Lindsey Jones Practice Questions With Correct Answer

A patient is undergoing a cardiac workup and tolerance assessment while riding a stationary bicycle. After a few minutes of observing the patient, the respiratory therapist increases the tension to the cycle and observes the following change in blood pressure, SpO2, and heart rate: Before After HR 98 119 BP 122/85 mm Hg 149/98 mm Hg SpO2 0.97 0.95 A. administer Dobutrex (dobutamine). B. reduce the cycle tension to the previous level. C. continue the evaluation. D. discontinue the assessment and document. - Answer C. continue the evaluation. A respiratory therapist is given the charge to sterilize a bronchoscope. Which of the following should the respiratory therapist use to accomplish sterilization? A. Steam autoclave B. Irradiation followed by ethylene oxide C. Alkaline gluteraldehyde (Cidex) D. Pasteurization - Answer C. Alkaline gluteraldehyde (Cidex) On a patient receiving mechanical ventilation, it is observed that peak airway pressures have been rising. During that same time interval, plateau pressures have been rising by approximately the same amount. This is most suggestive of A. increasing dynamic compliance. B. a decrease in pulmonary atelectasis. C. decreasing pulmonary compliance. D. increased elasticity of interstitial pulmonary tissue. - Answer C. decreasing pulmonary compliance. A patient is on his second week in the intensive care unit (ICU). A tracheostomy is in place and he is receiving ventilatory support by VC, A/C ventilation on the following settings: FIO2 0.6 PEEP 18 cm H2O Rate 18/min VT 450 mL Other data shows: PAW 42 cm H2O HR 110/min PAP 34/10 mm Hg CVP 6 mm Hg PCWP 8 cm H2O C.I. 2.3 L/min/m2 ABGs pH 7.30 PaCO2 51 mm Hg PaO2 50 mm Hg HCO3- 26 mEq/L BE -4 mEq/L Based on this information, the respiratory therapist should recommend A. an intra-aortic balloon pump. B. ECMO. C. transtracheal oxygen. D. NAVA ventilation - Answer B. ECMO. The current oxygen index is calculated to be above 50. Once an oxygen index is greater than 40, the patient 1) most likely has ARDS and could benefit from extracorporeal membrane oxygenation (ECMO). Oxygen index is calculated by: OI = (O2% x PAW) / PaO2 OI = (60 x 42) / 50 OI = 2520 / 50 OI = 50.4 A patient who has suffered a cerebral vascular accident cannot move her arms. She is recovering in a long-term care department of a 250-bed hospital. The patient requires frequent assistance with pulmonary hygiene as she is unable to expectorate. She has a strong and effective cough. Which of the following devices is the most appropriate to assist with secretion removal? A. oral tip catheter, self-administered B. nasal pharyngeal airway C. tracheostomy tube D. oral pharyngeal airway - Answer B. nasal pharyngeal airway Explanation : A nasopharyngeal airway, also known as a nasal trumpet, is inserted into one of the nostrils using a water-based lubricant. The size is determined by matching the inside diameter of the inner naris. The Iength is approximately equal to the distance between the earlobe and the nasal septum. When too long, the patient make cough uncontrollably. These devices help to facilitate secretion removal for a patient requiring frequent nasotracheal suctioning. A pulse oximeter reading is significantly less than oxygen saturation by blood gas. Which of the following could be the cause? A. decreased QsQt B. decreased CVP C. marked hypotension D. increased SVR - Answer C. marked hypotension Explanation : Pulse oximeters are also known as single wavelength spectrophotometers. There are multiple reasons why they may read inaccurately. Those reasons include: high ambient light, the use of fingernail polish, poor peripheral perfusion, and marked hypotension. All are correct. Which of the following equations would help determine cardiac output? A. ejection fraction B. A-aDO2 C. Fick D. oxygen consumption - Answer C. Fick What would most likely be indicated by an elevated CVP? a. Increased pulmonary vascular resistance b. Pulmonary embolism c. Fluid overload d. Left heart failure - Answer c. fluid overload An infant is delivered & has a one-minute APGAR score of 5. The infant is placed on the radiant warmer. What other equipment would be most helpful at this time? a. Croup tent b. Oxygen hood c. Nasal cannula d. Non-rebreathing mask - Answer b. oxygen hood An 81-kg adult male is orally intubated with a 6.5-mm endotracheal tube. The therapist reports difficulty removing secretions with the suction pressure set to 120 mmHg. The RT will FIRST: a. Instill Albuterol down the ETT b. Switch to an 8.0-mm ETT c. Increase suction pressure to 130 mmHg d. Decrease suction pressure to 100 mmHg - Answer b. switch to an 8.0-mm ETT An RT is monitoring the volume of gas a patient can inhale after a passive exhalation of tidal volume. The therapist is attempting to observe which of the following? a. Vital capacity b. Inspiratory capacity c. Inspiratory reserve volume d. Total lung capacity - Answer b. Inspiratory capacity A patient with Adult Respiratory Distress syndrome (ARDS) is receiving volume-controlled ventilation. As PEEP is increased and pulmonary shunting is decreased from 70% to 50%, the respiratory therapist should expect to see which of the following trend in PETCO2? A. decrease B. increase C. sudden fluctuation followed by a decrease D. no change - Answer B. increase As PEEP is increased and as pulmonary shunting reduces, it is likely that an increase in the effectiveness of ventilation will be observed. End-tidal CO2 will increase as ventilation increases. A patient has been gradually weaning from mechanical ventilation for the past two weeks. The physician requests data to determine the patient's current ability to breathe on his own. Which of the following tests would not be indicated? A. VC B. VT C. MVV D. MIP - Answer C. MVV A patient in the intensive care unit has the following clinical and laboratory data: PB 747 mm Hg PH2O 47 mm Hg pH 7.28 PaCO2 52 mm Hg PaO2 70 mm Hg HCO3- 27 mEq/L BE +2 mEq/L FIO2 0.6 SaO2 1.0 CvO2 12 vol% CaO2 17 vol% Hb 15 gm/dL Which of the following represents the C(a-v)O2? A. 2 vol% B. 200 vol% C. 5 vol% D. 25 vol% - Answer C. 5 vol% A patient is receiving volume-controlled ventilation following bariatric surgery for obesity. Which of the following medications should the respiratory therapist recommend to ensure the patient's comfort and assist in ventilator management? A. Pronestyl B. morphine sulfate C. vecuronium bromide (Norcuron) D. Mestinon - Answer B. morphine sulfate Morphine sulfate is one of the best medications to administer to patients receiving mechanical ventilatory support to help the patient rest pain-free and to generally sedate and relax the patient. A 12-year-old patient in the emergency room with asthma has received a dose of Solu-Medrol, four albuterol nebulizer treatments, and 1 hour of continuous albuterol at 10 mg/hr. The patient has not improved and maintains a PEFR of 50% of predicted and an SaO2 of 91% on air. The respiratory therapist should recommend which of the following? A. add Atrovent (Ipratropium bromide) to albuterol by nebulizer B. obtain an arterial blood gas C. administer 60%/40% helium-oxygen D. place the patient on high-flow oxygen - Answer C. administer 60%/40% helium-oxygen A infant who is receiving nasal CPAP therapy to address hypoxemia. The CPAP machine's low pressure alarm is continually sounding and the infant is crying. Pulse oximetery reveals an oxygen saturation of 89%. The respiratory therapist should do which of the following to remedy this situation? A. Increase CPAP pressure B. Provide an oral pacifier to the infant C. Increase the flow rate D. Stimulate the infant - Answer B. Provide an oral pacifier to the infant When an infant is crying, CPAP becomes ineffective because positive airway pressure will not develop with the mouth open. The solution is to provide an oral pacifier to the infant which will encourage closure of the mouth. A 75-kg (165-lb), 173-cm (5-ft 8-in) patient, who was intubated for accidental inhalation of kerosene, is on PC, A/C ventilation for the third week. The following is observed: FIO2 0.5 IP 30 cm H2O f 18/min PEEP 12 cm H2O ABGs pH 7.52 PaCO2 28 torr PaO2 80 torr Exhaled VT 755 mL The respiratory therapist should recommend A. reduce inspiratory pressure. B. increase the rate. C. increase PEEP. D. change mode to SIMV. - Answer A. reduce inspiratory pressure. Which of the following parameters is NOT consistent with readiness to wean from mechanical ventilation? A. A-aDO2 of 180 mmHg B. MIP of -30 cmH2O C. RSBI of 89 D. QS/QT of 30% - Answer D. QS/QT of 30% To wean from the ventilator pulmonary shunting must be less than 20%. RSBI must be less than 106 and the MIP must be more than -28 cmH2O. The alveoli-arterial gradient must be less than 300 mmHg. In this case a shunt of 30% is the only data indicating the patient is not ready to wean from the ventilator. A patient is demonstrating increased work of breathing and remains hypoxic in spite of supplemental oxygen by nonrebreathing mask. The patient is thrashing about in bed. Which of the following should the respiratory therapist recommend? A. administer an IPPB treatment with 3.0 cc normal saline B. arterial blood gas analysis C. institute full mechanical ventilatory support D. sedate the patient with Valium - Answer B. arterial blood gas analysis The cause or reason for the hypoxemia should be investigated. Arterial blood gas analysis will be most helpful in assessing the degree and cause the hypoxemia. Immediately following the extubation of an adult who was orally intubated for the past 2 weeks, the respiratory therapist hears moderate stridor. The therapist should recommend A. Administer racemic epinephrine B. Send to surgery C. Delivery aerosol therapy with cool mist D. Immediately intubate the patient - Answer A. Administer racemic epinephrine Moderate stridor, caused by inflammation in the upper airway, may be treated with racemic epinephrine. Mild stridor may be treated with the racemic epinephrine and/or cool aerosol. Marked or severe stridor is treated by reestablishment of an artificial airway. A patient has the following arterial blood gas results: pH 7.28 PaCO2 58 torr PaO2 62 torr HCO3- 26 mEq/L BE +1 mEq/L Which of the following can the respiratory therapist correctly conclude? A. minute ventilation is inadequate B. the patient has COPD C. hyperventilation is occurring D. the patient has over-compensated metabolic alkalosis - Answer A. minute ventilation is inadequate Within 30 minutes of a motorcycle accident a 32-year-old male's chest radiograph shows increased vascular markings in the left lung field and hyperlucency on the right chest. RR is 22/min and the patient is has mild cyanosis. What is the most likely explanation for these findings? A. pleural effusion B. pulmonary contusion C. pulmonary embolism D. pneumothorax - Answer D. pneumothorax For a patient receiving mechanical ventilation with a PB 840 ventilator, which of the following would reduce arterial carbon dioxide tension? 1. increase in minute ventilation 2. removal of tubing from the inspiratory limb of the circuit 3. removal of tubing between the circuit wye and the patient interface 4. removal of tubing from the expiratory limb of the circuit - Answer A. 1 and 3 only To reduce carbon dioxide, ventilation must be increased. This may be done by increasing tidal volume or rate independently or together. This is also referred to as a change in minute ventilation. Another way to reduce carbon dioxide by a small amount is to remove deadspace or tubing between the wye and the patient. Decreasing the duration of applied suction pressure is most appropriate when the patient is experiencing A. effective secretion clearance. B. retained secretions. C. a strong cough with suction attempts. D. bradycardia with suction attempts. - Answer D. bradycardia with suction attempts. The respiratory therapist should decrease suction pressure if mucosal trauma or cardiac distress is noted during the suction procedure. The following ECG tracing is recorded for a 65-year-old male who is being monitored in the cardiac intensive care unit. Based on this rhythm, the respiratory therapist will note which of the following in the medical record? (Q wave depression) A. cardiac ischemia is present B. patient has sustained cardiac tissue damage from a previous myocardial infarction C. patient has sinus tachycardia D. patient is currently experiencing myocardia injury - Answer B. patient has sustained cardiac tissue damage from a previous myocardial infarction A 70-kg (154-lb) female patient with myasthenia gravis is receiving mechanical ventilation by a volume-controlled ventilator in the assist/control mode on the following settings: Mandatory rate 10/min VT 600 mL FIO2 0.5 ABGs pH 7.47 PaCO2 33 mmHg PO2 81 mmHg HCO3- 23 mEq/L BE -1 mEq/L Which of the following represents the most appropriate action? A. add 50 mL of deadspace B. decrease rate to 8 C. decrease VT to 500 mL D. increase rate to 12 - Answer A. add 50 mL of deadspace Explanation : The arterial blood gas reveals that the CO2 is slightly low. There are three ways in which we can increase CO2 when the patient is on a ventilator - we can decrease rate, decreased tidal volume, or add dead space. The best option is to add 50 mL of dead space because it will change CO2 by a very small increment which is needed. Increasing the rate would further decrease CO2, which is a move in the wrong direction. Decreasing rate from 10 to 8 is too drastic. Decreasing tidal volume to 500 mL would place the tidal volume lower than the patient's range based on their ideal body weight. The following clinical information is documented after assessment of a home care COPD patient's SpO2 with varying levels of activity. What is the appropriate supplemental oxygen recommendation for this patient? SpO2 #1: room air, resting: 88% SpO2 #2: room air, slow walk for 5 minutes on room air: 86% SpO2 #3: 1 L/min nasal cannula at rest: 90% SpO2 #4: moderate walk for 5 minutes on 1 L/min nasal cannula: 88% SpO2 #5: 2 L/min nasal cannula at rest: 94% SpO2 #6: moderate walk for 5 minutes on 2 L/min nasal cannula: 91% A. 2 L/min continuously B. 1 L/min by oxygen-conserving device C. 1.5 L/min pulse-dose delivery device D. oxygen PRN - liquid oxygen source - Answer A. 2 L/min continuously The level of supplemental oxygen that maintains an acceptable SpO2 during a moderate walk is 2 L/min. While providing manual ventilation during a transport of a patient with a standard tracheostomy tube, the therapist notices it is difficult to squeeze the resuscitator bag. The therapist should NEXT A. deflate the cuff and reattempt manual ventilation. B. add air to the airway cuff. C. palpate the neck and clavicle for subcutaneous emphysema. D. provide manual ventilation with a bag and mask. - Answer A. deflate the cuff and reattempt manual ventilation. When it is difficult to provide manual resuscitation through a tracheostomy tube, the first action should be to check the patency of the tube by inserting a suction catheter. The next step would be to deflate the cuff to ensure that it has not herniated over the end of the tracheostomy tube. A respiratory therapist is delivering a small-volume nebulizer treatment to a patient with asthma. In addition to the aerosolized Abluterol, what other medication may the therapist mix in the treatment to enhance bronchodilation? A. Terbutaline B. Ipratroprium Bromide (Atrovent) C. Xopenex D. Metaproterenol (Alupent) - Answer B. Ipratroprium Bromide (Atrovent) Albuterol is considered to be a front door bronchodilator. To maximize bronchodilation a front door bronchodilator may be combined with a back door bronchodilator, such as Atrovent. A therapist palpates a popping sensation in the upper chest and neck within hours after the insertion of an 8.0-mm standard tracheostomy tube. Which of the following is the most likely cause? A. mal-positioned trach tube B. trach tube diameter is too large C. trach tube is too long D. loss of alveolar surface tension - Answer A. mal-positioned trach tube Popping sensations, also referred to as crackling sensations, during palpation of the tissues of the upper chest and neck are related to subcutaneous emphysema, which is a condition of air entering the dermal and subdermal spaces. It is usually caused by a mal-positioned tracheostomy tube. The respiratory therapist assesses a 78-year-old COPD patient who has a history of chronic carbon dioxide retention and has a 90-pack-year smoking history. The patient is placed on a 40% air-dilution mask. Twenty minutes after the placement of oxygen the patient seems more relaxed but ventilations are becoming shallow. The respiratory therapist should A. Place on a non-rebreathing mask B. Change to a partial rebreathing mask C. Switch to a 4 L/min nasal cannula D. Switch FIO2 to 0.28 via an air-dilution mask - Answer D. Switch FIO2 to 0.28 via an air-dilution mask Because this patient is COPD, oxygen delivery greater than 28% is inappropriate. When excessive oxygen is delivered to a COPD patient the result can be reduced depth and rate of respiration. The appropriate action is to decrease FIO2 to 28% or below or 1-2 L/min by nasal cannula. A patient is being sent home on a mechanical ventilator requiring oxygen bleed-in with the device. Which of the following should be recommended? A. E-Cylinders B. pulse-dose oxygen delivery C. oxygen concentrator D. liquid oxygen - Answer C. oxygen concentrator The best device for home oxygen therapy is a molecular sieve device, commonly known as an oxygen concentrator. This device is powered with electricity, which makes it appropriate for home use. A patient who is receiving mechanical ventilation is scheduled for fiberoptic bronchoscopy to investigate a lesion in the right mainstem bronchus. Which of the following represents the most significant threat to ventilation during the procedure? A. airway obstruction B. stimulation of the vagal nerve and bradycardia C. excessive airway resistance D. loss of PEEP through suctioning - Answer A. airway obstruction scope can be a large airway obstruction A 74-year-old male in the intensive care unit has the following arterial blood gas results while receiving volume-controlled ventilation at an FIO2 of 1.0 with PEEP of 10 cm H2O. pH 7.33 PaCO2 50 torr PaO2 220 torr HCO3 - 22 mEq/L BE -2 mEq/L The respiratory therapist should conclude which of the following regarding the patient's condition? A. venous admixture B. increased systemic vascular resistance C. ventilation/perfusion mismatch D. metabolic acidosis - Answer A. venous admixture The alveolar oxygen tension for a patient on 100% should be about 650 mmHg. When you subtract the PaO2, the A-a gradient is 430 mmHg. A gradient greater than 300 mmHg is called pulmonary shunting or venous admixture. A gradient greater than 65 but less than 300 mmHg is considered ventilation/perfusion mismatch. Which of the following are acceptable for home-care use for the cleaning of non-electric respiratory therapy equipment? A. Acetic acid B. Bleach C. Cidex D. Sonacide - Answer A. Acetic acid Acetic acid is another name for common household vinegar. Vinegar is a safe and effective cleaning agent for home use. Cidex is not a product that would be appropriate for use in the home. It is not safe to use bleach on respiratory therapy equipment in the home. The use of sonacide is not intended for home use. A 45-year-old patient has been receiving mechanical ventilation for 60 days. The respiratory therapist has been performing daily weaning attempts for the past week, but all attempts have failed. Which of the following should the therapist consider to facilitate weaning? A. pressure support B. 8 hr T-piece trials daily C. small diameter ET tube D. pressure control - Answer A. pressure support A patient who is having difficulty weaning may benefit from pressure support. Pressure support counteracts airway resistance and can decrease the labor of breathing during the weaning process. Which of the following is a goal for oxygen therapy? - Answer B. decrease cardiac work requirement Which of the following could be used to determine the level of carbon monoxide poisoning for the purpose of definitive diagnosis and treatment? - Answer C. Hemoximetry