3. At the level of the clavicles - ANS B. 1 and 2 only Beside assessment of a patient's ECG shows a sinus rhythm, normal P wave, QRS complex and T wave with an irregular rate. The respiratory therapist should interpret this as - ANS D. sinus arrhythmia One minute after birth, a 2600 g neonate exhibits the following: acrocyanosis, pulse 104/min, strong cry, some flexion of the extremities and slight grimace when stimulated. The APGAR score should be recorded as - ANS C. 7 A patient in the ICU received 5000 mL of IV fluid for treatment of hypotension. One hour later, lab testing reveals decreased levels of potassium and BUN. The patient's urine output via a catheter has been approximately 25 mL/hour. Upon auscultation, the respiratory therapist hears fine rates. The therapist should suspect that the patient has - ANS A. fluid overload A 26 year-old male patient has been orally intubated with 8.0 mm endotracheal tube. The physician asks the respiratory therapist to confirm proper endotracheal tube position with capnography. The capnograph reads 4 torr. The therapist should determine that - ANS C. the patient needs to be extubated and manually ventilated The respiratory therapist monitors a patient in the shock trauma unit who sustained a MVA. The patient has a pulmonary artery catheter in place. While assessing the pressure waveform, the therapist notes that there is no visible difference in the systolic and diastolic pressures. This can most likely be explained by - ANS D. inflated balloon A post-op patient in the post anesthesia care unit has been extubated. The patient remains unconscious and still requires occasional oral suctioning. Which of the following would be the most appropriate device for this patient - ANS D. Oropharyngeal Airway A 22 year old female is admitted to the ED with a narcotic overdose has been intubated for airway protection. Intravenous access is not currently available. The physician has administered naloxone (Narcan) via the endotracheal tube. Following administration of the drug , the respiratory therapist should - ANS A. Hyperventilate the patient for 30 seconds All of the following are considered limitations of a pneumatically powered resuscitation device EXCEPT - ANS C. 100% oxygen is delivered directly from a 50 psi gas source The respiratory therapist provides manual ventilation with a self-inflating resuscitation bag with the flowmeter set to flush during a resuscitation in the ICU. The therapist notices that the patient valve is stuck in the open position. The therapist's initial response should be to - ANS A. decrease the oxygen flow to the bag A responsive infant presents to the emergency department with a severe airway obstruction. After the respiratory therapist delivers back blows and chest thrusts, the infant become unresponsive. After placing the infant on a firm surface, the therapist should - ANS A. Initiate chest compressions The respiratory therapist is asked to evaluate an adult patient who is orally intubated and receiving mechanical ventilation. The physician is concerned that the patient is at risk for developing VAP because of the level of sedation the patient requires. The respiratory therapist should recommend - ANS B. insertion of a CASS tube A patient has been diagnosed with a large left upper lobe lung abscess. The patient cannot be scheduled for a lung resection for another 48 hours. Which of the following should the respiratory therapist recommend to prevent the abscess from spreading to the unaffected side ? - ANS A. Endobronchial tube A patient arrives in the ICU following a tracheotomy procedures. The respiratory therapist measures the pressure in the tracheotomy tube cuff and notes that the pressure is 36 cm H2O. The respiratory therapist should - ANS B. slightly deflate the cuff and recheck pressure A patient being mechanically ventilated in the ICU requires frequent suctioning. Which of the following would be the most appropriate suction catheter size if the patient had a size 9.5 mm ID endotracheal tube? - ANS D. 14 Fr While providing manual ventilation to a 28-week gestation age neonate, the respiratory therapist notes that the flow-inflating resuscitation bag is completely full prior to delivering each breath. The therapist should - ANS A. open the flow control valve The respiratory therapist performs endotracheal suction on a patient who has a standard tracheostomy tube in place attached to a trach collar. During the procedure, the therapist notices that the vacuum pressure has stopped. The therapist should check the 1. cuff inflation on the tracheostomy tube 2. patency of the suction catheter 3. connecting tubing to the canister 4. lid to the suction canister - ANS D. 2, 3, and 4 only A 26 year-old female patient was involved in a motor vehicle accident six weeks ago and required mechanical ventilation for a period of 4 weeks. The patient currently has a fenestrated tracheostomy tube connected to a tracheal speaking device. The occupational therapist determines that the patient is ready for oral liquid feeding. Prior to the patient's first feeding, the respiratory therapist should 1. remove the speaking device 2. inflate the cuff 3. clamp the pilot tube 4. insert the obturator - ANS c. 1 and 2 only A conscious patient is having difficulty clearing her secretions and the respiratory therapist decides to insert a nasopharyngeal airway to facilitate nasotracheal suctioning. Which of the following techniques should the therapist utilize to properly insert the airway? - ANS D. Insert the airway along the anatomic shape A 32 week gestation age infant has just been delivered. The infant's Apgar scores at 1 and 5 minutes are 2 and 3 respectively. The physician has determined that the infant requires intubation and mechanical ventilation. Which of the following equipment items would be necessary for this procedure? 1. Esophageal tracheal Combitube 2. Airway exchange catheter 3. Miller laryngoscope blade size 0 4. Endotracheal tubes sizes 2.5 and 3.0 mm - ANS c. 3 and 4 only A nurse has just finished bathing an adult patient receiving mechanical ventilation. The nurse reports to the respiratory therapist that the patient's endotracheal tube moved while she was turning the patient. While replacing the tape on the oral endotracheal tube, the therapist notes that the tube is taped at the 18 cm mark at the patient's lips. Tube placement for this patient should be between - ANS B. 21 - 25 cm To evaluate the amount of air leakage around the cuff of an endotracheal tube prior to extubation, the respiratory therapist should - ANS B. perform a qualitative The respiratory therapist is suctioning a patient who is receiving mechanical ventilation at the following setting: VC, SIMV, Vt 750 mL, f 12/min, Fi02 0.65, PEEP 20 cm H20. The suction pressure is set at 120 mm Hg and each time the therapist disconnects the patient from the ventilator for suctioning, the patient experiences bradycardia and hypotension. The therapist should recommend - ANS A. using a closed suction system A patient is admitted to the emergency following a 911 call for respiratory arrest. The paramedics inserted an esophageal tracheal Combitube at the arrest location. The respiratory therapist's first responsibility for airway management should be to - ANS C. replace the Combitube with an ET tube The respiratory therapist instructs a patient on using incentive spirometry. Which of the following is considered proper instruction for this therapy? - ANS B. Place the mouthpiece in his mouth and inhale maximally from resting exhalation When utilizing and inspiratory muscle training device , the respiratory therapist should initially set the resistor at - ANS C. The lowest available resistance setting The main indication for sustained maximal inspiration is to - ANS A. treat collapsed alveoli A physician orders IPPB therapy for a patient who is recovering from gall bladder surgery. As the respiratory therapist evaluates the patient's technique, he notices that the pressure manometer is hesitating during inspiration. To correct this situation , the therapist should - ANS B.increase flow