Lindsey Jones Practice Exam Qs w/ Explanations 100% Correct

1. A patient has undergone overnight oximetry. Data shows several episodes of O2 desaturation throughout the night. The RTT would expect orders for which of the following kinds of testing: a. V/Q scan b. pulmonary function testing c. polysomnography d. 24-hour Holter monitoring - Answer Your answer: C Correct answer: C The use of overnight oximetery is often used to detect O2 desaturation during the night that may be associated with central or obstructive sleep apnea. Because data indicates some periodic desaturation, the practitioner should suspect possible sleep apnea and should order diagnostic testing that will confirm or rule out the suspicion. A routine screening blood gas performed on an asymptomatic patient prior to surgery shows the following: pH: 7.38 PaCO2: 42 PaO2: 80 HCO3: 26 SaO2: 96% COHb: 24% What should the RRT do? a. place the patient on a NRB mask b. report the findings and emphasize that the patient is likely a smoker c. evaluate saturation using a single wave-length spectrophotometer d. run quality control material and evaluate the accuracy of the co-oximeter - Answer your answer: D correct answer: D In this case the patient is presented as asyptomatic. A patient with a COHb level of 24% would feel dyspnea and present with tachypnea. Therefore, the RRT should evaluate the accuracy of the lab results, specifically the COHb. When checking accuracy of lab results, one would use quality control measures. The infection control department of a small hospital informs the RRT supervisor that the biological control accompanying some durable autoclaved equipment shows viable spores. The supervisor should do which of the following with the equipment: a. incinerate b. record date and place into service c. wipe with isopropyl alcohol before use d. resterilize - Answer your answer: D correct answer: D The presence of viable spores indicates the possibility of living organisms developing in the sterilized package or on the sterilized equipment. Sterilization suggest the absence of living organisms, therefore the presence of viable spores indicates the need to resterilize. A post-op patient is not progressing with sustained maximal inspiratory therapy and refuses to cough because of pain along the incision site. The RRT should instruct the patient to: a. pause at the top of each inspiration b. press a pillow against the incision site when coughing c. attempt coughing 1 hour after pain medication has been administered d. avoid coughing until the pain subsides - Answer your answer: B correct answer: B Explosive coughing by a post-op patient can inadvertently open incision sites. To prevent this, splinting the site with a pillow is an appropriate option. Several hours after oral endotracheal extubation of an 8.0-mm tube, and adult patient begins to demonstrate inspiratory stridor. Which of the following would be most helpful to the patient: a. racemic epinephrine b. albuterol c. atropine sulfate d. heated aerosol by mask - Answer your answer: A correct answer: A When a patient is extubated and has swelling of the upper airway tissues as demonstrated by stridor, racemic epinephrine is an appropriate medication to reduce swelling quickly. Another, less effective option, is to provide a cool mist. In extreme cases, such as marked stridor, reintubation, or an emergency tracheotomy may be indicated. An adult patient is receiving mechanical ventilatory support and is being suctioned through the endotracheal tube at a pressure of -90 mmHg. Secretions have been difficult to remove. What can be done FIRST to increase suctioning efficiency: a. increase suction time b. decrease suction to 80 mmHg c. increase suction pressure to 100 mmHg d. increase suction catheter size - Answer your answer: C Correct answer: C An increase in suctioning effectiveness is done through three different ways - increasing suction catheter diameter, increasing suction pressure, and increasing suction time. Before increasing catheter size, the first thing that should be done is to ensure the appropriate range of suction pressure is being used. In this case, the appropriate suction pressure for an adult is 100-120 mmHg. A pressure of 90 mmHg is being used, which is insufficient suction pressure. This should be corrected before doing anything else to increase suction effectiveness. A chemical indicator tape found inside the sealed, packeaged disposable mask helps determine which of the following: a. if the equipment is sterile b. if the equipment has been properly sterilized c. if microorganisms remain viable on the equipment d. if the package has remained closed - Answer your answer: A correct answer: B A chemical indicator tape inside a sterilized package does not actually indicated the presence or absence of viable spores. It does, however, indicate if the equipment has been through the sterilization process. A 23-year old female patient in active child labor is receiving O2 by partial-rebreathing mask at 9/L/min. The reservoir bag collapses completely during contractions due to the patient's deep rapid breaths. The RRT should recommend: a. increasing the flow to the mask b. changing to a nasal cannula c. changing to 100% NRB d. coaching the patient to take smaller breaths - Answer your answer: C correct answer: A When the reservoir bag on a non-rebreather mask collapses completely with each breath, the problem is most likely due to insufficient flow to the mask. A radiology report of a chest x-ray indicates the end of the radio-opaque line on an oral endotracheal tube is resting 1 cm above the carina. The RRT should suggest: a. advance the ET tube 1 cm b. withdraw the ET tube 2 cm c. withdraw the ET tube 5 cm d. advance the ET tube 2 cm - Answer your answer: B correct answer: B The ET tube is properly positioned when the end is 2-5 cm above the carina. In this case, the tube is only 1 cm above the carina. Withdrawing the ET tube by 2-4 cm is appropriate. Peak flow measurements are indicated in which of the following conditions, if present? a. ARDS b. airway obstruction c. myasthenia gravis d. Guillain-Barre - Answer your answer: A correct answer: B Peak flow measurements are especially helpful in patients with asthma or patients who are suspected to have airway obstruction, mostly due to bronchoconstriction. A female patient is intubated with a 7.0 mm ET tube. The tube is noted to be positioned at 26 cm at the teeth. Breath sounds are not bilateral. Which of the following will best confirm placement of the artificial airway: a. capnography b. chest radiograph c. chest rise d. breath sounds - Answer your answer: B correct answer: B There are several ways to assess proper ET tube placement, such as auscultation of breathsounds, observance of symmetric chest rise, or end-tidal CO2 evaluation. However, this scenario asks for confirmation of proper placement, which is accomplished with a chest x-ray. A blood gas analyzer fails again to produce acceptable results on the pH value when running quality control material for the second time. The RRT should: a. remove the machine from service b. perform a one-point calibration c. perform proficiency testing d. monitor future results - Answer your answer: A correct answer: A When a blood gas machine fails to produce accurate results on one of its analytes the RRT may respond by removing the machine from service, notifying the supervisor, or rerunning the control. In this case, removing the machine from service is the only suitable answer offered. Following a full cardiopulmonary arrest and successful resuscitation, the patient has received dopamine to raise blood pressure, The RRT is having difficulty obtaining arterial blood from the radial artery due to hypotension. From which of the following sites should the therapist attempt to perform an arterial puncture: a. pedal artery b. femoral artery c. umbilical artery d. carotid artery - Answer your answer: B correct answer: B During CPR, blood pressure exists because of cardiac compressions and is usually low. Palpation of pulse, therefore, is difficult in the usual locations such as the radial or brachial arteries. When blood gases are needed during a code with a patient who has very low blood pressure, the femoral artery is the location of choice. While coaching a patient with CF on the use of a PEP therapy device, the patient suddenly becomes short of breath and cyanotic above the waist. The most appropriate action is to: a. schedule a V/Q scan after completion of the Tx b. discontinue the Tx c. perform NT suctioning d. switch to IPV - Answer your answer: D correct answer: B This patient is exhibiting an adverse reaction to the therapy. The first reaction of the therapist should be to stop the therapy and ensure the patient's vital stability. Subsequently, alternative therapies may be considered to accomplish the same objective without causing a similar adverse reaction. The low ventilator alarm is sounding on a 28-year old patient with myasthenia gravis. The respiratory therapist notes the oral endotracheal tube cuff is failing to hold pressure. The ET tube is positioned at 22 cm at the teeth. The RRT should: a. increase the tidal volume b. decrease the low tidal volume alarm c. replace the ET tube d. send to surgery for placement of a tracheostomy - Answer your answer: C correct answer: C An ET tube whose cuff is failing to retain air is considered defective and should be replaced. The following ECG tracing suddenly presents on a patient in the emergency department (ED) who was admitted for chest pain. The tracing is confirmed in two leads. The therapist should immediately: [asystole tracing] A. administer Lidocaine B. defibrillate at 360 joules with synchronization set to OFF C. administer sublingual nitroglycerin (Isordil) D. begin chest compressions - Answer Your answer was : D The correct answer is : D Explanation : After confirming this rhythm (asystole) in 2 leads, the primary treatment is chest compressions. The expired air over one minute that participates in active gas exchange is one's A. anatomical gas exchange. B. alveolar ventilation. C. respiratory quotient. D. minute ventilation. Your answer was : B The correct answer is : B - Answer Explanation : The total expired air over 1 minute is known as minute ventilation. Not all of this air participates in gas exchange due to anatomical dead space. Once anatomical deadspace is removed, the remaining ventilation is known as alveolar minute ventilation or simply alveolar ventilation. An air-entrainment jet nebulizer is set at 50%. The respiratory therapist analyzes the oxygen coming from the end of the tubing and finds it is 60%. Which of the following most likely explains this finding? A. excess water in the tubing B. leak in the tubing C. low flow through the jet orifice D. poorly calibrated analyzer - Answer Explanation : When administering oxygen by any device that has a venturi mechanism, back pressure on the venturi will slow the speed of gas, decrease room air entrainment, and result in an increase in FIO2. Of the options offered, only excess water in the tubing would cause this type of back pressure. A patient has been diagnosed with central sleep apnea. Which of the following would be helpful and most appropriate in the further treatment of the patient? A. full nocturnal ventilatory support B. weight loss C. surgical remove of soft tissue D. bi-level therapy with a rate - Answer Your answer was : D The correct answer is : D Explanation : A patient with central sleep apnea either needs mechanical ventilatory support or medication that stimulates ventilation. Dopram is such a medication. Mechanical ventilatory support can be achieved with bilevel therapy in conjunction with a rate. Immediately after oral intubation of an apneic patient, the respiratory therapist begins manual ventilation with a bag-valve assembly. The patient is simultaneously connected to an end-tidal carbon dioxide monitor. Which of the following should the respiratory therapist expect to observe when looking at the capnographic waveform? A. stair-step shifts in the CO2 tracing B. steady CO2 reading C. fall in CO2 followed by a subtle rise D. first a rise, then a fall in CO2 - Answer Your answer was : A The correct answer is : D Explanation : Initial ventilation attempts after a patient has been apneic will show reduced end-tidal CO2 followed by a steady rise as ventilation is provided. Ultimately, as ventilation continues the end-tidal CO2 will begin to decrease. At patient is receiving heliox therapy at a mixture of 70% / 30%. The gas mixture is flowing through an oxygen flow meter at 10 L/min. The actual flow to the patient is A. 18 L B. 16 L C. 10 L D. 12 L - Answer Your answer was : B The correct answer is : B Explanation : Helium-oxygen mixtures that are run through an oxygen flowmeter are less viscous than oxygen. This causes an error in the indicated flow rate on the oxygen flow meter. Essentially, the total flow is higher than is indicated. Each helium-oxygen mixture has a correction factor. A 70%/30% helium-oxygen mixture has a correction factor of 1.6. This means the 10 L/min indicated flow should be multiplied by 1.6 to determine the total gas flow. In this case, the total gas flow is 16 L/min. Which of the following equations would determine cardiac index? A. C.O. / BSA B. C.O. x BSA C. stroke volume x heart rate D. C.O. / ejection fraction - Answer Your answer was : A The correct answer is : A Explanation : Cardiac index can be calculated by dividing the cardiac output by the body surface area. The body surface area is given in units of millimeters squared. Body surface area rarely deviates from about 2 m², regardless of the size of the patient. So essentially, we could take cardiac output and divide it by two to get cardiac index. This can be done even if the body surface area of the patient is unknown. For example, if the cardiac output is 4 L/min, the cardiac index is about 2. Conversely, if cardiac index is 1.8, cardiac output could be estimated to be 3.6 L/min. A couple is found drowsy while driving on a long car trip. The highway patrol officer reports both the driver and the passenger were confused. The emergency room physician suspects carbon monoxide poisoning. Which of the following recommendations is most helpful at this time? A. IV injection of solu-mederol B. administration of Narcan C. high-flow oxygen D. administration of Dopram (doxapram) - Answer Your answer was : D The correct answer is : C Explanation : The treatment for suspected carbon monoxide poisoning is to drastically increase alveolar oxygen tension. This can best be accomplished by administering high-flow supplemental oxygen, preferably at 100%. Additional therapy that may be helpful is hyperbaric oxygen therapy. A respiratory therapist is suctioning a patient who is receiving positive pressure ventilation through a non-fenestrated tracheostomy tube when it is discovered that the suction catheter will not pass beyond the end of the tracheostomy tube. The patient is cyanotic and in obvious respiratory distress. After the therapist evacuates the cuff, the catheter passes easily. The therapist should first do which of the following? A. extubate the patient B. increase the pressure limit on the ventilator, monitor exhaled volumes C. remove the inner cannula and cap the tube D. inflate the cuff and resume positive pressure ventilation - Answer Your answer was : C The correct answer is : A Explanation : Because the catheter passes easily after the tracheostomy tube cuff is deflated, the most likely problem is that the tracheostomy tube cuff has become damaged and has herniated over the end of the tracheostomy tube. This means the tracheostomy tube should be changed to one that is not damaged. This starts with extubating the patient and providing ventilation and oxygenation, and generally ensuring the stability of the patient. A patient with significant pulmonary shunting is receiving volume-controlled ventilation on the following settings and has the following arterial blood gas results: Mode: assist/control Mandatory Rate: 18 VT: 500 mL FiO2: 0.70 PEEP: 25 cm H2O C.O.: 3.2 L/min HR: 118 pH: 7.36 PaCO2: 45 torr PaO2: 54 torr HCO3: 26 mEq/L BE: +2 mEq/L The therapist should decrease which of the following? a. FiO2 b. PEEP c. rate d. flow - Answer your answer: D correct answer: B This patient is hypoxic. To correct this either PEEP of FiO2 should be increased. However, closer examination of hemodynamic data, namely cardiac output, shows instability. Normal cardiac output is 4-8 L/min. This patient has low cardiac output most likely brought on by excessive levels of PEEP. The most appropriate action, in spite of hypoxemia, is to decrease PEEP. Which of the following parameters is NOT consistent with weaning from mechanical ventilation? A. VT to 500 mL B. RSBI of 86 C. A-aDO2 of 320 mmHg D. VD/VT of 0.50 - Answer Your answer was : C The correct answer is : C Explanation : In order to wean from a ventilator, the patient's dead space-tidal volume ratio must be below 60% or .60. The rapid shallow breathing index must be below 106. Spontaneous tidal volume must be greater than 5 mL per kilogram. The alveoli-arterial oxygen difference (A-a gradient) must be less than 300 mmHg. In this case, the dead space-tidal volume ratio is too high and the alveoli-arterial oxygen difference is too wide. These are the two criteria that indicate the patient is not ready to wean from the ventilator. A chest radiograph reveals excess fluid in the lower left chest, causing a partial hemothorax and considerable dyspnea for the patient. The respiratory therapist should recommend? A. Thoracentesis of the left chest cavity B. Administration of Lasix (furosemide) C. Palpate the trachea to check for deviation D. Chest tubes in the left chest between 2nd and 3rd intercostal space - Answer Your answer was : A The correct answer is : A Explanation : Excess fluid in the lower left chest may be removed by performing a thoracentesis of the left chest cavity. Upon entering a patient's room, the respiratory therapist finds the patient is unresponsive. The first action should be to A. call for help B. page the physician C. look, listen and feel for breathing D. check for a pulse - Answer Your answer was : A The correct answer is : A Explanation : Normally, calling for help is not the best option. When taking care of a patient in an emergency situation, YOU are the help. However, calling for help is a formal step in the basic life support procedure and therefore is appropriate in this case. A patient with ARDS receiving volume-controlled ventilation has the following arterial blood results on the settings below: Mode: assist/control Mandatory Rate: 22 VT: 350 mL FiO2: 0.70 PEEP: 22 cm H2O C.I.: 2.2 L/min/m2 HR: 102 pH: 7.35 PaCO2: 45 torr PaO2: 58 torr HCO3: 25 mEq/L BE: +1 mEq/L Which of the following changes is most appropriate? A. increase FIO2 to 0.8 B. decrease FIO2 to 0.6 C. increase PEEP to 25 cm H2O D. decrease PEEP to 20 cm H2O - Answer Your answer was : C The correct answer is : C Explanation : This patient is hypoxic. To correct this problem either PEEP or FIO2 must be increased. Because the patient is already on 70% the next logical step is to increase PEEP. Hemodynamic data, namely a normal cardiac output, supports this change. A patient with a history of hyper-reactive airway disease is having difficulty expectorating because the sputum is thick and tenacious. Which of the following medications should the respiratory therapist recommend? A. Solu-Mederol B. Beclamethasone (Beclovent) C. Spiriva (tiotropium bromide) D. Acetylcysteine (mucomyst) - Answer Your answer was : D The correct answer is : D Explanation : Hyperactive airway disease is associated with diseases such as asthma and consist of bronchoconstriction and inflammation. This patient appears to have difficulty with bronchoconstriction and thick secretions. Therefore, a mucolytic, such as acetylcysteine, and Solu-Medrol are appropriate.